The transmission of inequalities over the lifecourse is persistent. Inequalities in health during early years are likely to reproduce themselves over time, leading to educational inequalities during childhood as well as social and economic inequalities during adulthood. In order to break the transmission of inequalities between and across generations, the Commission on the Social Determinants of Health calls for early actions, universal and progressive, which help those most in need and deal with the unfair distribution of power and resources within societies.
Within this framework, this research aims to cover different aspects of the complex relationships between education and health across the lifecourse in four developing countries: Ethiopia, India, Peru and Vietnam. In particular, the research focuses on the transmission of health inequalities during infancy into educational inequalities prior to school enrolment and seeks evidence for interventions that could potentially reduce the transmission of these inequalities over time. Two of such interventions are access to preventative health care services and increasing maternal education. These are two different interventions that lie at the health of policy arenas in developing countries.
In addition, the research takes a step forward by looking into the relationship between educational inequalities and health inequalities later in childhood. Here, the aim is to demonstrate whether differential degrees of educational inclusion are associated with a health gradient, hence leading to health inequalities. The focus is on whether the transmission of educational inequalities to health inequalities are accounted for lack of opportunities, or to put it differently social constraints, or personal circumstances meaning individuals’ decisions.
The project uses data from the Young Lives Longitudinal Study which collected information on children born between 2000 and 2001 and between 1994 and 1995 and who were living in deprived areas of Ethiopia, the state of Andhra Pradesh in India, Peru and Vietnam (refer to http://www.younglives.org.uk for more information). The Young Lives study has followed these children over time, collecting relevant information in 2002 and also in 2007, five years after the first round of data collection. The study design has enabled us to make the connections between health and education at different stages of childhood and use information from different interventions to investigate the closing or widening of inequality gaps over time.
Using different statistical approaches, the project estimates the following specific dimensions:
- The nature of the health disparities between children with differential access to education.
- The effect of preventative actions, such as antenatal care, during pregnancy on reducing the negative effects of malnutrition on cognitive development.
- The role of maternal education as a protective factor in the transmission of disadvantage across generations.
- A clear gradient in the nutritional status of children with different access to schooling - children with meaningful access show better level of nutritional status than their counterparts. A large proportion of the nutritional gap between children with differential access to education is explained by structural differences – which in our research are described by previous health status, household wealth status, parents’ education, previous access to school, and parental working condition. However, a proportion of the nutritional gap between children with differential access to education is explained by unobserved characteristics, which may be attributable to the protective effect of education on health outcomes.
Overall our results suggest the importance to improve access to education to reduce inequalities, the results especially underline the protective effect of schooling on child health.
- Good access to antenatal care is positively associated with child’s cognitive development in Ethiopia, Peru, and Vietnam. More importantly, the effect of nutritional deficiencies in the first months of life on subsequent cognitive development can in part be weakened if the mother had access to antenatal care services during pregnancy and birth (Peru and Vietnam). Overall, our results suggest a key role for early life interventions on reducing the transmission of inequalities over the lifecourse.
- Results confirm the protective role of maternal education on maternal mental health and child development. Women with more than six years of education are less likely to show a higher number of depressive symptoms, and have children with better outcomes on both nutritional and cognitive development status. Additionally the relationship between maternal mental illness and child growth and cognitive development was detected only in the group of less educated women
Overall our results suggest that maternal education plays a protective role not only on mothers’ and children’s general wellbeing but it is a key factor in reducing the transmission of disadvantage across generations.
The project was disseminated in three conferences and several organised meetings. In terms of conferences, results from this project were presented at the SLLS Developments and Challenges in Longitudinal Studies from Childhood on the 22nd to 24th September 2010 in Clare College, Cambridge, UK. We also presented at the International Conference for the British Psychological Society in November 2010, Never Too Early, Never Too Late: Learning For Life at Milton Keynes, UK. We also presented at the London School of Education during the Reproductive Morbidity and Poverty Workshop Announcement in November 2010. We attended organised meetings by the Young Lives team in Oxford and the Global Health group of the University of Sussex during 2011. Meetings at the London School of Economics and at the University of Sussex were attended by NGOs and policymakers.
This project is intended to provide further evidence on the research themes of the Commission on the Social Determinants of Health. Health inequalities arise because of the circumstances in which people live, work and age and the systems put in place to deal with these life events. Unless one deals with these issues, health inequalities will continue to persist across generations.
For more information, please refer to the project website.