Pathways Between Education and Health: a Causal Modelling Approach

1
Pathways Between Education and Health a Causal
Modelling Approach Tarani Chandola
(UCL) Paul Clarke (Imperial) David Blane
(Imperial) Jerry Morris (London School of
Hygiene)
An ESRC funded project
2
ORs of long standing illness by education -
adjusting for deprivation (men)

• Degree 0.69 (0.56, 0.85)
• Below degree 0.78 (0.64, 0.97)
• A level 0.94 (0.77, 1.15)
• GCSE 5 A-C 0.95 (0.77, 1.16)
• GCSE 1- 4 A-C 0.76 (0.58, 0.99)
• GCSE D-G 1.03 (0.85, 1.26)
• None 1

White I, Blane D, Morris J, Mourouga P.
Educational attainment, deprivation-affluence and
self-reported health in Britain a
cross-sectional study. J.Epidemiol.Community
Health
3
Previous literature on education and health Ross
and Wu (1995) American Sociological Review The
links between education and health education soc
ial support/sense of control health education
healthy behaviours health education better
jobs/higher incomes health But the models test
the hypothesis education social
support control health healthy
behaviours better jobs higher incomes
4
Why do we need to test the intervening causal
pathways? 1. Erroneous conclusions Multiple
Measures of Socioeconomic Position and
Psychosocial Health Proximal and Distal Effects
A Singh-Manoux, P Clarke, M Marmot IJE (2002)

5
Why is this important (continued)? 2. Policy
relevance What is the appropriate level of
intervention for policies on reducing
inequalities in health? we need to
test for direct and indirect effects
6

• Why study Education and Health?
• Education directly affects health later on in
  life
• Policy
• Intelligence is the fundamental cause of social
  inequalities in health

7
Mechanisms1. Intelligence
Educational performance
Intelligence
Adult health
8
Mechanisms2. Health Behaviours
Healthy Behaviours
Education
Receptivity to health education messages
Health
9
Mechanisms3. Parental Social Class
Educational attainment of off-spring
Parental socio- economic position
Off-springs adult health
10
OR3. Parental Social Class
Parental socio- economic position
Educational attainment of off-spring
Off-springs adult health
11
Mechanisms4. Adult Social Class
Adult socio- economic position
Education
Adult health
12
OR4. Adult Social Class
Adult socio- economic position
Adult health
Education
13
Mechanism4. Sense of Control
Educational attainment
Sense of Control
Adult health
14
Mechanisms5. Childhood Health
Educational performance
Child health
Adult health
15
OR5. Childhood Health
Child health
Educational performance
Adult health
16

17

18
Data The National Child Development Study
(NCDS) is a continuing, multi-disciplinary
longitudinal study which takes as its subjects
all those living in Great Britain who were born
in the week between 3 and 9 March 1958. Following
the initial 1958 survey, there have been six
attempts to trace all members of the birth cohort
to monitor their physical, educational and social
development. These were carried out in 1965 (at
age 7, 1969 (age 11), 1974 (age 16), 1981 (age
23), 1991 (age 33) and 1999 (age 42). 17,416
babies 10,979 adults at age 42
19
Variables Measurement models for adult health
status, adolescent health status, health
behaviours and sense of control
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
Variables Education a six category ordinal
measure of increasing academic or vocational
qualifications from no qualifications to degree
level or higher. Childhood social class
(fathers social class at age 7, supplemented by
fathers social class at birth if missing) and
Adult social class (at age 33) were measured by
the Registrar Generals social classification- an
ordinal measure ranging from 1 (professional
occupations) to 6 (manual unskilled occupations).
Intelligence Childhood cognitive ability (at
age 7) was measured by maths and reading tests (a
higher score indicates greater ability).
24
Scatterplot of the association between
Educational Qualifications (age 23) and General
Self-Rated Health (age 42)
25
Bivariate Associations with Adult Health- Men
26
Bivariate Associations with Adult Health- Women
27
Direct Effects on Adult Health- Men
28
Direct Effects on Adult Health- Women
29
Indirect Effects on Adult Health- Men
30
Indirect Effects on Adult Health- Men
31
Indirect Effects on Adult Health- Women
32
Indirect Effects on Adult Health- Women
33

• Whats new?
• No direct effect of education on health
• Intelligence is not the fundamental cause of
  social inequalities in health
• Policy interventions need to focus on adolescent
  health, healthy behaviours and psychosocial
  factors

34
Some Policy Initiatives
35

• Limitations
• Missing data and drop out
• Measures of health
• Lack of details on mechanisms
• Cohort specific results

36
(No Transcript)