Thought for Food: Understanding Educational Disparities in Food Consumption

__Abstract__ Higher educated individuals are healthier and live longer than their lower educated peers. One reason is that lower educated individuals engage more in unhealthy behaviours including consumption of a poor diet, but it is not clear why they do so. In this paper we develop an economic theory of unhealthy food choice, and use a Discrete Choice Experiment to discriminate between the theoretical parameters. Differences in health knowledge appear to be responsible for the greatest part of the education disparity in diet. However, when faced with the most explicit health information regarding diet, lower educated individuals still state choices that imply a lower concern for negative health consequences. This is consistent with a theoretical prediction that part of the education differences across health behaviours is driven by the "marginal value of health" rising with education

What explains education disparities in screening mammography in the United States? A comparison with the Netherlands

Background: In the U.S., less educated women are substantially less likely to receive screening mammography. It is not clear whether this is due to differences in access to screening or in perceptions of breast cancer risks and the effectiveness of screening. We weigh the plausibility of these two explanations by examining how the dependence of mammography on education changes after conditioning on indicators of access and perceptions. We also compare estimates for the U.S. with those for the Netherlands where there is universal access to a publicly financed screening program. Method: Cross-sectional and cross-country comparable individual level data from the American Life Panel (n = 646) and the Netherlands Longitudinal Internet Studies for the Social Sciences (n = 1398) were used to estimate and explain education disparities in screening mammograms given to American and Dutch women aged 40+. The education gradient was estimated using logit models. Controls were sequentially added to detect whether disparities were explained by differences in access or perceptions of risks and effectiveness. Results: In the United States, high school graduates were 11.5 percentage points (95% CI: 1–22 percentage points) less likely than college graduates to receive a screening mammogram in the previous two years. This education gradient was largely explained by differences in income, insurance coverage and receipt of medical advice. It was not explained by educational differences in the perceived risk of breast cancer and the effectiveness of mammography. There were no education disparities in receipt of mammography among Dutch women within the 50–75 age range covered by the national screening program. Conclusion: In the absence of a universal screening program in the U.S., determinants of access—income, insurance coverage and receipt of medical advice—appear to drive the education disparities in screening mammography