Does health determine educational outcomes in high-income countries? a review of the evidence

1. Does health determine educational outcomes in high-income countries? a review of the evidence Marc Suhrcke Professor of Public Health Economics University of East Anglia, Norwich (UK) Oslo, 25/04/2010

2. Outline • Does it matter? • Conceptual framework • Literature review • Methodology • Main findings • Conclusions

3. Does it matter? • If education is so “important”, how do we improve it? • Reconsider cost-benefits calculations of child health interventions? • Virtual cycles between health & education? • Role of health in inter-generational transmission of economic status?

4. Conceptual framework

6. Literature review

7. Previous reviews • Currie (2008) • Taras & Pott-Datema (2005a, b, c) • Murray et al. (2007) • Cueto (2001) • Trudeau and Shephard (2008)

8. Methodology (I) • Dependent variables: • educational attainment and performance • Independent variables: • Health conditions (overall health, mental health, sleeping disorders, respiratory diseases) • Health behaviours (alcohol, marijuana, nutritional problems/obesity, physical activity, smoking) • Peer-reviewed journals; “good” working papers • 01/01/1995 – 30/06/2008

9. Methodology (II) • Types of literature considered: • medical, public health, economics, education, psychology, sociology, demography • Key-word search, hand-search, snowballing • Age range: 1-18 years

11. Main findings

12. Number of papers by health conditions and behaviours HEALTH CONDITIONS HEALTH BEHAVIOURS

13. Number of papers by educational outcome

14. Number of papers by country

15. Number of papers by methodology

16. Number of papers by field

17. The impact of health-related behaviours and risk factors on educational outcomes (I) • Binge drinking: • significant negative effect on educational attainment and educational performance, if possibly small. • Marijuana consumption: • Significantly negative significant on educational attainment and on academic performance according to all available evidence. • Smoking: • Strong predictor of educational under-performance in few studies that exist. (methodological problems)

18. The impact of health-related behaviours and risk factors on educational outcomes (II) • Nutritional issues: • particularly scarce literature; what exists indicates that a relevant connection is likely to exist between both factors. • Obesity and overweight: • negatively associated with educational outcomes, but contradictory findings on effects by gender; endogeneity mostly not addressed • Physical exercise: • some suggestive evidence that PE might have a positive impact on short-term aspects related of academic achievement

19. The impact of health conditions on educational outcomes (I) • Sleeping disorders: • Negative association with educational performance; measurement problems and causality not fully addressed • Anxiety and depression: • significantly and negatively associated with both short and long term educational outcomes. Further research is particularly required in the case of depression and its effect on education.

20. The impact of health conditions on educational outcomes (II) • Asthma: • clearly correlated with school attendance, but does not seem to show such a strong connection with educational performance • Overall child and adolescents´ health: • Clearly associated with educational outcomes, despite persistent measurement and endogeneity problems in the assessment of this relationship.

21. Renna (2008). Teens’ alcohol consumption and schooling. Econ of Education Rev Data: NLSY79 (1982-2002);only the two youngest cohorts of the survey, who were 18 in 1982/83 (n= 2263) Self-reported drinking (“consumed any alcohol in the last month”) & “bingeing” (“more than 5 drinks in one day in the last month”) Dependent variable (ordered probit): 0 for dropout, 1 for GED, 2 for high school diploma

22. Renna (2008). Teens’ alcohol consumption and schooling. Econ of Education Rev EDUCi = a + b ALCOHOLi + c X + εi Instruments: Mimimum legal drinking age at 18, at 19; tax on beer One additional episode of bingeing per month reduced the probability of receiving a high school diploma by 8 percentage points

23. Cawley/Spiess (2008). Obesity and Developmental Functioning Among Children Aged 2-4 Years. DIW WP • Data: GSOEP (Germany) • questionnaires on child development administered in 2005 to the parents of the “2003 cohort” of newborns and those administered in 2006 to the parents of the “2004 cohort” of newborns. (n=451)

24. Cawley/Spiess (2008). Obesity and Developmental Functioning Among Children Aged 2-4 Years. DIW WP • Weight and height of children acc to mothers’ self-report (BMI or categories) • Dependent vars: measures of developmental functioning (verbal skills, activities of daily living, motor skills, and social skills), self-report by mothers (scores from 1-10)

25. OLS regression results

26. Currie/Stabile (2007). Mental Health in Childhood and Human Capital. NBER WP • Data: Canadian National Longitudinal Survey of Children and Youth (NLSCY), and the American National Longitudinal Survey of Youth (NLSY) • Hyperactivity score, emotional behaviour score and aggressive behaviour score • Grade repetition, mathematics scores, reading scores, and special education

27. Currie/Stabile (2007). Mental Health in Childhood and Human Capital. NBER WP • Mental health conditions, and especially ADHD, have large negative effects on future test scores and schooling attainment, regardless of family income and maternal education.

28. Conclusions • Small but growing area of (multi-disciplinary) research • Lack of European evidence • A lot in favour of ‘health as a determinant of education’ • Really a causal effect? • Policy implications