Using original cross-sectional internet survey data from 32 countries covering six continents, we investigated the impact of education gaps between married partners on their health status and sustainable lifestyles using the instrumental variable method. A self-rated health status index, mental health index, and an objective health status index were utilized to assess the health statuses of individuals, and six unique indices were used to investigate the sustainable lifestyles. According to the main findings, work-family conflicts may be severe for both wives and husbands with high education levels, and the hypothesis regarding the positive effect of income was not supported. Two major conclusions were derived. First, in general, as opposed to couples with equal education levels, the probability of reporting a worse health status was higher, and the activities related to sustainable development such as improving environmental sustainability were less for couples with education gaps. Second, a comparison of the effects of education gaps on the health status of couples in various groups reveals that highly educated groups, women, and people in Asian or middle-income countries had a higher negative effect on their health status.

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