Causes and Consequences of Early Life Health

By Case, Anne; Paxson, Christina | NBER Reporter, Summer 2009 | Go to article overview

Causes and Consequences of Early Life Health


Case, Anne, Paxson, Christina, NBER Reporter


On average, wealthy people live longer and have less illness and disease than poor people. This has been well documented across countries, within countries at a point in time, and over time as economic growth occurs. And, the positive correlation between income and health is not limited to the bottom end of the income distribution. Indeed, the gradient in health status--the phenomenon that relatively wealthier people have better health and longevity--is evident throughout the income distribution.

However, the causes of the relationship between income and health are difficult to untangle in adults, and there is little consensus about the relative importance of mechanisms that lead from low income to poor health versus those that lead from poor health to low income. For this reason, we investigate the association between household income and children's health. By focusing on children, we can eliminate the channel running from health to income: generally, children in the United States do not contribute to family income, so lower earnings of children cannot explain the correlation between poor health in childhood and low family income (although children might reduce parental labor supply, a point we address in our work).

In a series of papers, we explore the links running from low income to poor health in childhood, and document the role of health in the intergenerational transmission of poverty: children born into poorer families experience poorer childhood health, lower investments in human capital, and poorer health in adulthood, all of which are associated with poorer employment opportunities and lower earnings in middle age--the time at which they themselves become parents.

Socioeconomic Status and Health in Childhood

Using several large, nationally representative datasets--including multiple rounds of the National Health Interview Survey, the Panel Study of Income Dynamics, and the National Health and Nutrition Examination Survey--we find that children's health in the United States is positively related to household income, and that the relationship between household income and children's health status becomes more pronounced as children grow older. (1) This continues to be true when we control for a rich set of parental and household characteristics. Moreover, children's health is most closely related to long-run average household income, and it appears that the adverse health effects of lower permanent income accumulate over children's lives. Poorer children arrive at the doorstep of adulthood in poorer health and with lower educational attainment--the latter, in part, as a consequence of poor health.

Mechanisms

A large component of the relationship between income and children's health can be explained by the arrival and effect of chronic health conditions in childhood. Children from lower-income households are more likely than wealthy children to experience some (although not all) chronic health conditions. In addition, among U.S. children with the same health conditions, those who are richer are reported to be in better health than those who are poorer, suggesting that the chronic conditions of wealthier children are less severe, or are better managed. While this may be because poorer children are less likely to be covered by health insurance, the evidence from research we conducted using data from the Health Survey of England suggests that this is unlikely to be the explanation. (2) Although children in the United Kingdom all have access to medical care through Britain's National Health Service, the income gradient in children's health increases with age by the same amount there as in the United States. We find that the effects of chronic conditions on health status are larger in the English sample than in the American sample, and that income plays a larger role in buffering childrens health from the effects of chronic conditions in England.

Children born into wealthier households also are taller on average, at every age, in both the United States and the United Kingdom--partly the result of healthier environments and better nutrition. …

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