High School Graduation
The Healthy People 2020 Social Determinants of Health topic area is organized into 5 place-based domains:
- Economic Stability
- Health and Health Care
- Neighborhood and Built Environment
- Social and Community Context
High School Graduation is a key issue in the Education domain.
A high school diploma is a standard requirement for most jobs—and for higher education opportuntites.1, 2, 3 Dropping out of high school is linked to a variety of negative health impacts, including limited employment prospects, low wages, and poverty.4, 5 A student’s ability to graduate from high school may be affected by factors related to the individual student as well as by broader institutional factors such as family, school, and community.6
Disparities in high school completion rates exist among racial and ethnic groups in the United States. According to data for the 2013–2014 school year, 89% of Asian/Pacific Islander, 87% of white, 76% of Hispanic, 73% of black, and 70% of American Indian/Alaskan Native students attending public high schools graduated within 4 years of beginning the 9th grade.7
Students’ home and school environments impact the likelihood that they will graduate from high school.6, 8, 9, 10 Researchers have found that students whose parents are not involved in their schooling are more likely to drop out of high school.8, 9 Studies also show that high school students who attend smaller schools and who rank their teachers as “high quality” are more likely to graduate.6, 9 Other school climate factors—such as teachers’ lack of interest and a student’s perception of an ineffective and unfair punishment system—are linked to higher rates of student dropout.10 Additionally, dropout rates are higher in schools with violence and safety issues.11 For example, lesbian, gay, bisexual, and transgender (LGBT) students report that physical and verbal abuse in school often influences their decision to drop out.12 LGBT high school students also tend to have less academic success and lower self-esteem.13
Research has indicated that students’ reading skill level by 3rd grade (e.g., proficient, basic, or below basic) can affect their long term academic achievement, particularly their likelihood of graduating from high school. 14 One study found that 23% of students with below-basic reading skill levels dropped out or failed to finish high school on time, compared to 9% of students with basic skill levels and 4% of students with proficient reading skills.14 Additionally, 26% of students who were not reading proficiently in 3rd grade and who lived in poverty for at least a year between 2nd and 11th grade dropped out or did not finish high school on time – compared to 9% for students with basic or below-basic reading skills who had never lived in poverty.14
Students from low-income families often have less access to resources and they tend to live in communities with underperforming schools.14 These factors may contribute to lower academic achievement and higher dropout rates.14 In 2015, the number of young people ages 16 to 24 who did not complete high school or were not enrolled in high school was 4.1 times higher in low-income families compared to high-income families.15
Among young women, teen pregnancy and teen parenthood are also important risk factors for school dropout.16, 17 One analysis found that at age 22, about 89% of women who had not given birth as teenagers had earned a high school diploma, while only 51% of those who were teen mothers had earned a high school diploma.16, 18
Students who drop out of high school may experience poor health and premature death.4, 19, 20 Individuals who do not graduate high school are more likely to self-report overall poor health.19, 21, 22, 23, 24 They also more frequently report suffering from at least 1 chronic health condition—for example, asthma, diabetes, heart disease, high blood pressure, stroke, hepatitis, or stomach ulcers—than graduates.25 Ultimately, finishing more years of high school, and especially earning a high school diploma, decreases the risk of premature death.26
Programs that encourage high school completion can improve the graduation rates of high-risk students and communities.4, 16 Increased educational attainment provides individuals with the opportunity to earn a higher income and gain access to better living conditions, healthier foods, and health care services. 2, 27, 28, 29, 30 Overall, high school graduation has the potential to improve population health.2
For every year of high school that a student completes, their lifetime wealth increases by 15%.31 In particular, lifetime earnings for male and female high school graduates, respectively, are $117,000 to $322,000 and $120,000 to $244,000 higher than for high school dropouts.27
Additional research is needed to further understand the effects of high school graduation on health outcomes and disparities. This additional evidence will facilitate public health efforts to address high school graduation as a social determinant of health.
Disclaimer: This summary of the literature on access to primary care as a social determinant of health is a narrowly defined review that may not address all dimensions of the issue.i, ii 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 Qu S, Chattopadhyay SK, Hahn RA, Community Preventive Services Task Force. High school completion programs: a community guide systematic economic review. Journal of Public Health Manage Pract. 2016;22(3):E47–E56.
2 Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Prev Chronic Dis. 2007;4(4):A107.
3 Orfield G, Losen D, Wald J, Swanson CB. Losing our future: How minority youth are being left behind by the graduation rate crisis. Cambridge (MA): The Civil Rights Project at Harvard University; 2004.
4 Hahn RA, Knopf JA, Wilson SJ, Truman BI, Milstein B, Johnson RL, et al. Programs to increase high school completion: a community guide systematic health equity review. American Journal of Preventive Medicine, 2015;48(5):599–608. doi: 10.1016/j.amepre.2014.12.005.
5 Wilson SJ, Tanner-Smith EE. Dropout prevention and intervention programs for improving school completion among school-aged children and youth: a systematic review. JSSWR Journal. 2013;4(4):357–72.
6 Rumberger RW. Why students drop out of school and what can be done. Paper prepared for the Conference, Dropouts in America: How Severe is the Problem? What Do We Know about Intervention and Prevention? Cambridge (MA): Harvard University; 2001 https://civilrightsproject.ucla.edu/research/k-12-education/school-dropouts/why-students-drop-out-of-school-and-what-can-be-done/rumberger-why-students-dropout-2001.pdf.
7 U.S. Department of Education, Office of Elementary and Secondary Education. Table 219.46. In: The condition of education. Public high school graduation rates. Available from: https://nces.ed.gov/programs/coe/indicator_coi.asp.
8 Jeynes WH. The relationship between parental involvement and urban secondary school student academic achievement. Urban Educ. 2007;42(1):82–110.
9 Rumberger RW. Dropping out of middle school: a multilevel analysis of students and schools. Am Educ Res J. 1995;32(3):583–625.
10 Wehlage GG, Rutter RA. Dropping out: how much do schools contribute to the problem? Booklist. 2011;108(4)–53.
11 Bekhuis T. Unsafe public schools and the risk of dropping out: a longitudinal study of adolescents. Paper presented at the annual meeting of the Eastern Psychological Association; 1995; Boston (MA).
12 Savin-Williams RC. Verbal and physical abuse as stressors in the lives of lesbian, gay male, and bisexual youths: associations with school problems, running away, substance abuse, prostitution, and suicide. J Consult Clin Psychol. 1994;62(2):261–69.
13 Kosciw JG, Palmer NA, Kull RM, Greytak EA. The effect of negative school climate on academic outcomes for LGBT youth and the role of in-school supports. J Sch Violence. 2013;12(1):45–63.
14 Hernandez DJ. Double jeopardy: how third-grade reading skills and poverty influence high school graduation. New York: The Annie E. Casey Foundation; 2011.
15 U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics. Percentage of high school dropouts among persons 16 through 24 years old (status dropout rate), by income level, and percentage distribution of status dropouts, by labor force status and years of schools completed: 1970 through 2015. Washington (DC); 2016. https://nces.ed.gov/programs/digest/d16/tables/dt16_219.75.asp
16 Steinka-Fry KT, Wilson SJ, Tanner-Smith EE. Effects of school dropout prevention programs for pregnant and parenting adolescents: A meta-analytic review. JSSWR. 2013;4(4):373–89.
17 Dalton B, Glennie E, Ingels SJ. Late high school dropouts: characteristics, experiences, and changes across cohorts. Descriptive Analysis Report. Report No.: NCES 2009-307. Washington (DC): National Center for Education Statistics; 2009.
18 Perper K, Peterson K, Manlove J. Diploma attainment among teen mothers. Child Trends, fact sheet. Washington (DC); 2010. Publication No.: 2010-01.
19 Ferraro KF, Farmer MM. Utility of health data from social surveys: is there a gold Standard for measuring morbidity?. Am Sociol Rev. 1999;64(2):303-315
20 Krueger PM, Tran MK, Hummer RA, Chang VW. Mortality attributable to low levels of education in the United States. PLoS One. 2015;10(7): e0131809.
21 Hahn RA, Truman BI. Education improves public health and promotes health equity. Int J Health Serv. 2015;45(4):657–78.
22 Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Social Behav. 1997;38(1):21–37.
23 Prus SG. Comparing social determinants of self-rated health across the United States and Canada. Soc Sci Med. 2011;73(1):50–59.
24 Schiller JS, Lucas JW, Ward BW, Peregoy JA. Summary health statistics for U.S. Adults: National Health Interview Survey, 2010. Vital Health Stat Series 10. 2012;(252):1–207.
25 Vaughn MG, Salas-Wright CP, Maynard BR. Dropping out of school and chronic disease in the United States. J Public Health. 2014;22(3):265–70.
26 Hummer RA, Lariscy JT. Educational attainment and adult mortality. In: International handbook of adult mortality. Netherlands: Springer;2011. p. 241–61.
27 Levin H, Belfield C, Muennig P, Rouse C. The costs and benefits of an excellent education for all of America's children (Vol. 9): Teachers College, Columbia University New York; 2007.
28 Ross CE, Wu CL. The links between education and health. Am Sociol Rev. 1995;60(5):719–45.
29 Cutler DM, Lleras-Muney A. Education and health: evaluating theories and evidence. Paper No.: w12352. National Bureau of Economic Research; 2006.
30 Day JC, Newburger EC. The big payoff: educational attainment and synthetic estimates of work-life earnings. Special Studies. Current Population Reports. Washington (DC): U.S. Census Bureau; 2002. Report No.: P23-210.
31 Oreopoulos P. Do dropouts drop out too soon? Wealth, health and happiness from compulsory schooling. J Public Econ. 2007;91(11):2213–29.