Child health and human capital.

• Author: Currie, Janet
• Position: Research Summaries

When economists use the phrase "human capital" it generally means "education." But one's health can also be viewed as a form of capital. Both education and health are strongly influenced by "family background" which is commonly measured using parent's education and income. Much of my research over the past decade seeks to evaluate the effect of public programs designed to improve the outcomes of children from disadvantaged backgrounds. In my forthcoming book, The Invisible Safety Net: Protecting the Nation's Poor Children and Families, I argue that while the cash welfare system receives more attention, elements of a largely invisible safety net of in-kind programs have proven remarkably effective in improving the lives of poor children. (1)

Intervention Programs

For example, my work with Eliana Garces and Duncan Thomas shows that Head Start (a pre-school intervention for poor children) improves long-term outcomes for disadvantaged children, although it does not bring these children up to the level of their more advantaged peers. Using a special supplement to the Panel Study of Income Dynamics, we ask whether children who attended Head Start had better outcomes (on a range of measures) than their own siblings who did not attend. We find that among whites, children who attended Head Start were about 25 percent more likely to have completed high school than their siblings who did not. Among African-Americans, the Head Start children were half as likely to have been booked or charged with a crime. This is the first study to show a lasting effect of Head Start. (2)

Still, programs like Head Start remain "black boxes" in that we know little about exactly why they work. It is possible that much of the beneficial effect of Head Start is not through explicitly educational interventions but rather through mandates to improve nutrition, link families with community services, and increase utilization of preventive health care. (3)

Head Start's emphasis on getting children into care remedies an important limitation of programs that focus primarily on extending health insurance via such programs as Medicaid or the State Child Health Insurance Program (SCHIP). Lack of health insurance remains an important issue, but is not the major determinant of child health. One reason is that providing eligibility for health insurance does not always lead people to use care appropriately. In a broader review of the "take up" of social programs, I discuss the low take-up rate among individuals eligible for public health insurance; this is an important social problem that reduces the use of preventive care and may increase the use of expensive palliative care. (4)

SES and Child Health

Maternal education is one important determinant of take-up and of other health behaviors. However, it has been difficult to demonstrate this relationship empirically because maternal education is a choice. To tackle this problem, Enrico Moretti and I compiled data on openings of two- and four-year colleges between 1940 and 1990. We used data about the availability of colleges in the woman's county of residence in her seventeenth year as an instrument for her education at the time of her child's birth. We found that higher maternal education does improve infant health, as measured by birth weight and gestational age. It also increases the probability that a new mother is married, reduces parity (birth order), increases use of prenatal care, and reduces smoking, thus suggesting that these are important pathways for the ultimate effect on health. (5)

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