There are many possible pathways between parental education, income, and health, and between child health and education, but only some of them have been explored in the literature. This essay focuses on links between parental socioeconomic status (as measured by education, income, occupation, or in some cases area of residence) and child health, and between child health and adult education or income. Specifically, I ask two questions: What is the evidence regarding whether parental socioeconomic status affects child health? And, what is the evidence relating child health to future educational and labor market outcomes? I show that there is now strong evidence of both links, suggesting that health could play a role in the intergenerational transmission of economic status.

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Healthy, Wealthy, and Wise: Socioeconomic Status, Poor Health in Childhood, and Human Capital Development

America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost.The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009--roughly $750 billion--was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances.About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care.This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

There is a strong, positive, and well-documented correlation between education and health outcomes. In this paper, we attempt to understand to what extent this relationship is causal. Our approach exploits two changes to British compulsory schooling laws that generated sharp across-cohort differences in educational attainment. Using regression discontinuity methods, we find the reforms did not affect health although the reforms impacted educational attainment and wages. Our results suggest caution as to the likely health returns to educational interventions focused on increasing educational attainment among those at risk of dropping out of high school, a target of recent health policy efforts.

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The Effect of Education on Adult Mortality and Health: Evidence from Britain

A goal of many health studies is to determine the causal effect of a treatment or intervention on health outcomes. Often, it is not ethically or practically possible to conduct a perfectly randomized experiment, and instead, an observational study must be used. A major challenge to the validity of observational studies is the possibility of unmeasured confounding (i.e., unmeasured ways in which the treatment and control groups differ before treatment administration, which also affect the outcome). Instrumental variables analysis is a method for controlling for unmeasured confounding. This type of analysis requires the measurement of a valid instrumental variable, which is a variable that (i) is independent of the unmeasured confounding; (ii) affects the treatment; and (iii) affects the outcome only indirectly through its effect on the treatment. This tutorial discusses the types of causal effects that can be estimated by instrumental variables analysis; the assumptions needed for instrumental variables analysis to provide valid estimates of causal effects and sensitivity analysis for those assumptions; methods of estimation of causal effects using instrumental variables; and sources of instrumental variables in health studies.

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Instrumental variable methods for causal inference

Many developed countries are currently considering a move toward subsidized, widely accessible child care or preschool. However, studies on how large- scale provision of child care affects child development are scarce, and focused on short-run outcomes. We analyze a large-scale expansion of subsidized child care in Norway, addressing the impact on children's long-run outcomes. Our precise and robust difference-in-differences estimates show that subsidized child care had strong positive effects on children 's educational attainment and labor market participation, and also reduced welfare dependency. Subsample analyses indicate that girls and children with loweducated mothers benefit the most from child care. {JEL J13, J16) increased demand for child care associated with the rise of maternal employment is attracting the attention of policy makers and researchers alike. Indeed, access to child care has gone up in many developed countries over the last years (Organisation for Economic Cooperation and Development (OECD) 2004), and there is a heated debate about a move towards subsidized, widely accessible child care or preschool, as offered in the Scandinavian countries. For example, the European Union's Presidency formulated in 2002 as a policy goal "to provide childcare by 2010 to at least 90 percent of children between 3 years old and the mandatory school age and at least 33 percent of children under 3 years of age" (European Union (EU) 2002, 13). Further, Quebec recently introduced highly subsidized child care, and other Canadian provinces are considering similar policies. In the US, the so-called "Zero to Five Plan" of US President Obama aims at making states move towards voluntary universal preschool. At the same time, studies on how large-scale provision of child care affect child development are scarce, focused on short-run outcomes, and the findings are mixed.

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No Child Left Behind: Subsidized Child Care and Children's Long-Run Outcomes

Season of birth is associated with later outcomes; what drives this association remains unclear. We consider a new explanation: variation in maternal characteristics. We document large changes in maternal characteristics for births throughout the year; winter births are disproportionally realized by teenagers and the unmarried. Family background controls explain nearly half of season-of-birth's relation to adult outcomes. Seasonality in maternal characteristics is driven by women trying to conceive; we find no seasonality among unwanted births. Prior seasonality-in-fertility research focuses on conditions at conception; here expected conditions at birth drive variation in maternal characteristics while conditions at conception are unimportant.

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Season of Birth and Later Outcomes: Old Questions, New Answers

There is enormous geographic variation in the use of cesarean delivery: For births over 2,500 grams, adjusted cesarean rates vary fourfold between low- and high-use areas. Even for births...

Geographic Variation In The Appropriate Use Of Cesarean Delivery

Research has found that season of birth is associated with later health and professional outcomes; what drives this association remains unclear. In this paper we consider a new explanation: that children born at different times in the year are conceived by women with different socioeconomic characteristics. We document large seasonal changes in the characteristics of women giving birth throughout the year in the United States. Children born in the winter are disproportionally born to women who are more likely to be teenagers and less likely to be married or have a high school degree. We show that controls for family background characteristics can explain up to half of the relationship between season of birth and adult outcomes. We then discuss the implications of this result for using season of birth as an instrumental variable; our findings suggest that, though popular, season-of-birth instruments may produce inconsistent estimates. Finally, we find that some of the seasonality in maternal characteristics is due to summer weather differentially affecting fertility patterns across socioeconomic groups.

This paper investigates the effect of the age difference between siblings (spacing) on educational achievement. We use a sample of women from the 1979 NLSY, matched to reading and math scores for their children from the NLSY79 Children and Young Adults Survey. OLS results suggest that greater spacing is positively associated with test scores for older siblings, but not for younger siblings. However, because we are concerned that spacing may be correlated with unobservable characteristics, we also use an instrumental variables strategy that exploits variation in spacing driven by miscarriages that occur between two live births. The IV results indicate that a one-year increase in spacing increases test scores for older siblings by about 0.17 standard deviations—an effect comparable to estimates of the effect of birth order. Especially close spacing (less than two years) decreases scores by 0.66 SD. These results are larger than the OLS estimates, suggesting that estimates that fail to account for the endogeneity of spacing may understate its benefits. For younger siblings, there appears to be no causal impact of spacing on test scores.

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Kasey Buckles

Papers

Season of Birth and Later Outcomes: Old Questions, New Answers

Geographic Variation In The Appropriate Use Of Cesarean Delivery

Season of Birth and Later Outcomes: Old Questions, New Answers

Birth Spacing and Sibling Outcomes

The effect of college education on mortality.