Money, schooling, and health: Mechanisms and causal evidence

Abstract

An association between higher educational attainment and better health status has been repeatedly reported in the literature. Similarly, thousands of studies have found a relationship between higher income and better health. However, whether these repeated observations amount to causality remains a challenge, not least because of the practical limitations of randomizing people to receive different amounts of money or schooling. In this essay, we review the potential causal mechanisms linking schooling and income to health, and discuss the twin challenges to causal inference in observational studies, in other words, reverse causation and omitted variable bias. We provide a survey of the empirical attempts to identify the causal effects of schooling and income on health, including natural experiments. There is evidence to suggest that schooling is causally related to improvements in health outcomes. Evidence also suggests that raising the incomes of the poor leads to improvement in their health outcomes. Much remains unknown beyond these crude findings, however; for example, what type of education matters for health, or whether there is a difference between the health impacts of temporary income shocks versus changes in long-term income.

On the promotion of human flourishing

“…Education is a strong cross-sectional predictor of health (82,83), but the extent to which this is causal is debated. Although some longitudinal and quasiexperimental designs do indicate a protective effect (83)(84)(85)(86), other strong designs suggest that this effect may be more modest than may have been previously thought, or may not apply to all contexts (83,87,88), with possibly a larger effect in the United States than in Europe (83). Concerning virtue and character, there is some evidence from longitudinal studies that education decreases the likelihood of criminal activity and increases the likelihood of voting and of democratic participation (83,89,90).…”

Trends in Life Expectancy by Income and the Role of Specific Causes of Death

“…It is evident that many social and behavioural processes are associated with health and length of life (Elo, 2009). Public health researchers tend to stress the impact of income on health (Kawachi, Adler, and Dow, 2010), but it is, however, also clear that a large part of the relationship between income and mortality is caused by ill-health reducing the possibilities of higher incomes (Deaton, 2003). Reduced sickness benefits, for example, would therefore widen the gap in life expectancy across income groups even if any effect of income on health remained constant.…”

Social stratification, classroom climate, and the behavioral adaptation of kindergarten children

“…These differences exert powerful constraints on human health, well being, and development, rendering SES the single most potent determinant of health within human populations (21,22). Beginning even early in life, disadvantaged, subordinate groups bear disproportionate burdens of disease and disorder, with poorer children sustaining higher rates of low birth weight (23), traumatic injury (24), infectious diseases (25), dental caries (26), psychiatric and developmental-behavioral disorders (27), and poor academic performance (28). Growing evidence suggests, moreover, that childhood exposures to socioeconomic inequalities establish enduring developmental trajectories, leading to lifelong differences in the rates and severities of medical conditions, disorders of mental health, and educational and occupational underachievement (29)(30)(31)(32).…”