Education matters more than income to reduce premature adult mortality in India
International Institute for Applied Systems Analysis
IIASA researchers explored why mortality among adults of working age remains high in India alongside rapid economic growth, finding that education – at both individual and community levels – is more strongly associated with lower premature mortality than income or household wealth.
Preventing premature death is a key objective of the UN Sustainable Development Goals (SDGs). Economic growth is often expected to improve survival by increasing resources for social protection, public health, and healthcare systems. While India has experienced sustained economic growth, the country accounts for around one fifth of global deaths among adults of working age, and about half of all deaths in India occur before the age of 60, amounting to around three million premature deaths each year. This places India well above the global average, with important consequences for households and the wider economy.
Using nationally representative data from the India Human Development Survey, which follows individuals over time, the IIASA-led study published in the Proceedings of the National Academy of Sciences (PNAS) examined the relative importance of education and economic resources for mortality among adults of working age (15–59) in India.
The analysis follows more than 115,000 individuals surveyed in 2004–05 and tracked through 2011–12. The authors compared how educational attainment and household economic status are related to the risk of dying during working ages, distinguishing between individual- and community-level effects. The models account for health status, age, marital status, caste, religion, health-related behaviors, employment, place of residence, and region.
The results show that adults with higher levels of education are less likely to die prematurely across all household wealth groups. In contrast, higher household wealth does not show a similarly consistent relationship with mortality once education is taken into account. For both men and women, differences in mortality by education level are larger than those observed by wealth level.
“Education shows a stronger association with survival at working ages than household wealth,” explains lead author Moradhvaj Dhakad, a guest research scholar in the Multidimensional Demographic Modeling Research Group of the IIASA Population and Just Societies Program and Marie Skłodowska-Curie Postdoctoral Research Scientist at Max Planck Institute for Demographic Research, Germany. “This relationship remains after accounting for health conditions, employment, and other background characteristics.”
The study also highlights the role of community context. Adults living in communities with higher average levels of education tend to have lower mortality risks, even after accounting for their own education and economic status, a pattern that is particularly evident among women. By contrast, higher average community wealth does not show a consistent protective relationship with mortality among adults of working age and, in some cases, especially among men, is associated with higher mortality risks.
“Our results show that education matters not only for individuals, but also for the communities they live in. Even after accounting for personal education and economic status, adults in more highly educated communities face lower mortality risks, especially women. This suggests that education shapes social and behavioral environments in ways that influence health beyond individual circumstances,” notes coauthor Erich Striessnig, a senior research scholar in the same research group at IIASA.
To better understand these differences, the researchers examined several possible pathways, including health behaviors, morbidity, occupation, caste, religion, and marital status. The findings show that most of the link between education and mortality at working ages is direct, while the association between household wealth and mortality operates mainly through intermediary factors, including morbidity.
“These patterns suggest that sustained reductions in premature adult mortality in India are unlikely to be achieved through income growth alone but are more strongly associated with long-term investments in education that strengthen individual capabilities and healthier community environments,” says coauthor Samir K.C., a senior research scholar at IIASA. “While growth expands resources and opportunities, it may however also introduce occupational, environmental, and behavioral risks that undermine adult health when not accompanied by investments in education, regulation, and social protection.”
“By showing that education consistently outweighs household wealth as a predictor of survival, not only for children – as has been shown repeatedly in the past – but also for working age populations, the study highlights a clear policy lever for jointly accelerating progress toward the health- and the education-related targets of the SDGs. Expanding access to quality education across the life course, particularly for women and disadvantaged groups, can deliver broad health dividends, saving lives today while building a more resilient and productive society for generations to come,” concludes IIASA Distinguished Emeritus Research Scholar and coauthor Wolfgang Lutz.
Reference
Dhakad, M., Striessnig, E., Saikia, N., KC, S., Lutz, W. (2026). For reducing premature adult mortality in India education matters more than income. Proceedings of the National Academy of Sciences (PNAS) DOI: 10.1073/pnas.2503809123
The publication fee for this paper will be covered through external funding from the Yidan Prize–supported project (Yidan Prize 25121), which supports research highlighting the role of education in advancing human capital, health, and sustainable development.
About IIASA:
The International Institute for Applied Systems Analysis (IIASA) is an international scientific institute that conducts research into the critical issues of global environmental, economic, technological, and social change that we face in the twenty-first century. Our findings provide valuable options to policymakers to shape the future of our changing world. IIASA is independent and funded by prestigious research funding agencies in Africa, the Americas, Asia, and Europe. www.iiasa.ac.at
Journal
Proceedings of the National Academy of Sciences
Article Title
For reducing premature adult mortality in India, education matters more than income
Article Publication Date
2-Feb-2026
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