How does educational achievement impact on health and health inequalities? An analysis of trajectories to inform policy options and development

Lead investigator

Professor Catherine Law, Institute of Child Health, UCL

Background

Education is thought to be a major mechanism through which health inequalities are generated and maintained, including across generations. Improving educational achievement is seen as a policy mechanism for addressing inequalities and improving life chances of disadvantaged children. However, there is limited evidence documenting the association between cognitive ability/educational achievement and health throughout childhood and adolescence.

Aims and methods

To investigate the association between cognitive ability/educational achievement and health during childhood and early adolescence.
To examine the extent to which intervening on educational achievement in childhood might improve health and reduce health inequalities in childhood and adolescence, and potentially across the life course.

Analysis of the Millennium Cohort Study (MCS), a nationally-representative sample of children born at the turn of the century, with data collected up to 14 years. MCS includes numerous measures of educational achievement and/or cognitive ability (assessed using formal school tests and objective measures), health and health behaviours, and socio‐economic circumstances.

Analyses focused on three objectives: 1) to examine associations between educational achievement/ability and health, cross‐sectionally and longitudinally; 2) to estimate the impact that interventions to improve educational ability might have on population level health (population attributable risk); 3) to simulate impacts of interventions (designed to improve educational achievement and/or ability) on health inequalities in children and adolescents using advanced mediation methods.

Contribution

Education is promoted by policy makers as a way to improve life success and reduce the transmission of disadvantage from one generation to the next. However, educational achievement and/or ability is likely to have more immediate benefits for children and adolescents, including on their health and health behaviours.

This analysis would inform policy options and development through clarifying the causal pathways between educational achievement and/or ability (represented by school readiness, cognitive tests and key stage assessment) and child and adolescent health, allowing us to investigate associations and then simulate interventions which would be impossible to trial in the real world.

First, this project would assess the age at which links between a child’s educational achievement and/or ability and health become established and so indicate when in a child’s life intervention (e.g. enhanced education input, better treatment of mental ill‐health) might be most effective. Second, it would identify educational risk factors for later adverse health outcomes (including health behaviours), and how many children have them and in what combination. Third, it would estimate the relative contributions of early life socio‐economic circumstances and educational achievement and/or ability to poor health (and health inequalities) in childhood and adolescence. This would inform policy decisions on how and how much education and school‐based interventions can compensate for material disadvantage earlier in life and/or in the home and wider environment. This in turn might focus policy development on the most efficient way to promote child and adolescent health and reduce health inequalities through tackling social determinants of health.

This project is linked to the PHRC project “Evaluating the impacts of policies on child health inequalities: How best can we exploit the predictive value of the integrated pre-school checks?” headed by Professor Margaret Whitehead.

Co-investigators

Margaret Whitehead, University of LiverpoolDavid Taylor-Robinson, University of Liverpool
Anna Pearce, Institute of Child Health, UCL
Steven Hope, Institute of Child Health, UCL
Russell Viner, DH Children’s Policy Research Unit, UCL

Duration: 01/01/2017 – 31/03/2018 (15 months)