Education Policy as Health Policy Flashcards
Causal pathways from education to health
Income
o Access and quality of healthcare
o Housing / built environment
Occupation o Safety of workplace o Job security o Redundancy o Benefits
Information and cognitive skills
o E.g., info on condom usage, smoking, drinking, etc.
o Critical evaluation skills
o Information alone does not necessarily reduce health inequalities, because certain people are better positioned than others to take advantage of the benefits of information
Family formation
o Education can delay marriage, age at which women start having children
o More educated = fewer children (on average)
Social networks
o If those you spend time with engage in unhealthy behaviors, you are more likely to do so as well
o Because the most impoverished rely on social networks more, they also tend to exhaust them faster
Personal autonomy / stress
Social status / rank
o If you increase the number of people who have a university education, then the degree to which you belong to a higher rank diminishes, possibly bringing down the health of the people at the top without raising that of those at the bottom
Education as a positional good
The value of education changes depending upon how many people within a society possess it (information, for instance, is NOT a positional good)
Potential confounders that may drive both education and health
(1) Genetics
(2) Family background
There may be some confounding variable, such as an individual’s unobserved social and genetic background, that drives both educational attainment and health behaviors
Reverse causation could also account for the observed correlation, with unhealthy people going on to obtain less education
Grossman (1972)
Suggests that education may result in increased productivity in activities associated with the ‘production of health,’ raising the benefits of health inputs such as doctor visits and therefore making an individual more efficient in producing health
Cutler and Lleras-Muney (2010); Rosenzweig and Schulz (1981)
Propose that education serves to affect health-relevant behaviors such as drinking, smoking, dietary choices, and adherence to safety precautions, perhaps by directly teaching what is healthy, or by producing educated people who are better able to both obtain and critically evaluate health information, as is suggested by Kenkel, 1991, Nayga, 2000, and de Walque, 2007
Lochner (2012); Oreopoulos and Salvanes (2011)
Postulate other channels through which education can affect health outcomes, such as by raising income and therefore facilitating the purchase of healthier foods, as well as residence in healthier environments and acquisition of better health insurance
Becker and Mulligan (1997); Fuchs (1982)
Hypothesize that education might improve health and health behaviors by positively affecting certain psychological predispositions, such as sense of control and time preferences
Gathmann, Jürges, and Reinhold (2015): overview
In an effort to establish the existence of a causal relationship between education and health, as well as to reconcile the divergent results found in much of the previous literature, Gathmann, Jürges, and Reinhold (2015) conduct a multi-country analysis, examining 18 compulsory schooling reforms implemented in European countries over the course of the twentieth century to estimate the average effect of compulsory schooling on mortality
In doing so, they compare various time periods and countries using harmonized data, rather than relying upon the different data sources and mortality measures frequently utilized by preceding studies
This analysis illuminates whether compulsory schooling reforms have a comparable effect on mortality rates across a range of diverse settings and countries, ultimately granting a better understanding of whether the treatment effects of these reforms are systematically associated with the characteristics of a given country
Gathmann, Jürges, and Reinhold: conclusions (1)
The first key takeaway from the multi-country analysis described in the paper is that, throughout the 20th century, compulsory education reforms carried a stronger effect on health among men than women, with the authors finding that, on average, a lengthening of compulsory schooling resulted in small reductions in mortality among men, but finding no significant reductions in mortality for women
Though the risk of dying between the ages of 18 and 38—the 20-year mortality rate—is reduced by 2.9% for men, with similar effects found for 30- to 50-year mortality, women’s mortality is not affected by the schooling reforms at any age
Various explanatory mechanisms for these asymmetrical effects are explored:
o The authors ultimately find that the disparities CANNOT be attributed to gendered differences in compliance with the new schooling laws, since, on average, the reforms have increased years in school by roughly the same amount for both genders: 0.501 for men and 0.541 for women
o Moreover, they find NO SUBSTANTIATION for the plausible explanation that the health benefits of compulsory schooling are realized through labor market participation, such as via higher earnings or higher occupational status, the idea being that lower rates of female participation in the labor market may account for the negligible effects of (especially earlier) reforms on female mortality
o Though the authors do not possess the data necessary to test this theorized relationship empirically, they suggest that the differential effect could potentially be the consequence of gender-specific occupational choices, with men traditionally overrepresented in blue-collar jobs, and therefore exposed in greater numbers to occupational health hazards (through greater educational attainment, a proportion of these men may have been able to acquire less dangerous white-collar jobs)
Gathmann, Jürges, and Reinhold: conclusions (2)
The second key finding of the study is that early twentieth century reforms are altogether more effective in reducing mortality than later reforms
The authors write, “Across alternative specifications, the effects on male mortality are larger if the education reform is implemented prior to 1930. On average, these reforms reduce male mortality between the ages 18 and 38 by 6.4%. In contrast, reforms implemented after 1970 reduce male mortality between the ages 18 and 38 by just 1.2%”
One proposed explanation for this pattern is that the earlier reforms increase the average school leaving age by more years than the later reforms:
o The authors do find that mortality reductions (indicated by an odds ratio smaller than one) are positively correlated with the effect of a given compulsory schooling reform on educational attainment, although THIS CORRELATION EXISTS TO A MUCH LESSER EXTENT FOR WOMEN
The authors recognize the possibility that reductions in mortality could be greater for the early reforms because compulsory schooling proves particularly effective when baseline educational attainment is low:
o However, they ultimately DISMISS THIS HYPOTHESIS, finding that the relationship between the minimum schooling requirements in place immediately before a reform and the estimate of the reform effects on mortality is very weak for men, and essentially nonexistent for women
The paper further postulates that if average income levels are low and/or poverty rates are high, additional compulsory education might beget higher income, and therefore potentially facilitate more health-improving investments:
o Using data on GDP per capita in the years around the reform as a proxy for average income, the authors find that reductions in mortality among men are slightly larger in countries with lower GDP per capita, but THERE IS NO EQUIVALENT RELATIONSHIP FOR WOMEN
o These results are in keeping with evidence from a Swedish compulsory schooling reform study that demonstrated stronger mortality reductions for men who came from more disadvantaged socioeconomic backgrounds
Gathmann, Jürges, and Reinhold (2015): in sum
The evidence collected by the authors “strongly suggests that conflicting results reported in the previous literature [on the causal effects of formal education on health outcomes] are not a coincidence but rather a systematic feature of different reform settings”
