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Enrollment in Higher Education

The Healthy People 2020 Social Determinants of Health topic area is organized into 5 place-based domains:

  1. Economic Stability
  2. Education
  3. Health and Health Care
  4. Neighborhood and Built Environment
  5. Social and Community Context

Enrollment in Higher Education is a key issue in the Education domain.

Higher education is any type of education after high school (12th grade), including 2-year college (community college), certificate programs, 4-year college (bachelor programs), graduate programs, and professional programs. This summary will focus on enrollment in and graduation from a 4-year college in relation to improved health and well-being.

Graduation from college has a positive impact on employment options.1, 2 Higher education helps people secure better-paying jobs with fewer safety hazards.2 Income from these employment opportunities may improve health by increasing people’s ability to accrue material resources, such as higher-quality housing, as well as psychosocial resources, such as higher social status.2, 3 While there are a number of benefits associated with college graduation, various factors hinder college enrollment and completion.

Preparing students for college is one component of primary and secondary education,4 and the quality of this preparation influences students’ likelihood of graduating from college.5 High schools that lack financial resources rarely provide advanced or honors classes, making it difficult for students at those schools to be academically prepared for college-level work.4 In addition to high school academic performance, knowledge of the college admissions process may affect a person’s decision to enroll in higher education.6 However, some high schools lack counselor support to help students select a college, apply for admission,7 and identify financial aid options.8

Students’ social context shapes their beliefs about higher education as well as their ability to succeed in applying to and graduating from college.9, 10, 11 For instance, students whose parents have attended college benefit from their parents’ knowledge and experiences. This helps them navigate the college admissions process,7 conform to academic expectations,9 and make informed decisions about their education.12 First-generation college students may not have the advantage of parental knowledge and experiences,12 but they still name family support as a main source of encouragement for college enrollment.13

Institutional factors at colleges may impede enrollment and graduation. Public funding for colleges has been decreasing,14 leading to steep increases in tuition and student debt.15 Despite the availability of federal loans for many would-be students, the complexity of the financial aid process leads some students to forgo college.16 College admissions policies may prevent students who need remedial education from enrolling,17 and about a quarter of college students take remedial classes, potentially delaying graduation.18,19 Many students need assistance adjusting to college (e.g., selecting courses, applying for ongoing financial aid), but funding for these services may be limited, particularly at community colleges.20,21

Racial and ethnic minorities may face unique barriers to higher education. African American and Hispanic individuals have lower college enrollment and graduation rates compared to white individuals,19,22 and Latino individuals are most likely to attend college part-time, which reduces their odds of graduating.23 Several factors may contribute to these outcomes. One study found that 3 in 4 Latino college students were not academically prepared for coursework.24 Moreover, recent evidence has shown that African American college students accumulate more federal education debt than students of other ethnicities.15 Despite this, loans help to increase the likelihood of enrollment persistence and graduation for African American students.25

The type of institution minority students attend may impact their ability to graduate. One study indicated that African American students attending predominately white colleges or universities (PWCU) have less academic success than African American students at historically black colleges or universities (HBCU), a relationship explained in part by students experiencing more stress related to racial discrimination at PWCU.26 Some minority students attending PWCUs experience social isolation, but colleges can provide programs that help minority students build social and cultural capital.21

Overall, higher education can lead to improved health and well-being, as well as reduced risk for premature death.2,3,27,28 College graduates have better self-reported health than high school graduates,28 and individuals with more education are less likely to report conditions such as heart disease, high blood pressure, diabetes, anxiety, and depression.3 Furthermore, individuals with more education are more likely to exercise, drink less alcohol, and seek preventive health care when needed.1,2,3

Pursuing higher education later in life still offers some benefits. One study showed better physical and psychological health at midlife for those who eventually earn a college degree compared to those who only receive a high school diploma.29 However, individuals who have a 2-year degree by age 25 and then earn their bachelor’s degree later in life report better health at midlife than those who do not have a 2-year degree by age 25 but later earn their bachelor’s degree.29 Regardless of how old someone is when returning to school, higher education can provide social interaction and intellectual stimulation. 30

Although barriers to higher education remain, there are a number of strategies to address them. Strengthening the curriculum in primary and secondary public schools may better prepare students for college.4 Peer and faculty mentoring can help students apply to schools, secure financial aid, and feel a sense of community.20, 21 Expanding access to subsidies such as scholarships and financial aid may increase college enrollment and completion.31

Further research is needed to identify how the association between higher education and health can be harnessed to improve health outcomes and reduce health disparities. Identifying, evaluating, and disseminating effective interventions to help students overcome barriers to college enrollment and graduation will be key. This additional evidence will facilitate public health efforts to address higher education as a social determinant of health.

Disclaimer:This summary of the literature on enrollment in higher education as a social determinant of health is a narrowly defined examination that may not address all dimensions of the issue.1, 2 Please keep in mind that the summary is likely to evolve as new evidence emerges or as additional research is conducted.


i Terminology used in the summary is consistent with the respective references. As a result, there may be variability in the use of terms, for example, black versus African American.

ii The term minority, when used in a summary, refers to racial/ethnic minority, unless otherwise specified.


1 Ross CE, Wu C. The links between education and health. Am Sociol Rev. 1995;60(5):719–45.

2 Kawachi I, Adler NE, Dow WH. Money, schooling, and health: mechanisms and causal evidence. Ann NY Acad Sci. 2010;1186(1):56–68.

3 Cutler DM, Lleras-Muney A. Education and health: evaluating theories and evidence. No. W12352. Cambridge (MA): National Bureau of Economic Research; 2006.

4 Haveman RH, Smeeding TM. The role of higher education in social mobility. Future Child. 2006;16(2):125–50.

5 Adelman C. Principal indicators of student academic histories in postsecondary education, 1972-2000. Washington (DC): U.S. Department of Education and Institute of Education Sciences; 2004.

6 Hahn RD, Price D. Promise lost: college-qualified students who don’t enroll in college. Washington (DC): Institute for Higher Education Policy; 2008.

7 McDonough PM. Choosing colleges: how social class and schools structure opportunity. Albany (NY): State University of New York Press; 1997

8 McDonough PM. Counseling matters: knowledge, assistance, and organizational commitment in college preparation. In: Tierney WG, Corwin ZB, Colyar JE, editors. Preparing for college: nine elements of effective outreach. Albany (NY): State University of New York Press; 2005. p. 69–87.

9 Bourdieu P. Cultural reproduction and social reproduction. In: Brown R, editor. Knowledge, education and social change. London: Taylor & Francis; 1974. p. 71–84.

10 Perna LW. Studying college access and choice: a proposed conceptual model. In: Smart JC, editor. Higher education: handbook of theory and research. Dordrecht, Netherlands: Springer; 2006. p. 99–157.

11 Nora A. The role of habitus and cultural capital in choosing a college, transitioning from high school to higher education, and persisting in college among minority and nonminority students. J Hispanic High Educ. 2004;3(2):180–208.

12 Valadez J. Cultural capital and its impact on the aspirations of nontraditional community college students. Community Coll Rev. 1993;21(3):30–43.

13 Leon A, Medina C. Success factors contributing to college enrollment among Latino migrant students [master’s thesis]. Sacramento (CA): California State University; 2016.

14 Oliff P, Palacios V, Johnson I, Leachman M. Recent deep state higher education cuts may harm students and the economy for years to come. Washington (DC): Center on Budget and Policy Priorities; 2013.

15 Grinstein-Weiss M, Perantie DC, Taylor SH, Guo S, Raghavan R. Racial disparities in education debt burden among low- and moderate-income households. Child Youth Serv Rev. 2016;65:166–74.

16 Bettinger EP, Long BT, Oreopoulos P, Sanbonmatsu L. The role of simplification and information in college decisions: results from the H&R Block FAFSA experiment. No. W15361. Washington (DC): National Bureau of Economic Research; 2009.

17 Attewell P, Lavin D, Domina T, Levey T. New evidence on college remediation. J Higher Educ. 2006;77(5):886–924.

18 Parsad B, Lewis L. Remedial education at degree-granting postsecondary institutions in fall 2000. NCES 2004-010. Washington (DC): U.S. Department of Education, National Center for Education Statistics; 2003.

19 Horn L, Berger R. College persistence on the rise? changes in 5-year degree completion and postsecondary persistence rates between 1994 and 2000. NCES 2005–156. Washington (DC): U.S. Department of Education, National Center for Education Statistics; 2004.

20 Brock T. Young adults and higher education: barriers and breakthroughs to success. Future Child. 2010;20(1):109–32.

21 Ovink SM, Veazey BD. More than “getting us through”: a case study in cultural capital enrichment of underrepresented minority undergraduates. Res High Educ. 2011;52(4):370–94.

22 Snyder TD, de Brey C, Dillow SA. Digest of education statistics 2015. NCES 2016-014. Washington (DC): U.S. Department of Education, National Center for Education Statistics; 2016.

23 Fry R. Latinos in higher education: many enroll, too few graduate. Washington (DC): Pew Hispanic Center; 2002.

24 Swail WS, Cabrera AF, Lee C. Latino youth and the pathway to college. Washington (DC): Pew Hispanic Center; 2004.

25 Jackson BA, Reynolds JR. The price of opportunity: race, student loan debt, and college achievement. Sociol Inq. 2013;83(3):335–68. doi: 10.1111/soin.12012

26 Greer TM, Chwalisz K. Minority-related stressors and coping processes among African American college students. J Coll Stud Dev. 2007;48(4):388–404.

27 Rogers RG, Everett BG, Zajacova A, Hummer RA. Educational degrees and adult mortality risk in the United States. Biodemography Soc Biol. 2010;56(1):80–99.

28 Goesling B. The rising significance of education for health? Soc Forces. 2007;85(4):1621–44.

29 Walsemann KM, Bell BA, Hummer RA. Effects of timing and level of degree attained on depressive symptoms and self-rated health at midlife. Am J Public Health. 2012;102(3):557–63.

30 Elman C. Guest editorial: adult education, bringing in a sociological perspective. Res Aging. 1998;20(4):379–90.

31 Dynarski S. Building the stock of college-educated labor. J Hum Resour. 2008;43(3):576–610.