HEALTH AND EDUCATION

The twentieth century saw extraordinary and dramatic improvements in human health. Life expectancy more than doubled, with most of the increase within the century's second fifty years. Improved income, higher levels of education, more and better food, better sanitation, public sewage systems, and new knowledge underpin these gains. This entry focuses on the effect of male and female education levels within the context of this broader range of determinants. The general discussion is illustrated with a more specific treatment of the child mortality rate across countries for the three decades from 1960 to 1990. Child mortality rate is defined as the number of deaths per 1,000 live births between birth and exact age five years; at the start of the twenty-first century the rate varies from less than 10 per thousand for high income countries to over 200 in some poor countries.

Education level has been constantly found to be related to the health status at the levels of individual, household, and country, usually with a stronger effect than that of income. Based on Jia Wang and Dean Jamison's 1997 estimations, one additional year of education for the female population can avert six deaths per thousand in child mortality rates. John Peabody and colleagues found that child mortality rates in 1993 and 1994 Bangladesh varied across the mothers' education level: 134 deaths per thousand for mothers with some primary education; 105 for mothers who completed primary education; and 90 for mothers with secondary or higher education.

In consequence, one way governments can improve health is to expand investment in schooling, particularly for girls. The World Bank's 1993 World Development Report concluded that education increases the opportunities for households, particularly for mothers, to seek access to information and to make better use of the financial resources to shape the diets, fertility, health care, and other lifestyle choices that have a crucial impact on the health of household members. Children's health is affected much more by the mother's education level than the father's. Educated mothers tend to marry and start families later, factors that diminish the child health risk associated with early pregnancies. Educated mothers are also more likely to use preventive care and delivery assistance, maintain better household hygiene, seek immunization more frequently, and have better use of medical services. According to the World Bank study, a 10 percent increase in female literacy rates in thirteen African countries in the period of 1975 through 1985 reduced child mortality rates by 10 percent, while a 10 percent increase in male literacy rates had little to no effect in decreasing child mortality (p. 42).

To give a sense of the methods and recent results of analyses of education's impact at the country level, it may be valuable to provide a brief illustration. Improved data sets now exist that include the following variables on individual countries at different points in time:

• Child mortality rates for all children, for girls, and for boys
• Real gross domestic product (GDP) per capita adjusted for purchasing power parity, expressed in 1985 U.S. dollars
• Education level for the female population and for the male population, calculated as the average number of years of education for the population aged 15 and over, according to Robert Barro and Jong-Wha Lee.

These variables are measured at a five-year interval for the period of 1960 though 1990 and they are available for 94 countries. The average years of education for the female and male population are 4 and 4.9 years for the period of 1960 to 1990. The mean child mortality rate is 75 deaths per 1,000 live births for boys, 69 deaths for girls, and 63 for both boys and girls. The income per capita has a mean of $2,368.

Education, income, and time (as a proxy for technical progress) are used by Anthony Bryk and Steve Raudenbusch as determinants of child mortality measures using hierarchical linear modeling (HLM). Jamison and Wang's 2001 study gives detailed information on data and methodology.

Three sets of analyses, with male education, female education, and both female and male education levels as the education measure, were done to assess gender differences in the effect of education on child mortality. Jamison and Wang found that an additional year of male education level is associated with a 3 to 4 percent reduction in child mortality. But the magnitude of the effect is statistically insignificant, whether it is child mortality for the whole population, for girls only, or for boys only. Female education level, on the other hand, has a statistically significant effect on all three measures of child mortality rates. The effect is about a 10 to 11 percent reduction in child mortality. Interestingly when the effect of time (or technical progress) is allowed to be country-specific the estimated effects of income and education on child mortality decline. That said, there is historical evidence to suggest that prior to major gains in medical science in the twentieth century, education had much less of an effect on mortality than today. The effects of new knowledge and of education appear to work together to contribute to the decline in child mortality.

This example confirms the existing literature on health and education in finding that higher education levels are associated with better health. A more careful look, however, finds that female education level has a much stronger effect in reducing child mortality rates than male education level, independent of whether it is the child mortality for boys only, for girls only, or for both.

See also: Gender Issues, International; International Development Agencies and Education, subentry on UN and InternationalAgencies.

bibliography

Barro, Robert, and Lee, Jong-Wha. 1996. "International Measures of School Years and Schooling Quality." American Economic Review: AER Papers and Proceedings 86: 218–223.

Behrman, Jere R. 1996. Human Resources in Latin America and the Caribbean. Baltimore, MD: Inter-American Development Bank/Johns Hopkins University Press.

Bryk, Anthony S., and Raudenbush, Steve W. 1992. Hierarchical Linear Models. Newbury Park, CA: Sage.

Cochrane, Susan H. ; Leslie, Joanne; and O'Hara, Donald J. 1982. "Parental Education and Child Health, Intracountry Evidence." Health Policy and Education 2: 213–250.

Elo, Irma, and Preston, Samuel H. 1996. "Educational Differences in Mortality: United States, 1979–1985." Social Science and Medicine 42: 47–57.

Jamison, Dean T., and Wang, Jia. 2001. "Education Inequity and Shortfalls in Female Life Expectancy." Paper presented at the 28th Global Health Council Conference, May 29 to June 1, Washington DC.

Jamison, Dean T. ; Wang, Jia; Hill, Kenneth; and Londono, Juan-Luis. 1996. "Income, Mortality and Fertility in Latin America: Country-Level Performance, 1960–90." Analisis Economico 11 (2):219–261.

Peabody, John, et al. 1997. Policy and Health: Implications for Development in Asia. Cambridge, Eng.: Cambridge University Press.

Preston, Samuel H., and Haines, Michael R. 1991. Fatal Years: Child Mortality in Late-Nineteenth-Century America. Princeton, NJ: Princeton University Press.

Pritchett, Lant, and Summers, Lawrence H. 1996. "Wealthier Is Healthier." Journal of Human Resources 31 (4): 841–868.

Wang, Jia; Jamison, Dean. T. ; Bos, Eduard; and Vu, My Thi. 1997. "Poverty and Mortality among the Elderly: Measurements of Performance in Thirty-Three Countries, 1960–1992." Tropical Medicine and International Health 2 (10):1001–1010.

World Bank. 1993. Investing in Health: World Development Report. Washington, DC: Oxford University Press for The World Bank.

Jia Wang

Dean T. Jamison