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Does Context Matter? Literacy Disparities in Self-rated Health Using Evidence from 17 Developed Countries

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Objectives: The study examines whether adult literacy skills predict self-rated health status beyond educational credentials in 17 developed countries using a cross-national survey, the Programme for the International Assessment of Adult Competencies (PIAAC). Methods: The study uses linear regression models with country-level fixed effects to predict self-rated health to account the unobserved country-level heterogeneity. A total of 73,806 respondents aged 25 to 65 were included in the analysis. Results: Although adult literacy is positively associated with better self-rated health in general, the strength of the relationship varies across nations. The literacy-related health inequalities are less severe in countries with the higher public share of health expenditures that may better address the needs of individuals with limited cognitive abilities. Curriculum standardization also contributes to reducing the literacy gradients in health by decreasing variations in skills obtained in school across individuals with different social origins. Conclusions: Overall, this study reveals that promoting equity in adult literacy skills is an important way to improve a population's health. Country-level differences in the strength of the relationship between literacy and self-rated health are systematically related to between-country differences in health financing and educational systems.
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Keywords: ADULT LITERACY; CROSS-NATIONAL SURVEY; CURRICULUM STANDARDIZATION; HEALTH EXPENDITURES; SELF-RATED HEALTH

Document Type: Research Article

Affiliations: Yeonjin Lee, Asia Research Institute, National University of Singapore, Singapore;, Email: [email protected]

Publication date: 2017-05-01

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  • The American Journal of Health Behavior seeks to improve the quality of life through multidisciplinary health efforts in fostering a better understanding of the multidimensional nature of both individuals and social systems as they relate to health behaviors.

    The Journal aims to provide a comprehensive understanding of the impact of personal attributes, personality characteristics, behavior patterns, social structure, and processes on health maintenance, health restoration, and health improvement; to disseminate knowledge of holistic, multidisciplinary approaches to designing and implementing effective health programs; and to showcase health behavior analysis skills that have been proven to affect health improvement and recovery.

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