Does Less Education Harm Health? Evidence from a Natural Experiment in a Developing Country

Khalil, Islam and Mallick, Debdulal and Nicholas, Aaron (2023): Does Less Education Harm Health? Evidence from a Natural Experiment in a Developing Country.

Abstract

We investigate the health outcome effects of a reduction in years of schooling in Egypt in 1988, a policy change that moves in the opposite direction in relation to the extant literature. We exploit this policy change as a natural experiment and employ a fuzzy regression discontinuity design to investigate a wide range of objectively measured health outcomes and behaviors. Despite the policy’s adverse effect on students’ years of schooling and ability to complete educational milestones, there is no effect on any health outcomes. Results also suggest that the reduction in years of schooling had no effect on labor market outcomes, thus providing a rationale for the lack of effect on health outcomes. Our results raise the possibility of a threshold model for understanding the relationship between education and health: while improvements in education may improve health, the inverse need not be true.

• Item Type: MPRA Paper
• Language: English
• Keywords: Education; Health; Natural experiment; Fuzzy regression discontinuity
• Subjects: C - Mathematical and Quantitative Methods > C9 - Design of Experiments > C99 - Other; I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I2 - Education and Research Institutions > I20 - General

References

Abdel-kareem, Noha (2009), “Sun'a Alqarar fi Assyasat Al‐taelimiah: Al'atraf Al‐faeilah Walaliat [Decision‐Making in Educational Policy: Actors and Mechanisms],” Al-Dar Al‐Masriah Al‐Lubnaniah, Cairo, Egypt.

Adjiwanou, Vissého, Moussa Bougma and Thomas LeGrand (2018), “The Effect of Partners' Education on Women's Reproductive and Maternal Health in Developing Countries,” Social Science & Medicine, 197, 104-115.

Alderman, Harold, Jere R Behrman, Victor Lavy and Rekha Menon (2001), “Child Health and School Enrollment: A Longitudinal Analysis,” Journal of Human Resources, 36 (1), 185-205.

Ali, Fatma Romeh M. and Mahmoud A. A. Elsayed (2018), “The Effect of Parental Education on Child Health: Quasi‐Experimental Evidence from a Reduction in the Length of Primary Schooling in Egypt,” Health Economics, 27 (4), 649-662.

Ali, Fatma Romeh M and Shiferaw Gurmu (2018), “The Impact of Female Education on Fertility: A Natural Experiment from Egypt,” Review of Economics of the Household, 16 (3), 681-712.

Assaad, Ragui, Abdurrahman Aydemir, Meltem Dayioglu and Guray Kirdar (2016), “Returns to Schooling in Egypt,” Economic Research Forum Working Paper No. 1000, Cairo, Egypt.

Assaad, Ragui, Deborah Levison and Hai-Anh Dang (2010), “How Much Work is too Much? Effects of Child Work Hours on Schooling–the Case of Egypt,” in Akee, Randall, Eric Edmonds and Kostantinos Tatsiramos, eds., Child Labor and the Transition between School and Work, 53-97, Emerald, Bingley.

Behrman, Jere R, Hans-Peter Kohler, Vibeke Myrup Jensen, Dorthe Pedersen, Inge Petersen, Paul Bingley and Kaare Christensen (2011), “Does More Schooling Reduce Hospitalization and Delay Mortality? New Evidence Based on Danish Twins,” Demography, 48 (4), 1347-1375.

Braakmann, Nils (2011), “The Causal Relationship between Education, Health and Health Related Behaviour: Evidence from a Natural Experiment in England,” Journal of Health Economics, 30 (4), 753-763.

Bratti, Massimilano, Elena Cottini and Paolo Ghinetti (2022), “Education, Health and Health-Related Behaviors: Evidence from Higher Education Expansion,” Institute for the Study of Labour (IZA) Working Paper No. 15035, Bonn, Germany.

Braveman, Paula, Susan Egerter and David R Williams (2011), “The Social Determinants of Health: Coming of Age,” Annual Review of Public Health, 32 (1), 381-398.

Brunello, Giorgio, Daniele Fabbri and Margherita Fort (2013), “The Causal Effect of Education on Body Mass: Evidence from Europe,” Journal of Labor Economics, 31 (1), 195-223.

Calonico, Sebastian, Matias D. Cattaneo and Rocio Titiunik (2014), “Robust Nonparametric Confidence Intervals for Regression-Discontinuity Designs,” Econometrica, 82 (6), 2295-2326.

Carneiro, Pedro, Claire Crawford and Alissa Goodman (2007), “The Impact of Early Cognitive and Non-Cognitive Skills on Later Outcomes,” Centre for the Economics of Education, LSE, London, UK.

Case, Anne, Angela Fertig and Christina Paxson (2005), “The Lasting Impact of Childhood Health and Circumstance,” Journal of Health Economics, 24 (2), 365-389.

Clark, Damon and Heather Royer (2013), “The Effect of Education on Adult Mortality and Health: Evidence from Britain,” American Economic Review, 103 (6), 2087-2120.

Cutler, David M and Adriana Lleras-Muney (2010), “Understanding Differences in Health Behaviors by Education,” Journal of Health Economics, 29 (1), 1-28.

Dickson, Matt and Colm Harmon (2011), “Economic returns to education: what we know, what we don’t know, and where we are going—some brief pointers,” Economics of Education Review, 30 (6), 1118-1122.

Dursun, Bahadır, Resul Cesur and Naci Mocan (2018), “The Impact of Education on Health Outcomes and Behaviors in a Middle-Income, Low-Education Country,” Economics & Human Biology, 31, 94-114.

Elbadawy, Asmaa (2014), “Education in Egypt: Improvements in Attainment, Problems with Quality and Inequality,” Economic Research Forum Working Paper No. 854, Cairo, Egypt.

Elgharably, Ahmed, Asmaa I Gomaa, Mary ME Crossey, Peter J Norsworthy, Imam Waked and Simon D Taylor-Robinson (2017), “Hepatitis C in Egypt–Past, Present, and Future,” International Journal of General Medicine, 10, 1-6.

Etilé, Fabrice and Andrew M Jones (2011), “Schooling and Smoking among the Baby Boomers–An Evaluation of the Impact of Educational Expansion in France,” Journal of Health Economics, 30 (4), 811-831.

Fang, Hai, Karen N Eggleston, John A Rizzo, Scott Rozelle and Richard J Zeckhauser (2012), “The Returns to Education in China: Evidence from the 1986 Compulsory Education Law,” NBER Working Paper No. 18189, Cambridge, MA.

Filmer, Deon and Lant H Pritchett (2001), “Estimating Wealth Effects without Expenditure Data—Or Tears: An Application to Educational Enrollments in States of India,” Demography, 38 (1), 115-132.

Freedman, Vicki A, Linda G Martin, Robert F Schoeni and Jennifer C Cornman (2008), “Declines in Late-Life Disability: The Role of Early-and Mid-Life Factors,” Social Science & Medicine, 66 (7), 1588-1602.

Fuchs, Victor R (1982), “Time Preference and Health: An Exploratory Study,” in Fuchs, Victor R., ed., Economic Aspects of Health, 93-120, University of Chicago Press, Chicago.

Glied, Sherry and Adriana Lleras-Muney (2003), “Health Inequality, Education and Medical Innovation,” NBER Working Paper No. 9738, Cambridge, MA.

Goldman, Dana P and James P Smith (2002), “Can Patient Self-Management Help Explain the SES Health Gradient?” Proceedings of the National Academy of Sciences, 99 (16),10929-10934.

Grossman, Michael (1972), “On the Concept of Health Capital and the Demand for Health,” Journal of Political Economy, 80 (2), 223-255.

Hamad, Rita, Holly Elser, Duy C Tran, David H Rehkopf and Steven N Goodman (2018), “How and Why Studies Disagree about the Effects of Education on Health: A Systematic Review and Meta-Analysis of Studies of Compulsory Schooling Laws,” Social Science & Medicine, 212, 168-178.

Harmon, Colm, Hessel Oosterbeek and Ian Walker (2003), “The returns to education: Microeconomics,” Journal of Economic Surveys, 17 (2), 115-156.

Hansen, Bent and Samir Radwan (1982), “Employment Planning in Egypt: An Insurance Policy for the Future,” International Labour Review, 121, 535.

Huang, Wei (2015), “Understanding the Effects of Education on Health: Evidence from China,” Institute for the Study of Labour (IZA) Working Paper No. 9225, Bonn, Germany.

Imbens, Guido W and Thomas Lemieux (2008), “Regression Discontinuity Designs: A Guide to Practice,” Journal of Econometrics, 142 (2), 615-635.

Jacob, Robin, Pei Zhu, Marie-Andrée Somers and Howard Bloom (2012), “A Practical Guide to Regression Discontinuity,” MDRC, New York.

Lee, David S and David Card (2008), “Regression Discontinuity Inference with Specification Error,” Journal of Econometrics, 142 (2), 655-674.

Lleras-Muney, Adriana (2005), “The Relationship between Education and Adult Mortality in the United States,” Review of Economic Studies, 72 (1), 189-221.

Lochner, Lance (2011), “Nonproduction Benefits of Education: Crime, Health, and Good Citizenship,” in Wolter, Stefan C. and Paul Ryan, eds., Handbook of the Economics of Education, 183-282, Elsevier, Amsterdam, The Netherlands.

Meara, Ellen R, Seth Richards and David M Cutler (2008), “The Gap Gets Bigger: Changes in Mortality and Life Expectancy, by Education, 1981–2000,” Health Affairs, 27 (2), 350-360.

Miech, Richard Allen and Michael J Shanahan (2000), “Socioeconomic Status and Depression over the Life Course,” Journal of Health and Social Behavior, 41 (2), 162-176.

Ministry of Health and Population [Egypt], El-Zanaty and Associates [Egypt] and ICF International (2015), Egypt Demographic and Health Survey 2014, (Cairo, Egypt; Rockville, Maryland, USA).

Montez, Jennifer Karas and Esther M Friedman (2015), “Educational Attainment and Adult Health: Under What Conditions Is the Association Causal?” Social Science & Medicine, 127, 1-7.

OAMDI, 2019a. Egypt Labor Market Panel Surveys (ELMPS), http://erf.org.eg/data-portal/, Version 2.0 of Licensed Data Files; ELMPS 2018. Egypt: Economic Research Forum.

OAMDI, 2019b. Harmonized Labor Force Surveys (HLFS), http://erf.org.eg/data-portal/, Version 1.0 of Licensed Data Files; LFS 2017- Central Agency for Public Mobilization and Statistics, Egypt: Economic Research Forum.

Powdthavee, Nattavudh (2010), “Does Education Reduce the Risk of Hypertension? Estimating the Biomarker Effect of Compulsory Schooling in England,” Journal of Human Capital, 4 (2), 173-202.

Rosenzweig, Mark R and T Paul Schultz (1982), “The Behavior of Mothers as Inputs to Child Health: The Determinants of Birth Weight, Gestation, and Rate of Fetal Growth,” in Fuchs, Victor R., ed., Economic Aspects of Health, 53-92. University of Chicago Press, Chicago.

Rutstein, Shea (1999), “Wealth Versus Expenditure: Comparison between the DHS Wealth Index and Household Expenditures in Four Departments of Guatemala,” ORC Macro, Calverton, Maryland.

Rutstein, Shea O and Kiersten Johnson (2004), “The DHS Wealth Index. DHS Comparative Reports No. 6,” ORC Macro, Calverton, Maryland.

Salehi-Isfahani, Djavad, Nadia Belhaj Hassine and Ragui Assaad (2014), “Equality of Opportunity in Educational Achievement in the Middle East and North Africa,” The Journal of Economic Inequality, 12 (4), 489-515.

Silles, Mary A. (2009), “The Causal Effect of Education on Health: Evidence from the United Kingdom,” Economics of Education Review, 28 (1), 122-128.

Stock, James H., Jonathan H. Wright, and Motohiro Yogo (2002), “A Survey of Weak Instruments and Weak Identification in Generalized Method of Moments,” Journal of Business & Economic Statistics, 20 (4), 518-529.

WHO, World Health Organization (2014), Global Status Report on Noncommunicable Diseases 2014, World Health Organization.

Xie, Shiqing and Taiping Mo (2014), “The Impact of Education on Health in China,” China Economic Review, 29, 1-18.