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This study investigates whether fundamental causes or learned effectiveness can better explain why well-educated young adults report high levels of self-rated health. Using longitudinal data from young adults age 15 to 29 in the NLSY97 and within-person fixed-effect models we find uniform support for fundamental causality; more-educated young adults are healthier and more educated primarily because of social and developmental advantages established in childhood or earlier. Fixed-effects regression models show the educational attainment gradient in self-rated health is large and persistent, but is in place long before educational attainment is completed. Among young adults, our results indicate that the educational gradient in self-rated health is primarily a product of their parents’ socioeconomic status rather than the causal effect of their own educational attainment. After adjustment for selection, the causal effect of educational attainment on self-rated health is close to zero for young adult males and females.