Tertiary-educated adults (25-64 year-olds) report better self-perceived health than those with lower levels of attainment. On average, 51% of tertiary-educated adults rated their health as very good or excellent, compared to just 26% of those with below upper secondary education.
Smoking prevalence varies significantly by country, educational attainment and age. Individuals with lower levels of education tend to smoke more frequently than their tertiary-educated counterparts, reflecting persistent socio-economic disparities in health behaviours. On average about 11% of tertiary-educated adults smoke every day, compared to about 38% of those with below upper secondary education.
In general, tertiary-educated adults are most likely to report enjoying life but the difference between them and adults with upper secondary attainment is very small. It is larger between adults with below upper secondary education and tertiary education: 61% of adults with below upper secondary attainment report enjoying life all or most of the time compared to about 74% of those with tertiary attainment.
Education at a Glance 2025
Context
Health is not simply a means of economic participation but a cornerstone of human well-being. Good health enables individuals to thrive, pursue personal goals and engage fully with family and community, thus fostering psychological resilience and social inclusion (Arslan, 2021[1]). Students with good physical and mental health are more engaged with their education and more likely to pursue it, underpinning their long-term skill development and employability (Kharroubi et al., 2024[2]). Incorporating health metrics into international education indicators provides a more comprehensive framework for tracking learning environments and targeting interventions that bridge education and labour-market outcomes.
After they complete compulsory education, health status can have a strong bearing on individuals’ participation in the labour market and their earning potential (Jusot, Or and Sirven, 2012[3]). Poor physical or mental health can impair people’s ability to engage in work or education, thereby limiting opportunities for skill development. High-skilled occupations – ranging from managerial roles to specialised professions in sectors such as health care, education and information and communications technology (ICT) (OECD, 2024[4]) – are generally less physically demanding, and these positions are more frequently held by individuals with higher incomes who typically have better access to healthcare services (Aggarwal et al., 2011[5]). Conversely, those in lower-skilled roles are more frequently exposed to physically demanding tasks and associated health risks, which may further compound existing inequalities (ILO, 2021[6]). Individuals with lower educational attainment are more likely to face mental health challenges due to greater exposure to stressors and limited access to treatment and support resources. These disadvantages can create a negative feedback loop, where poor mental health undermines academic engagement, further reinforcing socio-economic and educational disparities.
Mental health plays a critical role in labour-market outcomes, with mental illness negatively affecting employment rates, labour-force participation and job retention. Individuals experiencing mental health issues are more likely to work fewer weeks per year and have higher rates of absenteeism (OECD, 2021[7]). Moreover, mental illness significantly limits workforce participation and occupational progression (OECD, 2021[7]). The effects of poor mental health on labour-market engagement are particularly pronounced among women and older adults (OECD, 2021[8]). This chapter explores the relationship between education and a number of key health indicators.
In per cent; 25-64 year-olds
1. Source is the Australia’s National Health Survey (2022).
2. Source is the International Social Survey Programme for South Africa, Slovenia and Mexico.
For data, see Table A6.1 For a link to download the data, see Tables and Notes section.
Other findings
Higher educational attainment is linked to more positive mental health outcomes when considering depressive symptoms. On average, tertiary-educated individuals report more favourable indicators of mental well-being on this measure than those with lower attainment.
In Sweden and Poland, adults with below upper secondary education have the highest reported levels of life enjoyment, indicating that other factors beyond education can play major roles in affecting average levels of mental well-being.
The link between higher educational attainment and lower rates of smoking among 25-64 year-olds is also reflected in the young adult population (18-24 year-olds), though data related to tertiary attainment in this age group should be interpreted with caution as many will still be completing their education.
Note
Care should be taken when interpreting results from different survey sources, as differences in data collection methods and reference periods can affect comparability. This is especially important when examining data on individuals’ mental health status (Table A6.3 and Figure A6.3) where the timing and geographical coverage of data collection may influence the outcomes reported.
In Table A6.2, the data on smoking frequency from most sources refer specifically to tobacco smoking, but data from the EU Statistics on Income and Living Conditions (EU-SILC) include the use of electronic cigarettes (vapes).
Educational attainment affects health (both physical and mental) in a multitude of ways. Individuals with higher levels of educational attainment are more likely to be well informed about the implications of their choices on their health and therefore have more positive health-related behaviour, probably due to greater access to health education or increased health literacy (Murakami, Kuriyama and Hashimoto, 2023[9]). Those with higher levels of education are also more likely to work in knowledge-intensive occupations, which are generally less physically demanding. These roles can reduce the risk of work-related injuries and may support mental health through providing intellectually stimulating environments (Ford and Wiggins, 2012[10]). The combined effects of these two factors may protect more highly educated adults from some of the negative health impacts experienced by those with lower educational attainment but they may still face other health-related issues, such as sedentary behaviour, high stress levels or long working hours (Waters et al., 2016[11]).
Higher educational attainment is also often linked to greater earning potential (see Chapter A4), which may enable better access to healthcare services, including preventive care and specialised treatment (Jusot, Or and Sirven, 2012[3]). Research indicates that this higher earning potential also facilitates access to improved nutrition, as individuals can afford higher-quality food, which is often more costly (Aggarwal et al., 2011[5]).
In addition to these tangible benefits, higher income is associated with improved subjective wellbeing and mental health, particularly at lower to moderate income levels where material security plays a crucial role in meeting basic needs (OECD, 2023[12]). Moreover, perceptions of financial security relative to one’s peers–social comparison–can influence mental wellbeing, highlighting that it is not only absolute income but also relative standing that shapes psychological outcomes (OECD, 2009[13]).
Conversely, individuals with lower educational attainment may face barriers to accessing health care and nutritious food, which can exacerbate health disparities. The link between educational attainment and nutrition-related health is well researched. One study in Brazil finding that neighbourhoods classified as food deserts – areas with limited or no access to food retailers – have lower per capita incomes and a smaller mean number of literate individuals (Honório et al., 2021[14]). Wider access to health care and improved food quality would help bridge the health gap between individuals with different educational backgrounds, promoting better outcomes across the population. Addressing these disparities is essential for enhancing public health and ensuring that all individuals have the opportunity to achieve optimal health, regardless of their educational status (WHO, 2010[15]).
Self-rated health status and educational attainment
Self-reported health offers a proxy for assessing both physical and mental health. It also reflects individuals’ awareness of their own health status. Considering that self-reported health is influenced by factors such as education, income and working conditions, it serves as an important tool for identifying health inequalities across socio-economic groups and, in this context, among individuals with different levels of educational attainment (Schram et al., 2021[16]).
Figure A6.1 presents the share of adults (25-64 year-olds) who reported their physical and mental health as “very good” or “excellent” on average across the OECD in the Survey of Adult Skills (PIAAC), based on the question: “In general, would you say your health is excellent, very good, good, fair, or poor?” Data for other countries in the right-hand panel of Figure A6.1 were drawn from the International Social Survey Programme (ISSP), or other sources using comparable questions.
The results indicate that, on average across the OECD countries and economies participating in the Survey of Adult Skills, tertiary-educated adults have the most positive perception of their health (both physical and mental), with about 51% reporting excellent or very good health, followed by those with upper secondary or post-secondary non-tertiary educational attainment (37%). In contrast, only about 26% of adults with below upper secondary education report having very good or excellent health. The countries with the highest shares reporting very good or excellent health among this group were Israel (47%), Australia and New Zealand (38%), and Denmark and Ireland (36%). The lowest shares are in Korea (6%), Japan and Latvia (11%) and Chile (12%) (Figure A6.1).
It is important to note the slight difference in the relationship between educational attainment and (self)-reported physical and mental health between Figure A6.1 and that shown in Figure A6.3, which asks adults about their enjoyment of life. Figure A6.1 shows a clear gradient: the higher the level of educational attainment, the greater the share of individuals reporting excellent or very good health. The pattern in Figure A6.3 is more nuanced, with several countries where tertiary-educated adults do not report the highest levels of enjoyment in some cases, those with the lowest educational attainment report greater life enjoyment.
Health behaviours and educational attainment among adults
Health behaviours play a crucial role in determining an individual’s overall health status, as they reflect both awareness of healthy habits and the ability to maintain a healthy lifestyle.
Tobacco and alcohol are major risk factors for at least two of the leading causes of premature mortality – cardiovascular diseases and cancer. Furthermore, research done under the Global Burden of Disease study has found smoking and tobacco use to be strongly associated with eight negative health outcomes including lung cancer, laryngeal cancer and diseases of the arteries (Dai et al., 2022[17]). Over the past decade, daily smoking rates among adults have fallen considerably in most OECD countries, with the exception of Luxembourg, the Slovak Republic and the Republic of Türkiye (OECD, 2024[4]). This decline may be due to the spread of tobacco control policies, although smoking may still be culturally embedded in many countries (OECD, 2023[18]).
Figure A6.2 presents the share of daily smokers among adults across countries and economies, broken down by educational attainment. It excludes those who vape, except in Luxembourg, whose survey also covers adults who use electronic cigarettes. Smoking prevalence decreases as educational attainment increases. Among OECD countries and economies with data from the European Social Survey (ESS), about 38% of 25-64 year-olds with below upper secondary education are daily smokers on average, compared with about 25% for those with upper secondary or post-secondary non-tertiary education and about 11% for those with tertiary education.
In per cent; 25-64 year-olds
Note: The average includes only countries participating in the 2023 European Social Survey, not all OECD countries.
1. Source is the International Social Survey Programme (ISSP) for Mexico, South Africa, the United States, Japan, Denmark and New Zealand.
2. Korea Welfare Panel Study Survey (2023).
3. Source is the EU Statistics on Income and Living Conditions (EU-SILC) (2022).
4. Source is the Australia’s National Health Survey (2022).
5. Source is the Canadian Community Health Survey (CCHS) (2023).
For data, see Table A6.2. For a link to download the data, see Tables and Notes section.
Although the overall average across OECD countries is low, there is wide cross-country variation in the share of adults smoking every day. Among countries with ESS data, Bulgaria has the highest share of daily smokers among tertiary-educated adults, at 37%, while Sweden has the lowest (3%), followed by England, the Netherlands, and Norway (4%). Among countries with ISSP data, the share of daily smokers ranges from 4% of tertiary-educated adults in New Zealand, to 27% in Mexico. For each data source, smoking rates fall as educational attainment increases in most countries, but not all (Figure A6.2).
There is a parallel trend with educational attainment evident among individuals who have never smoked, with the share of those who report having never smoked increasing as educational attainment increases. About 34% of 25-64 year-olds with below upper secondary education report never having smoked, compared to about 39% of those with upper secondary or post-secondary non-tertiary education and about 50% of those with tertiary education (Table A6.2).
Bulgaria (29%) and Greece (34%) have the highest shares of young adults (18-24 year-olds) with upper secondary or post-secondary non-tertiary attainment who smoke daily. Among young adults with below upper secondary educational attainment, the highest share of daily smokers can be found in Hungary(45%) and the lowest share in Czechia (5%) (Table A6.2).
Data for tertiary-educated 18-24 year-olds are harder to interpret due to small sample sizes and the fact that some of this age group may be actively pursuing a tertiary degree despite not having yet attained one (Table A6.2).
These patterns highlight the relationship between smoking and educational attainment, suggesting that higher levels of education may be associated with greater awareness of the health risks of smoking and greater adherence to healthier lifestyles.
Mental health and educational attainment
Since the COVID-19 pandemic, mental health has garnered significant attention in OECD countries, emerging as a crucial topic for policy development. The lockdowns implemented during the pandemic had a negative impact on mental health, leading to increased rates of anxiety, depression and other mental health disorders (OECD, 2021[8]).
Previous OECD work on mental health has drawn on the widely recognised definition provided by the World Health Organization (WHO), which defines mental health as “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his or her community” (OECD, 2023[19]).
Despite increasing recognition of its importance, mental health care remains excluded from universal public healthcare provision in many OECD countries, exacerbating disparities by socio-economic status and by gender, as women report higher rates of anxiety and depression (OECD, 2021[8]). Individuals earning lower incomes also face barriers to care, as out-of-pocket costs make therapy unaffordable when not covered by insurance (Reiss et al., 2021[20]). The stigma surrounding mental health also remains a barrier to seeking help for many. In some countries, there is a belief that discussing mental health issues or visiting a therapist is a sign of weakness, which can deter individuals from pursuing the care they need (Corrigan, 2004[21]). As a result, individuals struggling with mental illness face even greater challenges in accessing education and participating fully in the labour market, further compounding the barriers to their social and economic inclusion.
The relationship between educational attainment and mental health outcomes is well established. Research indicates that individuals with lower educational levels are more likely to experience mental health challenges and have less access to effective treatment options (Demange et al., 2023[22]; Silverman and Teachman, 2022[23]). Sociological perspectives, such as Pearlin’s stress process model, highlight that stressors contributing to mental health challenges are not randomly distributed but are shaped by social and economic conditions (Pearlin, 1989[24]). Individuals with lower educational attainment or in lower socio-economic strata often face more frequent and severe stressors, while also having fewer personal and social resources to cushion their impact. These unequal distributions contribute to persistent disparities, affecting both the motivation and the willingness to pursue education, and creating a negative feedback loop in the relationship between mental health and academic engagement (Brännlund, Strandh and Nilsson, 2017[25]).
Figure A6.3 illustrates the share of adults who reported that they enjoyed life during the past week, using data from the ESS, based on the CES-D 8 scale, which is used to assess depressive symptoms (see Definitions section). The CES-D 8 is a standardised, internationally comparable scale with strong reliability (OECD, 2023[19]).
In per cent; 25-64 year-olds; enjoyed life all the time, almost all the time or most of the time
Note: The average includes only countries participating in the 2023 European Social Survey, not all OECD countries.
1. Korea Welfare Panel Study Survey (2023).
For data, see Table A6.3. For a link to download the data, see Tables and Notes section.
Among countries and economies with ESS data available, tertiary-educated 25-64 year-olds generally reported the highest rates of life enjoyment, with 75% on average reporting that they enjoyed life almost all or most of the time. This share decreases with lower educational attainment, with 71% of those holding an upper secondary qualification and 61% of those with below upper secondary education reporting that they enjoyed life almost all or most of the time (Table A6.3).
In many countries, higher educational attainment does not correlate with greater life enjoyment. For instance, in Sweden, only 64% of tertiary-educated adults reported enjoying life, compared to 84% of those with below upper secondary attainment and 79% of those with upper secondary or post-secondary non-tertiary education. These low relative levels of enjoyment among those with tertiary education could be in part due to high levels of workplace stress and job involvement (Azila-Gbettor, Atsu and Quarshie, 2022[26]) (Figure A6.3 and Table A6.3).
These results may reflect the multifaceted context-dependent nature of subjective health. Although higher levels of education are often associated with better physical and mental health outcomes – linked to higher income, improved access to health care and healthier lifestyles choices – the enjoyment of life is influenced by a broader range of social, cultural and psychological factors (Aggarwal et al., 2011[5]; Jusot, Or and Sirven, 2012[3]). For instance, individuals with lower educational attainment may benefit from stronger local social networks and greater reliance on community support, protective factors that can foster a greater sense of belonging and emotional stability. Life satisfaction is also influenced by personal expectations and cultural norms, which can vary widely across socio-economic groups. In some settings, lower educational groups may adopt more pragmatic or community-oriented definitions of success and happiness, which may contribute positively to their sense of enjoyment (Maass et al., 2016[27]; Inaba et al., 2015[28]). Thus, although education often enhances material well-being and health, its relationship with subjective life enjoyment is more complex and not necessarily linear.
Data from the ISSP provide insights into the share of individuals who reported feeling depressed in the past four weeks, by educational attainment. Among those with below upper secondary education, the highest rate was reported in Korea (27%), while the lowest was observed in South Africa (4%). For individuals with upper secondary or post-secondary non-tertiary education, Korea reported the highest rate (21%) and Mexico the lowest (3%). Among tertiary-educated individuals, rates were generally lower, ranging from 17% in Korea to just 1% in the United States. These data are consistent with those from ESS, which consistently found higher rates of adults reporting feeling depressed among those with below upper secondary education than those with tertiary educational attainment (Table A6.3).
Age group: Although there is explicit reference to 18-24 year-olds throughout this chapter, the term adult is used only in reference to 25-64 year-olds.
Educational attainment refers to the highest level of education successfully completed by an individual.
Levels of education: See the Reader’s Guide at the beginning of this publication for a presentation of all ISCED 2011 levels.
Mental health enables individuals to manage life’s challenges, realise their potential, perform effectively in learning and work, and contribute to their communities. It is an essential component of overall health, supporting both individual and collective capacities to make decisions, form relationships and shape the world around us (WHO, 2022[29]).
Self-rated health refers to an individual's own assessment of their health status, typically expressed through a survey or questionnaire. It is usually rated on a scale (e.g. from "excellent" to "poor") and reflects the person's perception of their physical and mental health.
The CES-D-8 is an eight-item version of the Centre for Epidemiologic Studies (CES) scale for assessing depressive symptoms. The scale is used to measure the frequency and severity of depressive feelings. Respondents of the scale were asked to indicate how often in the week previous to the survey they felt or behaved: felt depressed, felt that everything was an effort, slept poorly, felt lonely, felt sad, could not get going, enjoyed life, felt happy. Respondents chose their response from a 4 Likert scale ranging from "none" or "almost none of the time" to "all" or "almost all of the time". Scale scores are assessed using a non-weighted summed ranging from 0 to 24, the higher scores indicating a higher frequency and severity of depressive symptoms. Table A6.3 provides the remaining items from the scale.
Different questions were asked to survey respondents, depending on the data source:
Table A6.1.
1. Survey of Adult Skills (PIAAC) (2023) question: "In general, how would you rate your health: excellent, very good, good, fair, or poor?"
2. International Social Survey Programme (ISSP) (2021) question: "In general, would you say your health is: excellent, very good, good, fair, poor, can't choose".
3. EU Statistics on Income and Living Conditions (EU-SILC) (2024) question: "How is your health in general? Is it… very good, good, fair, bad, very bad".
Table A6.2.
1. European Social Survey (ESS) Round 11 (2023) question: “Now thinking about smoking cigarettes. Which of the descriptions on this card best describes your smoking behaviour?” The interviewer gave different options.
2. International Social Survey Programme (ISSP) (2021) question: “Do you smoke cigarettes, and if so, about how many cigarettes a day?” The interviewer gave different options.
3. EU Statistics on Income and Living Conditions (EU-SILC) (2022) question: “In the last 12 months, did you use tobacco (including water pipes, heated tobacco, chewing tobacco, etc.) or any other related products (electronic cigarettes with or without nicotine, nicotine pouches, etc.)?” Response categories include “Yes, daily; Yes, a few times a week; Yes, a few times a month; Yes, a few times a year; Not at all”.
Table A6.3.
1. European Social Survey (ESS) Round 11 (2023) question: “How much of the time during the past week did you feel this way…You felt depressed?, You could not get going?, You enjoyed life?, You felt that everything you did was an effort?, You were happy?, You felt lonely?, You felt sad?, Your sleep was restless?”. Respondents could choose from the following options: “None or almost none of the time”, “Some of the time”, “Most of the time”, “All or almost all the time”.
2. International Social Survey Programme (ISSP) (2021) question: “During the past 4 weeks how often… have you felt unhappy and depressed?”. Respondents could choose from the following options: “very often”, “often”, “sometimes”, “seldom”, “never”, “can’t choose”.
Australia’s National Health Survey (2022) – Tables A6.1 and A6.2.
Canadian Community Health Survey (CCHS) (2023) – Tables A6.2 and A6.3.
Canadian Social Survey (CSS) (2023) – Table A6.3.
European Social Survey (ESS) round 11 (2023) – Tables A6.2 and A6.3.
EU Statistics on Income and Living Conditions (EU-SILC) (2024) – Table A6.1.
EU Statistics on Income and Living Conditions (EU-SILC) (2022) – Table A6.2.
International Social Survey Programme (ISSP) (2021) – Tables A6.1, A6.2 and A6.3.
Korea Welfare Panel Study Survey (2023) conducted by Korea institute for Health and Social Affairs (KIHASA) – Table A6.2.
Survey of Adult Skills (PIAAC) Cycle 2 (2023) – Table A6.1.
For more information, please refer to Education at a Glance 2025 Sources, Methodologies and Technical Notes (https://doi.org/10.1787/fcfaf2d1-en)
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To download the data for the figures and tables in this chapter, click StatLink above.
Data cut-off for the print publication 13 June 2025.
Table A6.1. Self-reported health status, by educational attainment (2021, 2022, 2023 or 2024)
Note: The question in the Survey of Adult Skills (PIAAC) is: “The next question is about your health. Overall, would you say your health is excellent, very good, good, fair, or poor? By health, we mean both physical and mental health”. Does not include adults who were only administered the doorstep interview due to a language barrier.
The question in the International Social Survey Programme (ISSP) is: "In general, would you say your health is: excellent, very good, good, fair, poor, can't choose".
The question in EU-SILC is: "How is your health in general? Is it… very good, good, fair, bad, very bad".
Columns showing the standard errors, the categories very good and excellent together, and those showing data for All levels of education are available for consultation on line.
1. Source is the Australia’s National Health Survey (2022). S.E. refers to the relative standard errors.
2. Source is the EU Statistics on Income and Living Conditions (EU-SILC) (2024).
Table A6.2. Self-reported smoking status, by educational attainment and age group (2021, 2022 or 2023)
Note: The question in the International Social Survey Programme (ISSP) is: “Do you smoke cigarettes, and if so about how many cigarettes a day?” with response options as follows: Do not smoke and never did; Do not smoke now but smoked in the past; Smoke 1–5 cigarettes per day; Smoke 6–10 cigarettes per day; Smoke 11–20 cigarettes per day; Smoke 21–40 cigarettes per day; Smoke more than 40 cigarettes per day; Can’t choose.
The question in EU-SILC is: “In the last 12 months, did you use tobacco (including water pipes, heated tobacco, chewing tobacco, etc.) or any other related products (electronic cigarettes with or without nicotine, nicotine pouches, etc.)?” Response categories include: Yes, daily; Yes, a few times a week; Yes, a few times a month; Yes, a few times a year; Not at all.
Columns showing data for 18-24 year-olds and for all levels of education are available for consultation on line. ESS website last consultation: June, 2nd 2025.
1. Source is the Australia’s National Health Survey (2022).
2. Source is the Canadian Community Health Survey (CCHS) (2023).
3. Source is the Korea Welfare Panel Study Survey (2023).
4. Source is the EU Statistics on Income and Living Conditions (EU-SILC) (2022).
Table A6.3. Share of adults who responded "all or almost all the time" or "most of the time" to items assessing their mental health during the past week, by educational attainment (2021 or 2023)
Note: The question in the International Social Survey (ISSP) is: "During the past 4 weeks how often. have you felt unhappy and depressed?" The shares show the individuals who responded "very often".
Columns showing data for "Could not get going", "Felt everything is an effort", and "Felt sad", and for all levels of education are available for consultation on line. ESS website last consultation: June, 2nd 2025.
1. Source is the Canadian Community Health Survey (CCHS) and the Canadian Social Survey (CSS) (2023).
2. Source is the Korea Welfare Panel Study Survey (2023).
a – category not applicable; b – break in series; c – there are too few observations to provide reliable estimates; d – contains data from another column; m – missing data; r – values are below a certain reliability threshold and should be interpreted with caution x – contained in another column (indicated in brackets). For further control codes, see the Reader’s Guide.
For further methodological information, see Education at a Glance 2025: Sources, Methodologies and Technical Notes [(https://doi.org/10.1787/fcfaf2d1-en)
In per cent; 25-64 year-olds
Note: For notes on this table and a link to download the data, see Tables and Notes section above.
In per cent
Note: For notes on this table and a link to download the data, see Tables and Notes section above.
In per cent; CES-D 8 scale items assessing individuals' mental health; 25-64 year-olds
Note: For notes on this table and a link to download the data, see Tables and Notes section above.