Steven H. Woolf ^1*, Robert E. Johnson ², Robert L. Phillips, Jr ³, Maike Philipsen ⁴

¹ Departments of Family Medicine, Epidemiology and Community Health, Virginia Commonwealth University
² Departments of Biostatistics and Family Medicine, Virginia Commonwealth University
³ Robert Graham Center, American Academy of Family Physicians
⁴ Department of Foundations of Education, Virginia Commonwealth University

^* To whom correspondence should be addressed. E-mail: swoolf{at}vcu.edu.

	Abstract

Objectives. Social determinants of health, such as inadequate education, contribute greatly to mortality rates. We examined whether correcting the social conditions that account for excess deaths among individuals with inadequate education might save more lives than medical advances (e.g., new drugs and devices). Methods. Using US vital statistics data for 1996 through 2002, we applied indirect standardization techniques to estimate the maximum number of averted deaths attributable to medical advances and the number of deaths that would have been averted if mortality rates among adults with lesser education had been the same as those among college-educated adults. Results. Medical advances averted a maximum of 178193 deaths during the study period. Correcting disparities in education-associated mortality rates would have saved 1369335 lives during the same period, a ratio of 8:1. Conclusions. Higher mortality rates among individuals with inadequate education reflect a complex causal pathway and the influence of confounding variables. Formidable efforts at social change would be necessary to eliminate disparities, but the changes would save more lives than would society’s current heavy investment in medical advances. Spending large sums of money on such advances at the expense of social change may be jeopardizing public health.

Key Words: Health Service Delivery, Race/Ethnicity, Socioeconomic Factors, Mortality

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