Education and Health: Redrawing the Preston Curve

Exploring health outcome disparities in African regional economics communities: a multilevel linear mixed-effect analysis

BACKGROUND

In African Regional Economic Communities (RECs), notable and enduring disparities exist in health outcomes. This study investigates the impact of macro-level characteristics of countries on health outcomes disparities within the African Regional Economic groupings. The study used panel data from the World Bank Development Indicators (WDI) and the Worldwide Governance Indicators (WGI), spanning 37 African countries, grouped into eight RECs between 2000 and 2019. We employed infant and under-five mortality rates and life expectancy at birth as indicators of health outcomes.

METHOD

The study used a multilevel linear (ML) mixed-effect approach to examine the influence of country-level factors on health outcome disparities within the eight African RECs recognized by the African Union.

RESULTS

The findings show that higher unemployment rates and HIV incidence exacerbate these disparities, while a growing elderly population and improved access to basic drinking water can mitigate them. Increased internet usage correlates with higher within-regional inequalities in child mortality rates but reduces disparities in life expectant at birth. Urbanization trends contribute to lower-intra-regional inequality in infant mortality rates and life expectancy at birth. Higher domestic government health expenditure as a share of general government spending is linked to reduced disparities in under-five and infant mortality rates. Still, it increases inequalities in life expectancy at birth within the regional groupings. Moreover, a higher proportion of the population below 15 years old and trade gains positively influence regional disparities in life expectancy. Conversely, DTP immunization coverage among children aged 12-23 months is associated with higher within-regional inequality in infant mortality rates.

CONCLUSIONS

Polices aimed at reducing unemployment rates and HIV incidence should be prioritized. In addition, governments should invest in elderly care programs and infrastructure development for water supply. Efforts to promote internet access should be complemented by interventions to enhance child health and healthcare accessibility. Encouraging urban planning policies that prioritize developing healthcare infrastructure and facilitating healthcare access in urban areas is crucial. Furthermore, Governments should increase their health expenditure allocation in general government spending. Promoting strategies to enhance healthcare access and quality for specific demographics, alongside leveraging trade gains to invest in healthcare infrastructure and services, is imperative. Targeted interventions ensuring equitable access to immunization services should also be emphasized.

Post-growth: the science of wellbeing within planetary boundaries

There are increasing concerns that continued economic growth in high-income countries might not be environmentally sustainable, socially beneficial, or economically achievable. In this Review, we explore the rapidly advancing field of post-growth research, which has evolved in response to these concerns. The central idea of post-growth is to replace the goal of increasing GDP with the goal of improving human wellbeing within planetary boundaries. Key advances discussed in this Review include: the development of ecological macroeconomic models that test policies for managing without growth; understanding and reducing the growth dependencies that tie social welfare to increasing GDP in the current economy; and characterising the policies and provisioning systems that would allow resource use to be reduced while improving human wellbeing. Despite recent advances in post-growth research, important questions remain, such as the politics of transition, and transformations in the relationship between the Global North and the Global South.

Forecasting Africa's fertility decline by female education groups

While female education has long been recognized as a key driver of fertility decline during the process of demographic transition and most population projection models consider it implicitly or explicitly in their forecasts of overall fertility, there still is need for a method to forecast education-specific fertility trends directly. Here we propose a method for projecting education-specific fertility declines for cohorts of women in Sub-Saharan Africa based on all available demographic and health surveys data for African countries (including 1.03Mio cases). We study at different levels of aggregation (sample clusters, strata, and national) the associations between ideal family size and completed cohort fertility for education groups, on the one hand, and the average level of education in those units, on the other. The consistently very strong empirical associations suggest a plausible narrative by which a higher prevalence of educated women in a spatial unit influences the fertility levels of women in all specific education categories. Empirical associations between education-specific cohort fertility trends at the national level and newly available quality-adjusted human capital data for these cohorts are then operationalized to produce education-specific population projections as they are needed for-among other uses-the shared socioeconomic pathways scenarios that are widely used in the climate change research community. Sensitivity analyses including out-of-sample projections support the validity of the proposed method which is then applied to 37 African countries.

Exploration of Geographical Environmental Factors Influencing Regional Population Mortality Patterns in China

OBJECTIVES

The regional population mortality patterns in China exhibit substantial geographical distribution characteristics. This paper aims to explore the impact and mechanisms of geographical environmental factors on regional population mortality patterns.

METHODS

This study first utilized the data from China's Seventh Population Census to obtain mortality patterns for the 31 provincial-level administrative regions. Subsequently, a functional regression method was employed to explore the geographical environmental driving factors of regional mortality patterns.

RESULTS

The study provides a detailed explanation of the mechanisms and marginal contributions of key geographical environmental factors at different age groups.

CONCLUSIONS

(1) The impact of geographical environmental factors on mortality patterns shows distinct phased characteristics. Mortality patterns before the age of 40 years are hardly influenced by geographical environmental factors, with a noticeable impact beginning at ages 40-69 years and reaching the maximum influence after the age of 70 years. (2) In mortality patterns at ages 40-69 years, average altitude have the most substantial impact, followed by extreme low-temperature days and PM2.5 concentration. In mortality patterns at ages 70-94 years, high-temperature days have the greatest influence, followed by the impact of SO2 concentration. (3) In comparisons based on gender, socioeconomic factors, and geographical environmental factors, gender and urban-rural differences have the most significant impact on regional population mortality patterns, followed by the influence of other socioeconomic factors, with geographical environmental factors having a relatively smaller impact.

Provision of rehabilitation and assistive technology services in a low resource setting during the COVID-19 pandemic and introduction of telehealth: Service users' and providers' perspectives

The COVID-19 pandemic created a challenge for providing assistive technology (AT) and rehabilitation services, with many service providers implementing telehealth service provision for the first time. The objective of this study was to explore the experiences of people accessing and providing AT and rehabilitation services during the pandemic and to assess the implementation of telehealth service delivery at an assistive technology and rehabilitation center in India. A mixed-methods design, combining analysis of clinical data and semi-structured interviews, was utilized. A descriptive analysis of demographics and clinical characteristics of service users accessing services through telehealth, or in-person mode was completed. In addition, service users were interviewed to explore their experiences of accessing services during the pandemic. Service providers were also interviewed to gather their opinions on telehealth service delivery during the pandemic. Findings showed that telehealth was an alternative tool in the pandemic for continuing to deliver services in a low-resource setting. However, not all types of services could be successfully delivered via telehealth. There are barriers to the delivery of telehealth services that need to be considered and addressed to allow successful implementation, and it is important to consider that telehealth consultations are not suitable for all service users.

Diminishing marginal returns and sufficiency in health-care resource use: an exploratory analysis of outcomes, expenditure, and emissions

BACKGROUND

Increasing health expenditure in low-income countries is associated with rapid gains in health status. Less attention has been paid to the possibility of diminishing marginal returns to health expenditure at high levels of spending, or to the relationship between health-care greenhouse gas emissions and outcomes. Our study aimed to investigate the existence, scale, and implications of diminishing marginal returns to health-care expenditure and emissions.

METHODS

Segmented (piecewise) regression analysis was used to explore the relationship between two measures of health outcome from the Global Burden of Disease project (mortality amenable to health care [MAH] and health-adjusted life expectancy [HALE]), four aggregates of health expenditure per capita from the WHO Global Health Expenditure Database, and health-care sector greenhouse gas emissions per capita derived from a 2020 study by Lenzen and colleagues. Turning point knots-points at which the elasticity or velocity of increasing returns to expenditure and emissions changed substantially-were estimated and countries in the vicinity of these knots identified.

FINDINGS

Rapidly increasing returns (improvements in population health as measured by MAH and HALE) to health expenditure were estimated in low-income and lower-middle-income countries; at levels of spending above approximately US$500 per capita, these returns start to slow. At levels of spending above those seen in high-income countries such as Italy (approximately US$3400), there is little or no evidence of further health returns to additional spending or to increasing health-care greenhouse gas emissions.

INTERPRETATION

Dramatic improvements in population health outcomes could be achieved by additional investment in health expenditure in low-income countries. Conversely, continuing growth in health expenditure in high-income countries will, by itself, be unlikely to yield rapid improvements in health outcomes. Our findings inform the emerging debate on the importance of sufficiency within planetary boundaries-low-income countries need rapid growth in health expenditure, whereas high-income countries could potentially achieve better health outcomes at substantially lower levels of resource use.

FUNDING

None.

Research on social and economic factors influencing regional mortality patterns in China

Regional population mortality correlates with regional socioeconomic development. This study aimed to identify the key socioeconomic factors influencing mortality patterns in Chinese provinces. Using data from the Seventh Population Census, we analyzed mortality patterns by gender and urban‒rural division in 31 provinces. Using a functional regression model, we assessed the influence of fourteen indicators on mortality patterns. Main findings: (1) China shows notable gender and urban‒rural mortality variations across age groups. Males generally have higher mortality than females, and rural areas experience elevated mortality rates compared to urban areas. Mortality in individuals younger than 40 years is influenced mainly by urban‒rural factors, with gender becoming more noticeable in the 40-84 age group. (2) The substantial marginal impact of socioeconomic factors on mortality patterns generally becomes evident after the age of 45, with less pronounced differences in their impact on early-life mortality patterns. (3) Various factors have age-specific impacts on mortality. Education has a negative effect on mortality in individuals aged 0-29, extending to those aged 30-59 and diminishing in older age groups. Urbanization positively influences the probability of death in individuals aged 45-54 years, while the impact of traffic accidents increases with age. Among elderly people, the effect of socioeconomic variables is smaller, highlighting the intricate and heterogeneous nature of these influences and acknowledging certain limitations.

Age-related decline of various cognitive functions in well-experienced male rats treated with the putative anti-aging compound (2R)-1-(1-benzofuran-2-yl)-N-propylpentane-2-amine ((-)BPAP)

Aging-associated cognitive disorders lack proper medication. To meet this need translation-wise, modification of the animal models is also required. In the present study, effect of the putative anti-aging compound (2R)-1-(1-benzofuran-2-yl)-N-propylpentane-2-amine ((-)BPAP, a deprenyl derivative) on age-related cognitive decline was investigated in experienced, aged Long-Evans rats. During their lifetime, animals had acquired knowledge in various cognitive assays. Their performance in these tests was then parallel followed from the age of 27 months until their death meanwhile half of them were treated with BPAP. Cognitive performance in various tasks showed different sensitivities/resistances to age-related impairment. Pot jumping performance (motor skill-learning) started to impair first, at 21 months of age, followed by decreasing performance in five-choice serial reaction time task (attention) at 26 months. Navigation performance in Morris water maze (spatial learning) started to decline at 31 months. Performance in a cooperation task (social cognition) started to decline the latest, at 34 months. Our findings suggest that in this process, the primary factor was the level of motivation to be engaged with the task and not losing the acquired knowledge. The average lifespan of the tested rat population was 36 months. BPAP could not improve the cognitive performance; neither could it prolong lifespan. A possible reason might be that dietary restriction and lifelong cognitive engagement had beneficial effects on cognitive capabilities and lifespan creating a "ceiling effect" for further improvement. The results confirmed that experienced animals provide a translationally relevant model to study age-related cognitive decline and measure the effect of putative anti-aging compounds.

Hormetic Effects of Phytochemicals with Anti-Ageing Properties

In the fields of biology and medicine, hormesis is defined as the adaptive response of cells and organisms to moderate and usually intermittent stress. Examples include radiation, pharmaceutical agents, as well as dietary and lifestyle factors such as calorie restriction and physical exercise. However, in the present chapter, we will focus on the hormetic role of certain phytochemicals, compounds that naturally occur in plants, playing roles in plant colour, flavour, and disease resistance, with nutraceutical properties. Indeed, these compounds exhibit health-promoting, disease-preventing, or medicinal properties, mostly through a hormetic mechanism.

NITEO: an innovative mental health and education program designed to reengage students with mental health conditions in college

Objective: The prevalence of mental health symptoms on university campuses is high and rising, resulting in detrimental effects on academic performance. Few resources exist to address the needs of students who must leave school for mental health reasons. Participants: Seeking to understand the effect of a college reentry program (NITEO) to assist students in reengaging with undergraduate studies, we conducted in-depth qualitative interviews with all college coaches (N = 5), triangulating our findings with interviews of NITEO students (N = 31). Methods: We used a rapid and focused ethnographic approach with thematic and content analysis using NVivo software. Results: Two major themes arose from our analyses affirming the role of the college coach in (1) developing a strong working alliance as a foundation for coaching; (2) promoting self-determination. Conclusions: Programs that enable students with mental health conditions who have dropped out to reenter college are needed; college coaching can be an effective approach.

Individuals Eligible for Lung Cancer Screening Less Likely to Receive Screening When Enrolled in Health Plans With Deductibles

BACKGROUND

In 2015, the Centers for Medicare & Medicaid Services and commercial insurance plans began covering lung cancer screening (LCS) without patient cost-sharing for all plans. We explore the impact of enrolling into a deductible plan on the utilization of LCS services despite having no out-of-pocket cost requirement.

METHODS

This retrospective study analyzed data from the Population-based Research to Optimize the Screening Process Lung Consortium. Our cohort included non-Medicare LCS-eligible individuals enrolled in managed care organizations between February 5, 2015, and February 28, 2019. We estimate a series of sequential logistic regression models examining utilization across the sequence of events required for baseline LCS. We report the marginal effects of enrollment into deductible plans compared with enrollment in no-deductible plans.

RESULTS

The total effect of deductible plan enrollment was a 1.8 percentage-point (PP) decrease in baseline LCS. Sequential logistic regression results that explore each transition separately indicate deductible plan enrollment was associated with a 4.3 PP decrease in receipt of clinician visit, a 1.7 PP decrease in receipt of LCS order, and a 7.0 PP decrease in receipt of baseline LCS. Reductions persisted across all observable races and ethnicities.

CONCLUSIONS

These findings suggest individuals enrolled in deductible plans are more likely to forgo preventive LCS services despite requiring no out-of-pocket costs. This result may indicate that increased cost-sharing is associated with suboptimal choices to forgo recommended LCS. Alternatively, this effect may indicate individuals enrolling into deductible plans prefer less health care utilization. Patient outreach interventions at the health plan level may improve LCS.

Spatiotemporal evolution and characteristics of worldwide life expectancy

Exploring global differences in life expectancy can facilitate the development of strategies to narrow regional disparities. However, few researchers have systematically examined patterns in the evolution of worldwide life expectancy over a long time period. Spatial differences among 181 countries in 4 types of worldwide life expectancy patterns from 1990 to 2019 were investigated via geographic information system (GIS) analysis. The aggregation characteristics of the spatiotemporal evolution of life expectancy were revealed by local indicators of spatial association. The analysis employed spatiotemporal sequence-based kernel density estimation and explored the differences in life expectancy among regions with the Theil index. We found that the global life expectancy progress rate shows upward then downward patterns over the last 30 years. Female have higher rates of spatiotemporal progression in life expectancy than male, with less internal variation and a wider spatial aggregation. The global spatial and temporal autocorrelation of life expectancy shows a weakening trend. The difference in life expectancy between male and female is reflected in both intrinsic causes of biological differences and extrinsic causes such as environment and lifestyle habits. Investment in education pulls apart differences in life expectancy over long time series. These results provide scientific guidelines for obtaining the highest possible level of health in countries around the world.

Growing old in China in socioeconomic and epidemiological context: systematic review of social care policy for older people

BACKGROUND

From 2020 to 2050, China's population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer's disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country.

METHODS

Using official and population-level statistics, we summarise China's demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China's improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: 'what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?'. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China's second long-term care insurance pilot phase in 2020.

RESULTS

Rapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home.

CONCLUSIONS

China has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.

Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans

Introduction

Multimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associations between race/ethnicity and socioeconomic status and these trajectories.

Methods

Data from 13,699 respondents (age ≥51) in the Health and Retirement Study between 1998 and 2016 were analyzed with growth mixture models. Nine prevalent self-reported morbidities (arthritis, cancer, cognitive impairment, depressive symptoms, diabetes, heart disease, hypertension, lung disease, stroke) were summed for the morbidity count.

Results

Three trajectories of morbidity accumulation were identified: low [starting with few morbidities and accumulating them slowly (i.e., low intercept and low slope); 80% of sample], increasing (i.e., low intercept and high slope; 9%), and high (i.e., high intercept and low slope; 11%). Compared to non-Hispanic (NH) White adults in covariate-adjusted models, NH Black adults had disadvantages while Hispanic adults had advantages. Our results suggest a protective effect of education for NH Black adults (i.e., racial health disparities observed at low education were ameliorated and then eliminated at increasing levels of education) and a reverse pattern for Hispanic adults (i.e., increasing levels of education was found to dampen the advantages Hispanic adults had at low education). Compared with NH White adults, higher levels of wealth were protective for both NH Black adults (i.e., reducing or reversing racial health disparities observed at low wealth) and Hispanic adults (i.e., increasing the initial health advantages observed at low wealth).

Conclusion

These findings have implications for addressing health disparities through more precise targeting of public health interventions. This work highlights the imperative to address socioeconomic inequalities that interact with race/ethnicity in complex ways to erode health.

Live and let live: understanding the temporal drivers and spillovers of life expectancy in Europe for public planning

The European continent has one of the longest life expectancies in the world, but still faces a significant challenge to meet the health targets set by the Sustainable Development Goals of the United Nations for 2030. To improve the understanding of the rationale that guides health outcomes in Europe, this study assesses the direction and magnitude effects of the drivers that contribute to explain life expectancy at birth across 30 European countries for the period 2008-2018 at macro-level. For this purpose, an aggregated health production function is used allowing for spatial effects. The results indicate that an increase in the income level, health expenditure, trade openness, education attainment, or urbanisation might lead to an increase in life expectancy at birth, whereas calories intake or quantity of air pollutants have a negative impact on this health indicator. This implies that health policies should look beyond economic factors and focus also on social and environmental drivers. The results also indicate the existence of significant spillover effects, highlighting the need for coordinated European policies that account for the synergies between countries. Finally, a foresight analysis is conducted to obtain projections for 2030 under different socioeconomic pathways. Results reveal significant differences on longevity projections depending on the adoption, or not, of a more sustainable model of human development and provides valuable insight on the need for anticipatory planning measures to make longer life-spans compatible with the maintenance of the welfare state.

Differential impact of maternal education on under-five mortality in rural and urban India

Under-five mortality rate (U5MR) differs by rural-urban place of residence and mother's education; however, the rural-urban gap in U5MR by mother's educational attainment is unclear in the existing literature. Using five rounds of the national family health surveys (NFHS I-V) conducted between 1992-93 and 2019-21 in India, this study estimated the main and interaction effects of rural-urban and maternal education on U5MR. The mixed effect Cox proportional hazard (MECPH) model was used to predict the risk of under-five mortality (U5M). The finding shows that unadjusted U5MR remained 50 per cent higher in rural areas than in urban areas across the surveys. Whereas, after controlling for demographic, socioeconomic, and maternal health care predictors of U5M, the MECPH regression results indicated that urban children had a higher risk of death than their rural counterparts in NFHS I-III. However, there are no significant rural-urban differences in the last two surveys (NFHS IV -V). In addition, increasing maternal education levels were associated with lower U5M in all surveys. Though, in recent years, primary education has had no significant effect. The U5M risk was additionally lower for urban children than rural children whose mothers had secondary and higher education by NFHS-III; however, this additional urban advantage was no longer significant in recent surveys. The higher impact of secondary education on U5MR in urban areas in the past may be attributed to poor socio-economic, healthcare conditions in rural areas. Overall, maternal education, particularly secondary education, remained a protective factor for U5M in both rural and urban areas, even after controlling for predictors. Therefore, there is a need to increase the focus on secondary education for girls for a further decline in U5M.

Health, income, and the preston curve: A long view

Well-being is increasingly viewed as a multidimensional phenomenon, of which income is only one facet. In this paper I focus on another one, health, and look at its synthetic measure, life expectancy at birth, and its relationship with per capita income. International trends of life expectancy and per capita GDP differed during the past 150 years. Life expectancy gains depended on economic growth but also on the advancement in medical knowledge. The pace and breadth of the health transitions drove life expectancy aggregate tendencies and distribution. The new results confirm the relationship between life expectancy and per capita income and its outward shift over time as put forward by Samuel Preston. However, the association between nonlinearly transformed life expectancy and the log of per capita income does not flatten out over time, but becomes convex suggesting more than proportional increases in life expectancy at higher per capita income levels.

Is Economic Growth Good for Population Health? A Critical Review

A large multidisciplinary literature discusses the relationship between economic growth and population health. The idea that economic growth is good for societies has inspired extensive academic debate, but conclusions have been mixed. To help shed light on the subject, this paper focuses on opportunities for consensus in this large literature. Much scholarship finds that the health-growth relationship varies according to (1) which aspect of "health" is under consideration, (2) shape (e.g., positive linear or logarithmic), (3) issues of timing (e.g., growth over the short or long term), (4) a focus on health inequalities as opposed to population averages, and (5) multivariable relationships with additional factors. After reflecting upon these findings, I propose that economic growth promotes health in some respects, for some countries, and in conjunction with other life-supporting priorities, but does not by itself improve population health generally speaking. I then argue there is already wide, interdisciplinary consensus to support this stance. Moreover, policies focusing exclusively on economic growth threaten harm to both population health and growth, which is to say that political dynamics are also implicated. Yet multivariable approaches can help clarify the bigger picture of how growth relates to health. For moving this literature forward, the best opportunities may involve the simultaneous analysis of multiple factors. The recognition of consensus around these issues would be welcome, and timely.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42650-023-00072-y.

Unacceptable persistence of territorial inequalities in avoidable under-five mortality in Colombia between 2000 and 2019: a multilevel approach

OBJECTIVES

This study aimed at evaluating territorial inequalities in avoidable mortality in children under 5 years of age in Colombia between 2000 and 2019.

STUDY DESIGN

This was an ecological study.

METHODS

An ecological, longitudinal, multigroup study was conducted using secondary sources. Because of the hierarchical structure of the data, the effect of territorial characteristics on the count of avoidable under-five deaths was estimated using a three-level negative binomial regression model with random intercepts for municipality and fixed intercepts for time and departments.

RESULTS

Between 2000 and 2019, there were 216,809 avoidable under-five deaths in Colombia (91.3% of all registered deaths of children under 5 years of age). A total of 1117 municipalities located in 33 departments were analyzed over five 4-year periods. Ecological relationships were found between avoidable under-five mortality and the percentage of adolescent births, female illiteracy, and multidimensional poverty at the municipal level (standardized mortality ratio: 1.43 95% confidence interval: 1.33-1.54 for the group with the highest level vs the group with the lowest level of poverty). Furthermore, multidimensional poverty was a confounding factor for the association between the percentage of the population living in rural areas and avoidable child mortality.

CONCLUSIONS

Systematic and avoidable gaps were observed in mortality in children aged under 5 years in Colombia, where the territory constitutes an axis of inequality. Implementing strategies and programs that contribute to improving the conditions of women and socio-economic conditions in the territories should be a priority.

Impact of Economic Freedom and Educational Attainment on Life Expectancy: Evidence From the New EU Member States

Life expectancy is a significant indicator of public health, life quality, welfare and economic development. Therefore, improvement in life expectancy is among the priority targets of the countries. This paper investigates the effect of economic freedom and educational attainment on life expectancy in the new EU member states, experiencing an institutional, educational, and economic transformation, during the period 2000-2019 by using cointegration and causality tests, because economic freedom and educational attainment can foster the life expectancy through institutional and economic variables such as institutions, governance, sound monetary and fiscal policies, economic growth, innovation, technological development, better living standards and access to superior healthcare services. The causality and cointegration analyses reveal that economic freedom and educational attainment are significant factors underlying life expectancy in the short and long term. However, educational attainment is found to be more effective on life expectancy than economic freedom. The findings have important implications for educational and health policies in analyzed countries. Governments must understand the education-health relationship to be able to develop and promote educational policies that have the potential to improve public health.

The Impact of Informal Social Support on Older Health: Evidence from China

Objectives: To explore the impact of informal social support (ISS) on older health. Methods: Multiple regression was used as the baseline regression, grouping regression was used to examine whether there were health effect differences among groups based on age and household registration, and insurance was selected to explore moderating effects of formal social support (FSS). Results: First, economic support, accompanied support, and number of intimate contacts had significantly positive effects on older health except for care support’s negative effects. Second, ISS had different health effects for different groups based on age and household registration. Third, FSS was a significant moderating for ISS. Conclusions: The government should emphasize and strengthen the supplementary role of ISS to FSS and promote the effective combination of the two, especially for the older who are high-age and rural, and further improve the role of care support.

Links between obesity, weight stigma and learning in adolescence: a qualitative study

BACKGROUND

Educational attainment is a key social determinant of health. Health and education are linked by multiple pathways, many of which are not well understood. One such pathway is the association between being above a healthy weight and lower academic achievement. While various explanations have been put forward to explain this relationship, evidence for causal pathways is sparse and unclear. This study addresses that evidence gap.

METHODS

We interviewed 19 adults (late 20s; 14 female, 5 male) and one young person (14 years, male) from the UK in 2019/2020. Participants were recruited from the ALSPAC 1990s birth cohort, sampled to ensure diversity in socio-economic status and educational attainment, and a community-based weight management group for young people. Interviews focused on experiences of being above a healthy weight during secondary school and how this may have affected their learning and achievement. Interviews were face-to-face, digitally recorded, and transcribed verbatim. We analysed the data thematically.

RESULTS

We identified key pathways through which higher body weight may negatively impact educational performance and showed how these are linked within a novel theoretical model. Because larger body size is highly stigmatised, participants engaged in different strategies to minimise their exposure to negative attention. Participants sought to increase their social acceptance or become less socially visible (or a combination of both). A minority navigated this successfully; they often had many friends (or the 'right' friends), experienced little or no bullying at school and weight appeared to have little effect on their achievement at school. For most however, the behaviours resulting from these strategies (e.g. disruptive behaviour, truanting, not working hard) or the physical, social or mental impacts of their school experiences (e.g. hungry, tired, self-conscious, depressed) made it difficult to concentrate and/or participate in class, which in turn affected how teachers viewed them.

CONCLUSIONS

Action to combat weight stigma, both within schools and in wider society, is urgently required to help address these educational disparities that in turn can impact health in later life.

What have we learned about mortality patterns over the past 25 years?

In this paper, I examine progress in the field of mortality over the past 25 years. I argue that we have been most successful in taking advantage of an increasingly data-rich environment to improve aggregate mortality models and test pre-existing theories. Less progress has been made in relating our estimates of mortality risk at the individual level to broader mortality patterns at the population level while appropriately accounting for contextual differences and compositional change. Overall, I find that the field of mortality continues to be highly visible in demographic journals, including Population Studies. However much of what is published today in field journals could just as easily appear in neighbouring disciplinary journals, as disciplinary boundaries are shrinking.

Demographic perspectives in research on global environmental change

The human population is at the centre of research on global environmental change. On the one hand, population dynamics influence the environment and the global climate system through consumption-based carbon emissions. On the other hand, the health and well-being of the population are already being affected by climate change. A knowledge of population dynamics and population heterogeneity is thus fundamental to improving our understanding of how population size, composition, and distribution influence global environmental change and how these changes affect population subgroups differentially by demographic characteristics and spatial distribution. The increasing relevance of demographic research on the topic, coupled with availability of theoretical concepts and advancement in data and computing facilities, has contributed to growing engagement of demographers in this field. In the past 25 years, demographic research has enriched climate change research-with the key contribution being in moving beyond the narrow view that population matters only in terms of population size-by putting a greater emphasis on population composition and distribution, through presenting both empirical evidence and advanced population forecasting to account for demographic and spatial heterogeneity. What remains missing in the literature is research that investigates how global environmental change affects current and future demographic processes and, consequently, population trends. If global environmental change does influence fertility, mortality, and migration, then population estimates and forecasts need to adjust for climate feedback in population projections. Indisputably, this is the area of new research that directly requires expertise in population science and contribution from demographers.

Do Cardiovascular Diseases Significantly Influence Healthy Aging?

Population development is reflected by sustainable development indicators, among them are the indicators describing longevity and healthy aging. Longevity is reflected by life expectancy, and healthy aging is reflected by healthy life expectancy; high values of these indicators reflect good conditions of living for people. Life expectancy and healthy life expectancy analyses are of big interest among academics, policymakers, medical researchers, and others in order to direct the flow of funds in the most effective way possible to the population groups in most need. High life expectancy and low birth rate will lead to aging of the population, having profound implications on the school age population, politics, healthcare, labor force, social protection, social security issues, and public finances. Healthy life expectancy reflects health conditions, including the impacts of mortality and morbidity. As cardiovascular disease causes more than half of all deaths across Europe, this paper examines the influence of cardiovascular disease on longevity and healthy aging across Europe. The methodology was chosen so as to test the research hypotheses: (a) principal component analysis provided the socio-economic factors that are correlated to longevity and healthy aging; (b) regression analysis identified the relationship between healthy aging and cardiovascular disease; and (c) hierarchical cluster analysis allowed us to find common features of the groups of countries according to healthy aging and longevity.

COVID-19, Alcohol Consumption and Stockpiling Practises in Midlife Women: Repeat Surveys During Lockdown in Australia and the United Kingdom

Introduction: This project examined the impact of COVID-19 and associated restrictions on alcohol practises (consumption and stockpiling), and perceptions of health risk among women in midlife (those aged 45–64 years).

Methods: We collected online survey data from 2,437 midlife women in the United Kingdom (UK) and Australia in May 2020, recruited using a commercial panel, in the early days of mandated COVID-19 related restrictions in both countries. Participants were surveyed again (N = 1,377) in July 2020, at a time when COVID-19 restrictions were beginning to ease. The surveys included the Alcohol Use Disorder Identification Test—Consumption (AUDIT-C) and questions alcohol stockpiling. Analysis involved a range of univariate and multivariate techniques examining the impact of demographic variables and negative affect on consumption and acquisition outcomes.

Results: In both surveys (May and July), UK women scored higher than Australian women on the AUDIT-C, and residence in the UK was found to independently predict stockpiling of alcohol (RR: 1.51; 95% CI: 1.20, 1.91). Developing depression between surveys (RR: 1.53; 95% CI: 1.14, 2.04) and reporting pessimism (RR: 1.42; 95% CI: 1.11, 1.81), and fear/anxiety (RR: 1.33; 95% CI: 1.05, 1.70) at the beginning of the study period also predicted stockpiling by the end of the lockdown. Having a tertiary education was protective for alcohol stockpiling at each time point (RR: 0.69; 95% CI: 0.54, 0.87).

Conclusions: COVID-19 was associated with increases in risky alcohol practises that were predicted by negative emotional responses to the pandemic. Anxiety, pessimism and depression predicted stockpiling behaviour in UK and Australian women despite the many demographic and contextual differences between the two cohorts. Given our findings and the findings of others that mental health issues developed or were exacerbated during lockdown and may continue long after that time, urgent action is required to address a potential future pandemic of alcohol-related harms.

The impact of population's educational composition on Healthy Life Years: An empirical illustration of 16 European countries

Healthy Life Years (HLY) is a prominent summary indicator for evaluating and comparing the levels of population health status across Europe. Variations in HLY, however, do not necessarily reflect underlying differences in health and mortality levels among countries and the indicator is particularly sensitive when broken down by subpopulations. For instance, despite European countries showing large HLY inequalities by educational level, these countries are also heterogenous regarding their population composition by educational attainment, which most likely affects their HLY levels. We demonstrate how this compositional effect shapes HLY levels by providing estimates for HLY by educational attainment and gender for 16 European countries using the Sullivan method. We use prevalence data about limitations in daily activities from the European Union Statistics on Income and Living Conditions (EU-SILC) and mortality data from the Eurostat database. Finally, we adjust for compositional effects by means of standardization. The education-adjusted HLY estimates do not differ much from conventional HLY. Yet, we find that in some countries HLY levels are indeed affected by the population composition by educational attainment. For example, low-, medium-, and high educated individuals in Portugal show more HLY than their counterparts in Poland. Still, Poland's total HLY value slightly exceeds that of Portugal, indicating favorable health and mortality conditions in Poland. It is Poland's lower relative number of low educated individuals in its population that is responsible for producing this higher total HLY value. We conclude that differentials in HLY due to differences in the relative size of educational subpopulations are generally small in HLY across Europe but they can play an important role for countries that experienced large differences in their educational expansion.

Does Education Mitigate the Effect of Population Aging on Health Expenditure? A Panel Data Study of Latin American Countries

Objective: To examine whether the effect of population aging on healthcare expenditures as a share of Gross Domestic Product (GDP) is attenuated in more educated countries. Method: The analysis is based on a dataset of 22 Latin American countries between 1995 and 2013. We estimate panel data models with country and time fixed effects, and control for potential nonlinear effects of population aging on health expenditure. Results: We find population aging increases health expenditure as a share of GDP in economies characterized by low levels of education, but this effect is mitigated in economies with higher levels of education. Results are driven by private health expenditures. Discussion: Results suggest population aging and education have a stronger influence on healthcare expenditures in less developed countries. This finding is important in a context in which the rapid growth of the aging population is likely to lead to significant costs in terms of health expenditures, but less so in more educated societies.

Zapico A, Gusi N, Aznar S, Alcaraz PE, González-Valeiro M, Serra-Majem L, Terrados N, Tur JA, Segú M, Lassale C, Homs C, Oses M, González-Gross M, Sánchez-Gómez J, Jiménez-Zazo F, Marín-Cascales E, Sevilla-Sánchez M, Herrera-Ramos E, Pulgar S, Bibiloni MDM, Sancho-Moron O, Schröder H, Barón-López FJ. Screen Time and Parents' Education Level Are Associated with Poor Adherence to the Mediterranean Diet in Spanish Children and Adolescents: The PASOS Study

The aim of this study is to evaluate if screen time and parents' education levels are associated with adherence to a Mediterranean dietary pattern. This cross-sectional study analyzed a representative sample of 3333 children and adolescents (8 to 16 years) included in the Physical Activity, Sedentarism, lifestyles and Obesity in Spanish youth (PASOS) study in Spain (which ran from March 2019 to February 2020). Data on screen time (television, computer, video games, and mobile phone) per day, Mediterranean diet adherence, daily moderate or vigorous physical activity, and parents' education levels were gathered using questionnaires. A descriptive study of the variables according to sex and parents' education level was performed. Logistic regression models (adjusted by sex and weight status) were fitted to evaluate the independent association between screen time and Kids' level of adherence to the Mediterranean diet (KIDMED) index, as well as some of its items. A greater amount of screen time was associated with worse adherence to the Mediterranean diet; a lower consumption of fruit, vegetables, fish, legumes, and nuts; and a greater consumption of fast food, sweets, and candies. A lower parents' education level was associated with worse adherence to the Mediterranean diet. It is necessary to promote the responsible, limited use of screen time, especially in children with parents with a lower education level.

Hired Latinx Child Farmworkers in North Carolina: Educational Status and Experience Through a Social Justice Lens

We examine the educational experience of Latinx hired child farmworkers in North Carolina, using a social justice framework. Qualitative (n = 30) and quantitative (n = 202) data collected among children ten to seventeen years of age revealed elevated rates of grade retention and dropout status. Children reported disruption to their schooling caused by international and interstate migration and intrastate movement. Few worked during school time; nevertheless, children reported missed participation in educational enrichment opportunities and little integration into school life. Schools often failed to accommodate language difficulties and problems caused by migration, and an atmosphere of racism prevailed. Educational programs for children in farmworker families were established during the 1960s. However, they do not meet the needs of hired child farmworkers. Policies to reduce child employment in agriculture and to meet their educational needs are necessary to ensure the education needed for future health and well-being. We discuss the applied implications of findings.

Systems Thinking to Understand National Well-Being from a Human Capital Perspective

Well-being has become an important policy goal to replace gross domestic product (GDP) as an indicator of national progress. Several multidimensional metrics and indicators of well-being have been developed mostly based on the four-capital model that includes natural, economic, human and social capital. These multidimensional measures of well-being, however, are highly categorical and lack a systems perspective that focuses on underlying mechanisms of the metrics and the interconnections between them. This study aims at bringing a systems thinking approach to understanding and measuring national well-being, particularly from a human capital perspective. For this purpose, we employ a qualitative systems mapping approach and identify the direct or indirect relationships between the well-being indicators related to human capital. The results show that the human capital system is governed by several reinforcing feedback loops through economic progress, health and life expectancy, which gives a central role to human capital to enhance well-being. There are balancing loops, however, that may have adverse effects on human capital formation and well-being, for instance through migration and ageing. Future studies can focus on the other three subsystems in the four-capital model, and on quantifying the relationships between different dimensions of well-being.

Understanding Social Determinants of Cardiometabolic Disease Risk in Rural Women

Women living in rural America experience significant disparities in cardiometabolic diseases warranting research to aid in understanding the contextual factors that underlie the rural and urban disparity and in planning effective primary prevention interventions. While research has established a general understanding of cardiometabolic risks individually, the combination or bundling of these risk behaviors is not clearly understood. The purpose of this study is to explore the association of social determinants of health on obesity and adiposity related cardiometabolic disease risk among rural women. Data were from the multi-state Rural Families Speak about Health Study. A total of 399 women were included in the analyses. Data were collected using a self-administered questionnaire on women's demographics, economic stability, education, and health and healthcare. Food insecurity, education, healthcare access and comprehension health literacy were associated with higher obesity and adiposity-related cardiometabolic risk. Health behaviors, tobacco use and physical activity were not associated with higher cardiometabolic risk in this sample of rural women. This is one of the first studies to focus on multiple social determinants of health and cardiometabolic risk in rural American women. Understanding combinations of risk behaviors can assist health care providers and community health professionals in tailoring multiple health behavior change interventions to prevent cardiometabolic disease among rural women. The findings support a focus on community and societal level factors may be more beneficial for improving the cardiometabolic health of rural women.

Socioeconomic development and life expectancy relationship: evidence from the EU accession candidate countries

This paper investigates the effect of the socioeconomic development on life expectancy at birth as an indicator of mortality or longevity in five EU accession candidate countries (Macedonia, Serbia, Bosnia and Herzegovina, Montenegro, and Albania). Using aggregate time series pool data on an annual level from UN and World Bank databases for the period 1990–2017 and Full Information Maximum Likelihood model, it was found that this connection between the socioeconomic conditions and life expectancy at birth is a prerequisite for longer life in all these five countries. Our dependent variable was the life expectancy at birth, and the background exploratory variables for the socioeconomic development were GDP per capita and infant mortality rate. The main results are that higher values of GDP per capita and lower values of infant mortality levels lead to higher life expectancy at birth suggesting that longevity of people in these five countries is increasing. These results are supported by our theoretical background and research framework hypotheses.

Mass Education, International Travel, and Ideal Ages at Marriage

Opportunities to document associations between macro-level changes in social organization and the spread of new individual attitudes are relatively rare. Moreover, of the factors generally understood to be influential, little is known about the potential mechanisms that make them so powerful. Here we use longitudinal measures from the Chitwan Valley Family Study (CVFS) to describe the processes of ideational change across 12 years among a representative sample from a rural agrarian setting in South Asia. Findings from lagged dependent variable models show that (1) two key dimensions of social organization--education and international travel--are strongly associated with change in attitudes, net of prior attitudes; (2) reorganization of education and travel are associated with attitudes toward ideal age at marriage; and (3) this association varies by gender. Using the study's prospective design, we document not only these important associations but also potential mechanisms of education and travel--exposure to the English language and friends' international travel experience--as potentially powerful social influences on individuals' attitudes, independent of their own experiences.

A Framework of Minority Stress: From Physiological Manifestations to Cognitive Outcomes

Cognitive impairment and dementia continue to threaten the aging population. Although no one is immune, certain groups, namely black older persons, are more likely to have a diagnosis of certain dementias. Because researchers have not found a purely biological reason for this disparity, they have turned to a biopsychosocial model. Specifically, black persons in the United States are more likely to live with social conditions that affect their stress levels which in turn affect physiological regulation leading to conditions that result in higher levels of cognitive impairment or dementia. Here we discuss some of these social conditions such as discrimination, education, and socioeconomic status, and how physiological dysregulation, namely allostatic load that can lead to cognitive impairment and dementia in black persons especially.

Competing mortality risks analysis of prediagnostic lifestyle and dietary factors in colorectal cancer survival: the Norwegian Women and Cancer Study

Background

It remains unclear whether or which prediagnostic lifestyle and dietary factors influence colorectal cancer (CRC) survival following diagnosis. This study used competing mortality risks analysis to evaluate the association between these factors and CRC survival.

Methods

A total of 96 889 cancer-free participants of the Norwegian Women and Cancer Study completed the study’s baseline questionnaire on lifestyle and dietary factors between 1996 and 2004. Of the 1861 women who subsequently developed CRC, 550 had CRC as the cause of death, while 110 had a non-CRC cause of death. We used multiple imputation to handle missing data. We performed multivariable competing mortality risks analyses to determine the associations between prediagnostic lifestyle and dietary factors and CRC survival. Cause-specific HRs were estimated by Cox regression and subdistribution HRs were estimated by the Fine-Gray regression with corresponding 95% CIs.

Results

Following multivariable adjustment, a prediagnostic vitamin D intake of >10 μg/day compared with ≤10 μg/day was associated with better CRC survival (HR=0.75, 95% CI 0.61 to 0.92). Other prediagnostic lifestyle and dietary factors showed no association with CRC survival. The corresponding results obtained from cause-specific Cox and Fine-Gray regressions were similar.

Conclusion

Our study shows that prediagnostic vitamin D intake could improve CRC survival.

Does schooling protect sexual health? The association between three measures of education and STIs among adolescents in Malawi

While multiple studies have documented shifting educational gradients in HIV prevalence, less attention has been given to the effect of school participation and academic skills on infection during adolescence. Using the Malawi Schooling and Adolescent Study, a longitudinal survey that followed 2,649 young people aged 14-17 at baseline from 2007 to 2013, we estimate the effect of three education variables: school enrolment, grade attainment, and academic skills-numeracy and Chichewa literacy-on herpes simplex virus type 2 (HSV-2) and HIV incidence using interval-censored survival analysis. We find that grade attainment is significantly associated with lower rates of both HSV-2 and HIV among girls, and is negatively associated with HSV-2 but not HIV among boys. School enrolment and academic skills are not significantly associated with sexually transmitted infections (STIs) for boys or girls in our final models. Efforts to encourage school progression in high-prevalence settings in sub-Saharan Africa could well reduce, or at least postpone, acquisition of STIs.

The persistent influence of caste on under-five mortality: Factors that explain the caste-based gap in high focus Indian states

OBJECTIVE

Although under-five mortality rate (U5MR) is declining in India, it is still high in a few selected states and among the scheduled caste (SC) and scheduled tribe (ST) population of the country. This study re-examines the association between caste and under-five deaths in high focus Indian states following the implementation of the country's National Rural Health Mission (NRHM) program. In addition, we aim to quantify the contribution of socioeconomic determinants in explaining the gap in under-five death risk between the SC/ST population and non-SC/ST population in high focus states in India.

DATA AND METHOD

Using data from the National Family Health Survey (NFHS), we calculated the U5MR by applying a synthetic cohort probability approach. We applied a binary logistic regression model to examine the association of under-five deaths with the selected covariates. Further, we used Fairlie's decomposition technique to understand the relative contribution of socioeconomic variables on under-five death risk between the caste groups.

FINDINGS

In high focus Indian states, the under-five mortality risk between well-off and deprived caste children has declined in the post-NRHM period, indicating a positive impact in terms of reducing caste-based inequalities in the high focus states. Despite the reduction in under-five death risk, children belonging to the SC population experience higher mortality rates than children belonging to the non-SC/ST population from 1992 to 2016. Both macro level (district level mortality rates) and individual (regression analysis) analyses showed that children belonging to SCs experience the highest likelihood of dying before their fifth birthday. A decomposition analysis revealed that 83% of the caste-based gap in the under-five deaths is due to the distribution of women's level of educational attainment and household wealth between the SC/ST and non-SC/ST population. Program indicators such as place of birth and number of antenatal care (ANC) visit also contributed significantly to widening caste-based gaps in U5MR.

CONCLUSION

The study indicates that there is still room to improve access to health facilities for mothers and children belonging to deprived caste groups in India. Continuous efforts to raise the level of maternal education and the economic status of people belonging to deprived caste groups should be pursued simultaneously.

Exploring geographical differences in the incidence of colorectal cancer in the Norwegian Women and Cancer Study: a population-based prospective study

PURPOSE

Norway has experienced an unexplained, steep increase in colorectal cancer (CRC) incidence in the last half-century, with large differences across its counties. We aimed to determine whether geographical distribution of lifestyle-related CRC risk factors can explain these geographical differences in CRC incidence in Norwegian women.

METHODS

We followed a nationally representative cohort of 96,898 women with self-reported information on lifestyle-related CRC risk factors at baseline and at follow-up 6-8 years later in the Norwegian Women and Cancer Study. We categorized Norwegian counties into four county groups according to CRC incidence and used Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk factors. We used the Karlson, Holm, and Breen (KHB) method of mediation analysis to investigate the extent to which the risk factors accounted for the observed differences in CRC incidence between counties.

RESULTS

During an average of 15.5 years of follow-up, 1875 CRC cases were diagnosed. Height (HR=1.12; 95% CI 1.08, 1.17 per 5 cm increase); being a former smoker who smoked ≥10 years (HR=1.34; 95% CI 1.15, 1.57); or being a current smoker who has smoked for ≥10 years (HR=1.28; 95% CI 1.12, 1.46) relative to never smokers was associated with increased CRC risk. Duration of education >12 years (HR=0.78; 95% CI 0.69, 0.87) vs ≤12 years, and intake of vegetables and fruits >300 g (HR=0.90; 95% CI 0.80, 0.99) vs ≤300 g per day were associated with reduced CRC risk. However, these risk factors did not account for the differences in CRC risk between geographical areas of low and high CRC incidence. This was further confirmed by the KHB method using baseline and follow-up measurements (b=0.02, 95% CI -0.02, 0.06, p=0.26).

CONCLUSION

Lifestyle-related CRC risk factors did not explain the geographical variations in CRC incidence among Norwegian women. Possible residual explanations may lie in heritable factors.

The Association of Pension Income with the Incidence of Type I Obesity among Retired Israelis

Previous studies have identified obesity and overweight as the fourth leading risk factor for global mortality. The objective of the current study is to investigate gender differences and the impact of wealth and income from pensions, sociodemographic variables, and self-assessment of health conditions on the projected probability to become obese in the postretirement age (67 years and older). We are unaware of previous studies, which explored the direct relationship between obesity, monetary income from pensions, wealth, and self-assessment of health conditions. To conduct this research, we make use of an extensive questionnaire concerning the economic and sociodemographic features and health and housing conditions of individuals administered within the framework of the 2015-2016 longitudinal survey conducted by the Israeli Central Bureau of Statistics (CBS). The survey is representative of the Israeli population and also includes information regarding the weight, height, gender, and age of each household member. Results of our study demonstrate that while for the female respondents older than 67, the projected probability of type I obesity (BMI ≥ 30) drops by 0.41% (p=0.0021) to 0.52% (p=0.0001) with an incremental 10,000 NIS (about $2,500) rise of gross annual income from a pension, for the male respondents above 67 years, the projected probability remains unchanged (p=0.4225). This outcome remains robust even when the 2015 BMI measurement of type I obesity (BMI ≥ 30) is controlled. This drop among women attenuates with a cutoff point increase from BMI ≥ 25 (overweight) to BMI ≥ 30 (type I obesity) to BMI ≥ 35 (type II obesity). Further results indicate that for both genders above 67 years and for men above 62 years, the projected BMI drop of one year decreases with income from a pension (p=0.013, p=0.039, and p=0.007, respectively), although the spread around the projection becomes wider. Compared with other martial status categories, for widowed females, the projected probability of obesity and self-reporting on improved health conditions drops by 6.58% (p=0.0419) to 11.28% (p=0.0048) and 6.55% (p=0.0190) to 7.47% (p=0.0036), respectively. For females older than 67, family status divorced drops the projected probability of obesity by 9.25% (p=0.0319). For males older than 67, results show a rise in projected obesity with car ownership by 6.10% (p=0.0897) to 6.41% (p=0.0469) and a drop in projected obesity with academic degree status by 9.93% (p=0.0106) to 10.14% (p=0.0118) and immigration status from American-European countries by 7.67% (p=0.0821) to 8.99% (p=0.0398) and Asian-African countries by 11.63% (p=0.0245) to 11.99% (p=0.02). Research findings stress the differences and similarities in male-female patterns of obesity after the retirement age of 67 years and may be of assistance to welfare and public health experts.

Educational expansion and health disparities in Ethiopia, 2005-2016

Research shows that basic education improves population health, yet it remains unclear whether the expansion of primary education decreases health disparities. In this paper, I assess whether disparities in healthcare utilization decreased in conjunction with educational expansion among women of reproductive age in Ethiopia. Healthcare utilization rates in low-resource countries are often confounded with simultaneous developments in education and access to basic healthcare. Using decomposition of rates, I first disentangle the changes in health disparities induced by educational expansion from the overall increase in healthcare utilization. Then, I use the Blinder-Oaxaca decomposition method to investigate the determinants of disparities in healthcare utilization and how these determinants changed over a 10-year period as primary education became more prevalent. Overall, disparities in healthcare utilization in Ethiopia decreased over time, yet the association between educational expansion and health disparities varies by region. Literacy explains much of the disparities in healthcare utilization, yet it loses significance over time as primary education becomes widespread. Economic factors remain persistent sources of disparities, and non-financial barriers such as the distance to travel and women's ability to travel alone become more significant. Heterogeneity in healthcare utilization across regions has distinct implications for how educational expansion may shift health disparities.

Evidence for causal links between education and maternal and child health: systematic review

OBJECTIVE

Numerous studies have documented an inverse association between years of schooling attained, particularly by women, and reduced maternal, infant and child mortality. However, if factors affecting educational attainment - many of which are unobservable, e.g. motivation and genetic endowment - also affect the likelihood of engaging in behaviours that enhance health, then assumed effects of schooling will be inflated in analyses that do not address this endogeneity. This systematic review assesses evidence for a causal link between education and maternal and child health in low and middle-income countries.

METHODS

Eligible studies controlled for observable and unobservable factors affecting both education and health. Reported effects were converted into partial correlations. When possible, we also conducted meta-analyses to estimate mean effects by outcome.

RESULTS

Of 4952 papers identified, 16 met the inclusion criteria. The 15 child health papers examined neonatal, infant and child mortality, stunting and wasting. Significant effects of education on infant and child health were observed for 30 of 33 models that did not account for endogeneity. In contrast, only 18 of 46 effects were significant in models that addressed endogeneity. Notably, for only one outcome -child mortality measured dichotomously -was the effect of maternal educational attainment significant in a meta-analysis. The one maternal morbidity paper found significant effects for the two preventable outcomes considered.

CONCLUSION

While we find evidence for a causal link between education and health, effects are weaker in models that address endogeneity compared to naïve models that do not account for unobservable factors affecting both education and health. Advances in women's educational outcomes have undoubtedly played a role in improving health in many settings; however, the effect is not as strong as some researchers and advocates have claimed.

Intergenerational Educational Pathways and Self-Rated Health in Adolescence and Young Adulthood: Results of the German KiGGS Cohort

Health differences in social mobility are often analysed by income differences or different occupational positions. However, in early adulthood many young people still have very diffuse income situations and are not always fully integrated into the labour market despite many having finished school. This article focusses on the link between intergenerational educational pathways and self-rated health (SRH) among young adults considering their SRH in adolescence. The data source used is the German KiGGS cohort study. The analysis sample comprises 2175 young people at baseline (t0: 2003⁻2006 age 14⁻17) and first follow-up (t1: 2009⁻2012 age 19⁻24). Combining parent's and young people's highest school degree, the data can trace patterns of intergenerational educational pathways (constant high level of education, upward mobility, downward mobility, constant low level of education). Young people's SRH was recorded at t0 and t1. During adolescence and young adulthood, participants were less likely to report poor SRH if they had a constant high intergenerational education or if they were upwardly mobile. The differences were particularly striking among young adults: average marginal effects (AME) for poor SRH showed much higher risk among downwardly mobile compared to peers with an intergenerational constant high education (AME: 0.175 [0.099; 0.251]), while the upwardly mobile had a significantly lower risk for less than good SRH than peers with an intergenerational constant low level of education (AME: -0.058 [-0.113; -0.004]). In the context of great societal demands and personal developmental needs, educational differences in health tend to increase in young adulthood. Public Health should pay more attention to educational and health inequalities in young adulthood.