Academic journal article Economic Perspectives

Does Education Improve Health? A Reexamination of the Evidence from Compulsory Schooling Laws

Academic journal article Economic Perspectives

Does Education Improve Health? A Reexamination of the Evidence from Compulsory Schooling Laws

Article excerpt

Introduction and summary

Improving the long-term health of the population is clearly an important goal for policymakers. It is also likely to become even more so in the coming years with the aging of the baby boomers and the anticipated health-related costs that will accompany this demographic change. Therefore, understanding which policy levers might improve health is of interest. In a provocatively titled front page article, "A surprising secret to a long life: Stay in school," the New York Times recently suggested that many researchers now believe that education is the key factor in promoting health. (1) While social scientists have long known that there is a strong positive correlation between education and longevity, many researchers have speculated that this association was not truly causal, meaning one didn't necessarily lead to the other. Rather, the link was thought to reflect either the fact that for a variety of other reasons (for example, parental income and personal attitudes), people who tend to acquire more schooling also tend to be in better health, or that healthier children stayed in school longer. Of course, in the absence of evidence of a causal link, there is no reason to expect that policies aimed at increasing educational attainment will result in improvements in health.

The New York Times article was based upon the results of a recent study by economist Adriana Lleras-Muney (2005) that provides perhaps the strongest evidence to date that education has a causal effect on health. By implementing an instrumental variables (IV) strategy, this research analyzes changes in compulsory schooling and child labor laws across different states early in the twentieth century and uses this information to infer the effects of education on mortality. The idea behind this strategy is that if differences in these laws induced people born in different states in different years to obtain different levels of schooling for reasons that are unrelated to any other determinants of health, then one can estimate a true causal effect that is not confounded by the other factors. Lleras-Muney finds that increased schooling due to these laws led to dramatic reductions in mortality rates during the 1960s and 1970s. In fact, the results imply that one more year of schooling would lower the mortality rate over a ten-year period by nearly 60 percent--a result that is perhaps implausibly large.

If it is true that more education leads to improved health, such a finding also raises a second important question--namely, how, exactly, does education affect health? Economists have proposed a variety of theories including: that more education leads to better jobs and more financial resources; that education improves knowledge and decision-making ability, which improves health; and that education influences other kinds of behavioral responses that, in turn, lead to better health outcomes. So far, however, there is little convincing empirical evidence on how to evaluate the importance of these factors.

In this article, I reexamine the use of these compulsory schooling laws as a way of identifying the causal effects of education on health through the IV approach. Given the fundamental importance of the question of whether more education is causally linked to better health, it is worth investigating the robustness of the relationship. I estimate the same types of models used in the earlier research, using a much larger sample and improved measures of compulsory schooling laws. I also present alternative specifications of the statistical model that may better account for other reforms that were going on during the same period. For example, during the early period of the twentieth century, there were fairly dramatic improvements in public health measures that led to large declines in concurrent mortality (Cutler and Miller, 2005). For school-age children specifically, new nutrition and vaccination programs may have resulted in improved long-term health, independent of any effects of increased education. …

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