Through the Health Gap research project, the Norwegian Institute of Public Health has found that one effect of social inequality during school years is linked to the probability of shorter life expectancy. Boys perform worse at school from primary school all the way to university.
Through the Health Gap research project, the Norwegian Institute of Public Health has found that one effect of social inequality during school years is linked to the probability of shorter life expectancy. Boys perform worse at school from primary school all the way to university.

Different maturity between boys and girls can lead to social inequality and poor health

A new research project from the Health Gap project conducted by the Norwegian Institute of Public Health (NIPH) has found that social inequality in schooling is linked to the probability of dying young.

Different rates of development for boys and girls is one of the conditions that helps to explain the social inequality that prevails in Norway. Poor school performance is likewise associated with everything from ostracism to illness and early death.

The Health Gap research project carried out by the Norwegian Institute of Public Health (NIPH) has reported these findings.

Fartein Ask Torvik is a senior researcher at the NIPH and has managed the research project. He explains that the aim of the project was to find out why boys get worse grades in school and what that means for health later in life.

“We know that boys perform worse at school – from primary school all the way to university. We see differences in maturation starting in first grade, and then the differences increase during the teenage years and through puberty. About a quarter of the differences in grades can be attributed to the difference in timing of puberty between boys and girls, which in turn leads to social inequality,” says Torvik.

Social inequality affects health

The project manager points out that the NIPH has found very strong correlations between health and education, and health and income, as a result of educational choices.

“We know that the grades pupils get, especially in lower secondary school, are important for whether they finish upper secondary school or not, and whether they go on to higher education. That is why it matters that boys lag behind. It creates a social inequality that also affects health,” he says.

“We’re not surprised to find a correlation, but it’s greater than we thought. It’s quite clear that pupils who get lower grades, who are often boys, do worse than those with good grades.”

Premature death

Bjørn-Atle Reme has also been involved in the project. He is a senior adviser at the NIPH and has researched the relation between social inequality and premature death, which in this context is defined as before the age of 30.

“The correlation between social background – that is, what kind of family you come from – and the likelihood of dying prematurely is significant. This link is strong for both girls and boys, but more pronounced for boys,” says Reme.

The research project has found that early mortality can be explained to a greater extent by school performance than social background, as measured by parents' income and education.

“When we adjust for differences in school performance, social background is almost insignificant when considering the risk of premature death.”

Possible long-term consequences

Reme believes there is reason to think about the long-term consequences this may have, and points out that school is probably an important arena for preventing social inequalities in health.

“We know that doing poorly at school is a clear marker for having a higher risk of dying early. These early deaths tend to be due to risky behaviour, which lead us to believe that school can be an important arena for trying to prevent this type of health inequality.”

Speaking to measures that could address this inequality, Reme says, “The most concrete thing you can do is to think about how different types of subjects are weighted in school. School consists of a lot of language-based subjects, where girls consistently perform much better than boys. Primary school consists of fewer technical and practical subjects, and a lot of language subjects, and this contributes to the large gender differences.”

“If, on the other hand, the weighting were based more on the type of subject, so that the weight were assigned more evenly across language-based, technical subjects and physical subjects, then you’d see a smaller gender difference at school,” says Reme.

This adjustment could potentially contribute to reducing social health inequalities, perhaps especially for boys. However, here more research is needed to be able to confirm such causal relationships.

Recommends flexible primary school start

Torvik thinks introducing a more flexible start at primary school might therefore be a good idea.

“Right now almost everyone starts school when they’re six years old, and only one per cent are approved for a delayed school start. This is connected with children’s maturity level, and the results of a flexible start to school can have a positive effect in the long term.”

Health Gap’s project leader points out that the research project has not looked specifically at how to prevent social inequality in health, but rather at how it has arisen. This area is where Torvik believes the school and course of education play a central role.

“There should be a greater focus on health among people with low education and poor grades, because that is the group that ends up with the worst health. In the long run, this is how we can solve this complex problem,” says Torvik.

Minister of Health: Definitely concerned

“We know that social differences in health are one of the challenges that reinforce the need for healthcare, so this is clearly one of the major challenges in society,” says Health and Care Minister Ingvild Kjerkol (Ap) about the new findings in the research project.

She is pleased that this issue is being addressed by the NIPH and says it is a topic that is close to her heart.

“I am clearly concerned about the increasing social inequalities in schools, and there is no doubt that they are closely linked to health-related issues.”

The Minister of Health and Care Services fully concurs that a person’s course of education is linked to how good their health is later in life. The minister believes that collaborating across ministries is important for finding good solutions to what she refers to as a ‘complex problem.’

“It’s important for me to work well with the Minister of Education and Research and the Minister of Children and Families on this issue. Soon I will also be presenting the public health report, the government's national strategy to equalize inequalities in health-related matters,” says Kjerkol.

Translated by: Ingrid P. Nuse

Read the Norwegian version of this article at


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