Modelling opportunity in health under partial observability of circumstances

This paper proposes a behavioural model of inequality of opportunity in health that integrates John Roemer's framework of inequality of opportunity with the Grossman model of health capital and demand for health. The model generates a recursive system of equations for health and lifestyles, which is then jointly estimated by full information maximum likelihood with freely correlated error terms. The analysis innovates by accounting for the presence of unobserved heterogeneity, therefore addressing the partial‐circumstance problem, and by extending the examination of inequality of opportunity to health outcomes other than self‐assessed health, such as long‐standing illness, disability and mental health. The results provide evidence for the existence of third factors that simultaneously influence health outcomes and lifestyle choices, supporting the empirical relevance of the partial‐circumstance problem. Accounting for these factors, the paper corroborates that the effect of parental and early circumstances on adult health disparities is paramount. However, the particular set of circumstances that affect each of the analysed health outcomes differs substantially. The results also show that differences in educational opportunities, and in social development in childhood, are crucial determinants of lifestyles in adulthood, which, in turn, shape the observed health inequalities. Copyright © 2010 John Wiley & Sons, Ltd.     

Childhood neighborhoods and health: Census-based neighborhood measures versus residential lived experiences

This study examines the impact of neighborhood disadvantage and neighborhood social connectedness during childhood on subsequent health status during early adulthood. We link longitudinal data from the Panel Study of Income Dynamics with Census data on children's surrounding neighborhoods. We estimate results with conventional linear regression and novel methods that better adjust for neighborhood selection processes. We find that neighborhood connectedness in childhood is protective against psychological distress in early adulthood, net of selection effects. However, greater connectedness exacerbates the risk of obesity within disadvantaged contexts for Black youth. Our results highlight a potential pathway for improving population health by investing in the social connectedness of neighborhoods alongside reducing structural inequalities.     

Impact of childhood and adulthood socioeconomic position on cause specific mortality: the Oslo Mortality Study

OBJECTIVE: To study the impact of childhood and adulthood social circumstances on cause specific adult mortality. DESIGN: Census data on housing conditions from 1960 and Personal Register income data for 1990 were linked to 1990-94 death registrations, and relative indices of inequality were computed for housing conditions in 1960 and for household income in 1990. PARTICIPANTS: The 128 723 inhabitants in Oslo aged 31-50 years in 1990. MAIN RESULTS: Adulthood mortality was strongly associated with both childhood and adulthood social circumstances among both men and women. Cardiovascular disease mortality was more strongly associated with childhood than with adulthood social circumstances, while the opposite was found for psychiatric and accidental/violent mortality. Smoking related cancer mortality was related to both adulthood and childhood social circumstances in men, but considerably more strongly to adult social circumstances. CONCLUSIONS: Childhood social circumstances have an important influence on cardiovascular disease risk in adulthood. Current increases in child poverty that have been seen in Norway over the past two decades could herald unfavourable future trends in adult health.     

Childhood family income and life outcomes in adulthood: findings from a 30-year longitudinal study in New Zealand

The aims of this study were to use data gathered over the course of a 30-year longitudinal study to examine the linkages between economic circumstances in childhood and subsequent developmental outcomes spanning educational achievement; economic circumstances; crime; mental health; and teenage pregnancy. All of these outcomes have been linked with childhood economic conditions and it is frequently argued that reducing income inequalities will mitigate psychosocial risks of children reared in families facing economic hardship. Alternatively it may be suggested that the associations between childhood family economic circumstances and later outcomes are mediated by individual, family and social factors that are correlated with low family income and contribute to later outcomes. To examine these issues, data were drawn from a birth cohort of New Zealand children born in 1977 and followed to age 30. Declining childhood family income was associated with a range of negative outcomes in adulthood, including: lower educational achievement; poorer economic circumstances; higher rates of criminal offending; higher rates of mental health problems; and higher rates of teenage pregnancy. After covariate adjustment, childhood family income remained significantly associated with educational achievement and economic circumstances, but was no longer significantly associated with the mental health, offending and teenage pregnancy outcomes. These findings suggest that, after due allowance has been made for social, family and individual contextual factors, low family income during childhood is associated with a range of educational and economic disadvantages in adulthood but is not directly related to increased risks of crime, mental health problems or teen pregnancy.     

Childhood and adulthood risk factors for socio-economic differentials in psychological distress: evidence from the 1958 British birth cohort

Social inequalities in psychological status have been attributed to health selection and to social causation. We used data from the 1958 British birth cohort, followed over three decades, to identify causes of inequality in adulthood. Psychological status prior to labour market entry influenced inter-generational mobility, but selection effects were weaker for intra-generational mobility, between age 23 and 33. However, selection failed to account for social differences in risk of distress of approximately threefold in classes IV&V compared with I&II. Both childhood and adult life factors appeared to contribute to the development of inequalities. The principal childhood factors were ability at age 7 for both sexes and adverse environment (institutional care for men and low class for women). Adult life factors varied, with stronger effects for work factors (job strain and insecurity) for men and qualifications on leaving school, early child-bearing and financial hardship for women. Gradients in psychological distress reflect the cumulative effect of multiple adversities experienced from childhood.     

The lasting impact of childhood health and circumstance

We quantify the lasting effects of childhood health and economic circumstances on adult health, employment and socioeconomic status, using data from a birth cohort that has been followed from birth into middle age. Controlling for parental income, education and social class, children who experience poor health have significantly lower educational attainment, poorer health, and lower social status as adults. Childhood health and circumstance appear to operate both through their impact on initial adult health and economic status, and through a continuing direct effect of prenatal and childhood health in middle age. Overall, our findings suggest more attention be paid to health as a potential mechanism through which intergenerational transmission of economic status takes place: cohort members born into poorer families experienced poorer childhood health, lower investments in human capital and poorer health in early adulthood, all of which are associated with lower earnings in middle age-the years in which they themselves become parents.     

Social and economic background and class inequalities in health among young adults

This paper considers which socio-economic factors in childhood and early adulthood are most strongly associated with social class differences in health at age 23. Longitudinal data from the 1958 (NCDS) cohort were used for this purpose. By age 23 class gradients were evident for several health measures, including self-rated health, 'malaise', psychological morbidity and height. The contribution of earlier socio-economic background was established by assessing how far class differences in the health indicators were reduced by controlling for earlier circumstances. While class differentials were not eliminated after taking account of earlier circumstances, substantial reductions were associated with a number of factors in childhood, in particular social class, housing tenure, crowding, family size and receipt of free school meals. More recent experiences of unemployment and family formation were also important.     

Determinants of health in early adulthood: what is the role of parental education, childhood adversities and own education?

BACKGROUND: Of the many studies assessing the impact of childhood living conditions on health and health inequalities in adulthood, only few have combined information on current determinants of health with detailed individual level data on different aspects of childhood living conditions and adversities. This study aims (i) to assess the role of parental education, self-reported childhood adversities and family structure as determinants of different dimensions of health in early adulthood, and (ii) to identify the role of the respondent's own education as a modifier of the association between childhood living conditions and health. METHODS: The study is based on a representative sample (n = 3669; participation rate 83%) of young adults aged 18-39 years in 2000 in Finland. The main outcome measures were poor self-rated health (SRH), psychological distress (by GHQ12) and somatic morbidity. RESULTS: Parental education, problems in childhood and the respondent's own education were independently related to SRH and psychological distress. The impact of childhood living conditions on health varied by gender and according to the measure of health. Childhood conditions were strongly associated with poor SRH and psychological distress, whereas the connection with somatic morbidity was weaker. The associations remained relatively unchanged after controlling for the respondent's own education. CONCLUSIONS: Childhood living conditions and adversities are strongly associated with poor SRH and psychological distress in early adulthood. Early recognition of childhood adversities followed by relevant support measures may play an important role in preventing health problems in adulthood.     

The long-term impacts of Medicaid exposure in early childhood: Evidence from the program's origin

This paper examines the long-term impact of exposure to Medicaid in early childhood on adult health and economic status. The staggered timing of Medicaid's adoption across the states created meaningful variation in cumulative exposure to Medicaid for birth cohorts that are now in adulthood. Analyses of the Panel Study of Income Dynamics suggest exposure to Medicaid in early childhood (age 0–5) is associated with statistically significant and meaningful improvements in adult health (age 25–54), and this effect is only seen in subgroups targeted by the program. Results for economic outcomes are imprecise and we are unable to come to definitive conclusions. Using separate data we find evidence of two mechanisms that could plausibly link Medicaid's introduction to long-term outcomes: contemporaneous increases in health services utilization for children and reductions in family medical debt.