Indirect health-related selection or social causation? Interpreting the educational differences in adolescent health behaviours

Adolescents’ health behaviours vary with educational achievement. This has been interpreted as indirect health-related selection contributing to later socioeconomic health inequalities. This article discusses whether this pattern rather should be considered within a social causation framework. As adolescents usually are labelled with respect to school performance before engaging in typical unhealthy practices, it may be questioned whether behaviours are important selective factors for being sorted into different educational tracks. In addition, a social causation perspective that emphasises influences from immediate social environments such as social class background and peer milieus seems insufficient to account for the association between health behaviours and school achievement. Educational differences in health behaviours could be due to how education imposes a sorting of adolescents into hierarchies of learning performance and social prospects, with corresponding inequalities in moral recognition. These experiences are likely to impact on adolescents’ identities and behavioural inclinations. Motivations such as communicating feelings of stress, adaptation to future socioeconomic milieus and opposition to the social authorities that have denied them social value may contribute to the higher frequency of unhealthy behaviours among low-achieving adolescents. It is concluded that a social causation perspective may be fruitful for analysing the association between adolescents’ educational careers and their health-related practices.