Does Health cause Schooling or Does Schooling cause Health? Tiago Neves Sequeira Abril, 2007 Texto para Discussão – Nº E – 01/2007 DEPARTAMENTO DE GESTÃO E ECONOMIA Ficha Técnica Director José Alberto Fuinhas Secretariado Elisabete Saraiva Ramos Conselho Editorial José Alberto Fuinhas Paulo Maçãs Nunes Zélia Serrasqueiro Colaboradores João Leitão Composição e Impressão Departamento de Gestão e Economia da Universidade da Beira Interior Estatuto Editorial Os Textos para Discussão do DGE propõem-se disponibilizar, on-line, trabalhos em fase avançada de elaboração, no âmbito da Gestão e da Economia, desenvolvidos por docentes, investigadores, mestrandos, doutorandos e docentes de outras universidades que sejam colaboradores do Departamento de Gestão e Economia da Universidade da Beira Interior. Está aberta a contribuições que utilizem métodos de investigação que se enquadrem nas correntes de pensamento científico nas áreas da Gestão e da Economia. Normas para Publicação On-Line Os trabalhos propostos para publicação deverão ter a aprovação de dois doutorados do Departamento de Gestão e Economia da Universidade da Beira Interior e um membro do Conselho Editorial. Universidade da Beira Interior Departamento de Gestão e Economia (DGE) Pólo das Ciências Sociais e Humanas Estrada do Sineiro 6200-209 Covilhã PORTUGAL TLF: 275319600 - FAX: 275319601 http://www.dge.ubi.pt Does Health cause Schooling or Does Schooling cause Health?∗ Tiago Neves Sequeira† Abstract Using a panel data approach we investigate whether schooling cause health or health cause schooling. We found evidence that supports the influence of the level of health in increases in education and the influence of education growth in health improvements. Both effects are present in poor countries but not in rich ones. Keywords: Education, Health. JEL Classification: I00, J24, O15, O50. ∗ I thank Ana Balcão Reis for useful comments and suggestions. I gratefully acknowledge the excellent research assistance of Margarida Rodrigues. I also acknowledge financial support from the FCT, under the Project POCTI/EGE/60845/2004. The usual disclaimer applies. † Departamento de Gestão e Economia, Universidade da Beira Interior and INOVA research centre, Faculdade de Economia, Universidade Nova de Lisboa and (Address: Universidade da Beira Interior, Departamento de Gestão e Economia, Estrada do Sineiro, 6200-209 Covilhã, Portugal, [email protected]). 1 1 Introduction There are three main reasons to be concerned with causality between education and health. First, both health and education may be simply outcomes of a separate cause such as time preference which cause a correlation but not causality. Second, education may affect health by improving the productivity of health services or by improve basic sanitation care. Third, poor health early in life limits educational attainment while poor health on the job may limit training and wage growth (for a survey on these reasons and on theories linking education to health, see Hunt-McCool and Bishop, 1998). Macroeconomic theory has focused human capital accumulation as dependent on health and demographic features. However, the direction of causality is not yet clear. Zhang et al. (2001, 2003) and Kalemli-Ozcan et al. (2000) assumed that a decrease in the mortality rate and the simultaneous decrease in fertility tend to increase parental investment in each child. Bloom, Canning and Sevilla (2001) and Cropper (2000) argue that mortality rate is correlated with the health status of the population and thus a decrease in mortality induces increases in the human capital quality and thus accumulation of human capital becomes more productive. Meltzer (1992) and Preston (1980) estimates that high mortality rate reduces expected value of future returns from education. These references pointed out a causality from health to education. Nevertheless, one can also think that education improves the health status of the population. Both evidence and theories on the inverse causality are more recent and rare. For instance, Arendt (2005) uses a panel data analysis using school reforms in Denmark for identification but the analysis on the effect of education in health “remain inconclusive”. Tamura (2006) found positive effects of education in adult survival and also positive influence of health in education, between 1850 and 1990 for a sample of 92 countries. We add to these literature the evaluation of causality between health and education, controlling for income and overall education in a broad cross-section of near a hundred countries and adressing the differences between poor and rich countries. To this end, we use dynamic panel data estimators, that control for different types of endogeneity, namely simultaneity bias. Our results tend to confirm the causality from health to education growth and the causality 2 between education growth and health growth. These results are driven essentially by what is happening in poor countries. 2 Data on Education and Health We distinguish two different indicators of Education: the first, that measures quantity of schooling (years) in total population above 15 years old (tyr) and the second, that weight this quantity with a quality measure from Hanushek (2001) (tyr ∗ QL).1 As a proxy for health, we use life expectancy (in natural logarithms), because it is the widely used and the mostly available proxy for health. To control for family background when explainning schooling, we introduced adult education, measured by total years of primary education in total population above 25 years old and income, measured by real per capita GDP using the chain index, from the Penn World Tables. Years of Education come from the Barro-Lee (2000) database and Life Expectancy come from World Development Indicators. 2.1 Descriptive Statistics and Correlations Table 1 shows descriptive statistics on the variables used in this article. Table 1 - Descriptive Statistics N Average S.D. Min. Max. Dependent Variables tyr 937 4.803 2.846 0.086 12.049 tyr ∗ QL 734 0.254 0.155 0.006 0.615 Society Background Log(GDP ) 1000 8.146 1.054 5.717983 10.537120 Adult Education1 930 3.134 1.817 0.023 7.667 Health Variable Log(Life Expectancy) 1066 4.059169841 0.220213167 3.459926377 4.385104211 1 Average Years of Primary Education in Population above 25 years Next table shows correlations between the dependent variables and the used covariates in the panel database. From these figures, we conclude that there is a positive strong association 1 We use the first quality measure (QL1 ) presented in Hanushek (2001). 3 between income, adult education, life expectancy and schooling growth. However we cannot infer nothing about causality. Table 2 - Correlations u : Hj,i,t tyr tyr ∗ QL Society Background Log(GDP ) 0.85*** 0.81*** 1 Adult Education 0.94*** 0.88*** Health Variable Log(Life Expectancy) 0.85*** 0.76*** 1 Average Years of Primary Education in Population above 25 years *** stands for a 1% significance level; ** for 5% and * for 10% 3 Panel Procedures 3.1 GMM Estimators for Dynamic Panel Models In this article, we use the Dynamic Panel Data system estimator developed by Arellano and Bover (1995) and Blundell and Bond (1998). Compared with the single cross-section analysis, the panel analysis increases the regressions’ degrees of freedom due to the increased number of observations and, as a GMM method, it controlls for country specific effects and for other possible sources of endogeneity, such as omitted variable bias, measurement errors and causality. This is quite important in this context, as Hanushek et al. (1996) argued that aggregation implies a significant upward ommited variables bias, namely linked with different institutions and policies throughout countries. Given the properties of this estimator, we believe we are correcting for the problem, since it controls for both fixed and variable ommited variables. The use of this estimator is also extremely important due to our enphasis in causality. We estimated the following equations: u u e Hj,i,t = α0 + α1 Hj,i,t−1 + α2 GDPi,t + α3 Adult Edi,t + α4 Hi,t + vi + εi,t (1) e e e u Hi,t = β 0 + β 1 Hi,t−1 + β 2 ∆Hi,t−1 + β 3 GDPi,t + β 4 Hj,i,t−1 + ui + ξ i,t (2) 4 with i = 1, ..., N being the number of countries, j = 1, 2 the indicator used for schooling dependent variables (H u ), t = 60, 65.., 2000, vi and ui are the country specific effects and H e the natural logarithm of life expectancy. For each t, GDP per capita and life expectancy are e are the average measured in the preceding five-year period (e.g. for 1960, GDPi,t and Hi,t between 1955 to 1959). Adult Education (Adult Ed) is measured contemporaneously with the dependent variable. The third term in equation (2) is inserted so that the moment conditions were fullfilled. Under the assumptions that (a) the error terms (εi,t and ξ i,t ) are not serially correlated and (b) the explanatory variables are weakly exogenous (i.e., the explanatory variables are assumed to be uncorrelated with future realizations of the error term), the GMM dynamic u 1 panel uses the following moment conditions: E[Hi,t−1−s ∆εi,t ] = 0, E[Xi,t−s ∆εi,t ] = 0 and e 2 E[Hi,t−s ∆ξ i,t ] = 0, E[Xi,t−s ∆ξ i,t ] = 0, for s ≥ 2; t = 3, ..., T ; i = 1, ..., N, where X 1 is the complete matrix of covariates in equation 1, which includes Adult Edi , Hie and GDPi (in logs) and X 2 is the complete matrix of covariates in equation 2, which includes Hiu and GDPi (in logs). Because we use the system GMM estimator, there are the following additional moment u 1 restrictions for the levels equation: E[∆Hi,t−1 (vi + εi,t )] = 0, E[∆Xi,t−1 (vi + εi,t )] = 0 and e 2 E[∆Hi,t−1 (ui + ξ i,t )] = 0, E[∆Xi,t−1 (ui + ξ i,t )] = 0, for t = 3, ..., T. It is worth noting that these conditions allow for the levels of explanatory variables to be correlated with the unobserved country-specific effects. Thus, we use these moment conditions and employ a GMM procedure to generate consistent and efficient parameter estimates. This system estimator is preferable to the difference estimator if the dependent variable is highly persistent, as is the case for education stocks and if the number of time-series observations are small, as is also the case. The third term in equation (2) is inserted so that the moment conditions were fullfilled. Consistency of the GMM estimator depends on the validity of the instruments. To address this issue, we consider two specification tests: the first is the Hansen test of over-identifying restrictions, which tests the overall validity of the instruments; the second is the second-order autocorrelation test for the error term. Overall, both specification tests indicate that the instruments used are valid. When the comparison between the number of observations and the 5 number of instruments indicate an overfitting bias in the empirical model (this is, an excess of instruments), we decrease the number of instruments. In all regressions we introduce a constant and time-period dummies that are not presented in tables. As we use dynamic estimators, i.e. that accounts for previous levels of the dependent variable, this is the same as considering explanatory variables as influencing the growth of the dependent variable. Thus, when analysing the effect of life expectancy in education (eq. (1)), in fact we are interpreting the effect of life expectancy on education in period t given the level of education in t − 1. This is the same as interpreting it as the effect of life expectancy on education rise. 4 Does Health influence Education? In this section, we investigate the causality from health to education. This is the direction for which there is more literature, which is mainly theorectical. To control for family background effects, which have been pointed out as the main determinant of education (Hanushek, 1986, 2003), we introduce per capita GDP and adult primary education in population above 25 years. However, as adult education seems to have low effects in total sample, we ommit this variable in the two last columns in the Table. Table 3 - Does Health influence Education? Dependent Variable tyr tyr ∗ QL1 tyr tyr ∗ QL1 Lagged Dep. Variable 0.778*** 0.977*** 0.896*** 0.973*** (p-value) 0.000 0.000 0.000 0.000 Log(GDP ) 0.324*** 0.003 0.129 -0.001 (p-value) 0.003 0.459 0.153 0.649 Adult Ed 0.129 -0.003 – – (p-value) 0.164 0.433 – – Log(Lif eExpectancy) 0.218 0.046** 0.815** 0.054*** (p-value) 0.574 0.030 0.013 0.003 Number of Instrum. 82 82 97 75 Hansen J 0.224 0.481 0.356 0.317 (p-value) AR(1) (p-value) 0.000 0.002 0.000 0.000 AR(2) (p-value) 0.520 0.516 0.564 0.505 Number of Countries 98 80 100 80 Number of Obs. 726 597 738 597 Notes: (1) p-values based on robust variance-covariance matrix in parenthises; (2) *** stands for a 1% significance level; ** for 5% and * for 10% 6 The analysis of the table points out that only when the dependent variable weights quantity of schooling with its quality, does the Life Expectancy positively influences education. Income only influences quantity (tyr), when controlling for education and life expectancy. If we exclude life expectancy, only income would influence positively education for the two dependent variables. Additionally, when we ommit the less significant Adult Education variable, we obtain a significant effect of life expectancy in both education variables, as can be seen in the last two columns in the table. If we detail the results and divide the sample into poor and rich samples, we easily conclude that the result showed above arise only in the poor sample. Thus, we consider rich countries those that are above the median for the majority of periods considered (considering all the period, the median is 3347 USD). Otherwise, we consider the country as poor. Results are presented in the following table. Table 4 - Does Health influence Education in Rich and Poor Countries? Rich Countries Poor Countries Dependent Variable tyr tyr ∗ QL1 tyr ∗ QL1 tyr tyr ∗ QL1 tyr ∗ QL1 Lagged Dep. Variable 0.617*** 0.934*** 0.971*** 0.761*** 1.003*** 1.001*** (p-value) 0.000 0.000 0.000 0.000 0.000 0.000 Log(GDP ) 0.468** 0.010 -0.000 0.125* 0.006** 0.003 (p-value) 0.014 0.372 0.963 0.050 0.024 0.372 Adult Ed 0.292* -0.001 – 0.245*** -0.003 – (p-value) 0.057 0.905 – 0.003 0.325 – Log(Lif eExpectancy) 0.851 0.028 0.042 0.666*** 0.031* 0.032*** (p-value) 0.381 0.435 0.240 0.004 0.053 0.003 Number of Instrum. 60 60 62 60 60 46 Hansen J 0.651 0.684 0.739 0.956 1.000 0.999 (p-value) AR(1) (p-value) 0.000 0.000 0.000 0.000 0.003 0.003 AR(2) (p-value) 0.378 0.463 0.464 0.379 0.557 0.570 Number of Countries 56 55 55 42 25 25 Number of Obs. 420 412 412 306 184 184 Notes: (1) p-values based on robust variance-covariance matrix in parenthises; (2) *** stands for a 1% significance level; ** for 5% and * for 10% From the Table analysis, the main conclusion is that the positive effect of Life Expectancy on schooling growth occurs essentially in poor countries. In fact, from the variables considered, Life Expectancy is the most important in explaining schooling in these countries. Other interesting fact is that in rich countries, education (weighted by quality) is only explained by its lagged value, which means that none of the explanatory variables in the regression is statistically 7 significant in explaining differences in schooling between these countries and throughout time. When accounting for quality, in the sample of poor countries there is evidence of divergence in education as the coefficient on the lagged dependent variable is above unity. Income has a positive influence years of schooling in both groups but also the education measure that accounts for quality in poor countries, when taking adult education into account. Adult education has a positive effect only on years of schooling, effect that disapears when accounting for quality of schooling. If the effect of Life Expectancy was excluded results on other determinants do not change significantly from what is presented in the Table. 5 Does Education cause Health? Only two of the references that studied the relationship between education and health had focused the direction of causality from education to health. Whether one of them (Arendt, 2005) found inconclusive results, Tamura (2006) reported a positive influence. In this section, we add to these literature new results with other techniques and data. Table 5 - Does Education influence Health? Dependent Variable Log(Lif eExpectancy) u : Measure of Hj,i,t tyr tyr ∗ QL1 tyr tyr ∗ QL1 (p-value) 0.972*** 0.000 0.515*** 0.005 0.019** 0.001 -0.006* 0.055 0.957*** 0.000 0.919*** 0.000 0.009** 0.035 0.030 0.420 ∆Schooling Schooling – – 0.960*** 0.000 0.648*** 0.000 0.011*** 0.007 – – 0.035*** 0.006 87 1.014*** 0.000 0.878*** 0.000 0.005 0.226 – – 0.035** 0.014 77 Lagged Dep. Variable (p-value) Lag. Dif. Dep Variable (p-value) Log(GDP ) (p-value) Schoolingt−1 (p-value) – – Number of Instrum. 88 77 Hansen J 0.113 0.223 0.115 0.284 (p-value) AR(1) (p-value) 0.086 0.049 0.086 0.017 AR(2) (p-value) 0.554 0.985 0.737 0.952 Number of Countries 103 80 100 80 Number of Obs. 570 455 567 455 Notes: (1) p-values based on robust variance-covariance matrix in parenthises; (2) *** stands for a 1% significance level; ** for 5% and * for 10% 8 Table 5 shows evidence according to which the education quantity decreases health and education that takes quality into account has no influence in health. However, schooling growth has a positive and significant effect on health improvements. This is a crucial aspect of causality: while health affects schooling growth in levels it is affected by schooling in growth and not in levels. When education growth is taken in account, GDP becomes a non-significant explanatory variable for life expectancy. Elliminating this variable from regression would not influence the robust positive influence of schooling growth on health improvements. When we divide the sample into one of poor and another of rich countries, we reach similar results to those presented in the previous table for the Poor sample and no significance of education or its growth in the Rich sample. We report in the following table results on the regressions of health on education growth, from which we can conclude that the results presented above are solely driven by the poor countries. Table 5 - Does Education influence Health in Rich and Poor Countries? Dependent Variable Log(Lif eExpectancy) Rich Countries Poor Countries u : Measure of Hj,i,t tyr tyr ∗ QL1 tyr tyr ∗ QL1 Lagged Dep. Variable 0.942*** 0.942*** 1.078*** 1.110*** (p-value) 0.000 0.000 0.000 0.000 Lag. Dif. Dep Variable 0.330*** 0.338*** 0.399 1.103 (p-value) 0.003 0.001 0.256 0.000 Log(GDP ) 0.001 0.001 -0.025 -0.015 (p-value) 0.901 0.863 0.912 0.943 ∆Schooling 0.024 0.024 0.014 0.036** Schooling (p-value) 0.360 0.343 0.234 0.043 Number of Instrum. 56 56 35 35 Hansen J 0.382 0.391 0.341 0.993 (p-value) AR(1) (p-value) 0.001 0.001 0.077 0.047 AR(2) (p-value) 0.163 0.160 0.603 0.102 Number of Countries 56 55 44 25 Number of Obs. 320 314 247 140 Notes: (1) p-values based on robust variance-covariance matrix in parenthises; (2) *** stands for a 1% significance level; ** for 5% and * for 10% 6 Conclusions This article adds evidence based on a panel data approach to the discussion of causality between education and health. We found evidence that supports the influence of the level of health in 9 increases in education and the influence of education growth on health improvements. Both effects are present in poor countries but not in rich ones. References [1] Arellano, M. and S. Bond (1991), “Some Tests of Specification for Panel Data: Monte Carlo evidence and an Application to Employment Equations”, Review of Economic Studies, 58: 277-297. [2] Arellano, M. and O. Bover (1995), “Another Look at the Instrumental Variables Estimation of Error-Components Model”, Journal of Econometrics, 68: 29-52. [3] Arendt, J. (2005), “Does Education cause Better Health? A panel data analysis using shool reforms for identification”, Economics of Education Review, 24 (2), 149-160. [4] Barro, R. and J. Lee (2000), International Data on Educational Attainment: Updates and Implications, Working-Paper 42, Centre for International Development at Haward University, April. [5] Bloom, D., D. Canning and J. Sevilla (2001), The Effect of Health on Economic Growth: Theory and Evidence, NBER working Paper 8587. [6] Blundell, R. and S. Bond (1998), “Initial Conditions and Moment restrictions in Dynamic Panel Data Models”, Journal of Econometrics, 87:115-143 [7] Hanushek, E. (1986), “The Economics of Schooling: Production and Efficiency in Public Schools”, Journal of Economic Literature, 24, September: 1141-1177. [8] Hanushek, E., S. Rivkin and L. Taylor (1996), “Aggregation and the Estimated Effects of School Resources”, Review of Economics and Statistics, 78, 4: 611-627. [9] Hanushek, E. (2003), “The failure of Input-Based Schooling Policies”, The Economic Journal, 113:64-98. 10 [10] Hanushek, E. and D. Kimko (2001), “Schooling, Labor Force Quality and Economic Growth”, American Economic Review, 90, 1(5): 1184-1208. [11] Hunt-McCool, J. and D. Bishop (1998), “Health Economics and the Economics of Education: Specialization and Division of Labor”, Economics of Education Review, 17 (3), 237-244. [12] Kalemli-Ozcan, S., H. Ryder and D. Weil (2000), “Mortality Decline, Human Capital Investment and Economic Growth”, Journal of Development Economics, 62 (1), 1-23. [13] Psacharopoulos, G. (1994), “Returns to Investment in Education: A Global Update”, World Development, vol. 22(9), 1325-1343. [14] Summers, R. and A. Heston (2002), Penn World Table, Center for International Comparisons, University of Pennsylvania. [15] Tamura, R. (2006), “Human Capital and Economic Development”, Journal of Development Economics, v.79(1), 26-72. [16] Zhang, J. et al. (2003), “Rising Longevity, education, savings and growth”, Journal of Development Economics, v.70, 83-101. [17] Zhang, J. et al. (2001), “Mortality Decline and Long-Run Economic Growth”, Journal of Public Economics, v.80(3), 485-507. [18] World Bank (2004), World Development Indicators 2004, CD Database. 11 A Variable Description tyr tyr ∗ QL1 Log(GDP ) Adult Education Life Expectancy Measure Source Dependent Variables total years of educatiom Barro-Lee (2000) The last weighted by a measure of quality Barro-Lee (2000) and Hanushek (2001) Society Background Real Chain Index GDP per capita PWT Primary Years of Education above 251 Barro-Lee (2000) Health Variable Life Expectancy at birth2 WDI WDI - World Development Indicators Database, World Bank (2004); PWT - Penn World Table, Summers and Heston (2002) Detailed Definitions: 1. PYR : Average years of primary schooling in the total population above 25 years old. 2. Life expectancy at birth indicates the number of years a newborn infant would live if prevailing patterns of mortality at the time of its birth were to stay the same throughout its life. 12 Textos para Discussão do DGE (Textos on-line em http://www.dge.ubi.pt) 2005 Área de Economia Nº E-01/2005 The standard neo-classical view on tax competition. 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