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This Article Figures Only Full Text Full Text (PDF) Supplemental Data All Versions of this Article: AJPH.2005.084848v1 97/4/679    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (10) Citing Articles via Google Scholar Google Scholar Articles by Woolf, S. H. Articles by Philipsen, M. Search for Related Content PubMed PubMed Citation Articles by Woolf, S. H. Articles by Philipsen, M. Related Collections Other Health Service Delivery Other Race/Ethnicity Socioeconomic Factors Mortality

Steven H. Woolf, MD, MPH, Robert E. Johnson, PhD, Robert L. Phillips, Jr, MD, MSPH and Maike Philipsen, PhD

Steven H. Woolf is with the Departments of Family Medicine, Epidemiology, and Community Health, Virginia Commonwealth University, Richmond. Robert E. Johnson is with the Departments of Biostatistics and Family Medicine, Virginia Commonwealth University, Richmond. Robert L. Phillips, Jr, is with the Robert Graham Center of the American Academy of Family Physicians, Washington, DC. Maike Philipsen is with the Department of Foundations of Education, Virginia Commonwealth University, Richmond.

Correspondence: Requests for reprints should be sent to Steven H. Woolf, MD, MPH, Department of Family Medicine, Virginia Commonwealth University, 1200 E Broad St, PO Box 980251, Richmond, VA 23298-0251 (e-mail: swoolf{at}vcu.edu).

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.

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