The Effects of Education Quantity and Quality on Child and Adult Mortality: Their Magnitude and Their Value

Abstract

This chapter analyzes the economic returns to education investments from a health perspective. It estimates the effects of education on under-five mortality, adult mortality, and fertility. It calculates the economic returns to education resulting from declines in under-five mortality and adult mortality, while considering the effects of education investments on income. It also develops policy-relevant recommendations to help guide education investments.Our study adds to the evidence that education is a crucial mechanism for enhancing the health and well-being of individuals. The relationship between education and health is bidirectional, because poor health could affect educational attainment (Behrman 1996; Case, Fertig, and Paxson 2005; Currie and Hyson 1999; Ding and others 2009). Historical findings in the education and health literature have highlighted the strong association between education and health. Recent literature has exploited natural experiments to provide causal evidence of the impact of education on health. Studies show that education plays a critical role in reducing the transmission of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in women by improving prevention and treatment. Keeping adolescent girls in secondary school significantly attenuates the risk of HIV/AIDS infection (Baird and others 2012; Behrman 2015; De Neve and others 2015). Early child development has a lifelong impact on the mental and physical health of individuals. Other studies have demonstrated that progress in education can increase positive health-seeking behaviors (such as accessing preventive care) and reduce overall dependency on the health system (Cutler and Lleras-Muney 2010; Feinstein and others 2006; Kenkel 1991; Sabates and Feinstein 2006).Previous literature on education, health, and economic productivity suggests that the impact of education is more significant in times of rapid technological progress (Preston and Haines 1991; Schultz 1993). The morbidity and mortality differentials across levels of schooling are significant in the presence of increasing scientific knowledge about diseases and behaviors, as well as access to medicines and vaccines. Additionally, analysis by Jamison, Murphy, and Sandbu (2016) shows that most variation in under-five mortality can be explained by heterogeneities in the speed at which countries adopt low-cost health technologies to increase child survival.Different studies that have assessed the effects of education on mortality and fertility show an association between educational attainment and reductions in both outcomes. This chapter goes beyond previous work by using improved and updated data, and by controlling tightly for country-specific effects in both levels and rates of change of mortality. Although several studies have examined the effects of female schooling on child mortality, we are aware of only one other cross-national study (Wang and Jamison 1998) that estimated the macro effects of schooling on adult mortality. Other studies have focused on the relationship between schooling and adult health, but they primarily do so for a single country or small set of countries. Some key findings from our study are highlighted in box 30.1.Our study comes at a critical juncture for education and health, as the global community moves forward in the context of the Sustainable Development Goals, which stress the importance of taking into account the cross-sectoral nature of global development challenges.This chapter is organized into three broad sections: The first section presents the results of our regression analysis, which examines the effects of increases in mean years of schooling, as well as schooling quality, on under-five mortality, adult female mortality, adult male mortality, and fertility. We also decompose the changes in mortality between 1970 and 2010, and estimate the mortality impact of education gains in the Millennium Development Goal (MDG) period. The findings from our regression inform the subsequent sections, which use the estimated effect size to determine the rates of return to and benefit-cost ratios (BCRs) of education. The second section explores the effects of augmenting the traditional rates of return analysis for education with its mortality-related health effects. We also estimate the BCR of education from earnings-only and health-inclusive perspectives, and address the question: What would be the returns to investing US$1 in education in low-, lower-middle-, and upper-middle-income countries? Finally, we discuss our findings, present recommendations, and consider the next steps the global education community might take to ensure that all countries make substantial progress toward global education targets.