Understanding socio-economic inequalities in childhood respiratory health

Asthma is the most common chronic disease of childhood. Recent evidence has shown a socio-economic gradient in its distribution. This paper examines whether a number of factors argued to have led to a rise in the incidence of asthma might also explain the social gradient. Several of these have been the object of policy intervention, though not necessarily with the aim of lowering childhood respiratory conditions. Using a large cohort study (the Avon Longitudinal Study of Parents and Children) we find significant inequalities in three respiratory conditions in middle childhood. We investigate eight potential mediating factors: exposure to other children in infancy, child's diet, poor housing conditions, maternal smoking, parental history of asthma, poor child health at birth, maternal age at child's birth and local deprivation. We find that each of these alone typically explains a relatively modest part of each respiratory inequality, with child's diet, local deprivation and maternal smoking generally the most important. But taken together, the mediating factors account for a substantial part of the respiratory inequalities. So the socio-economic gradient appears to operate through a number of inter-correlated pathways, some of which may be amenable to policy intervention.Asthma, wheeze, socio-economic inequalities, mediating

Health Supplier Quality and the Distribution of Child Health

There is emerging evidence to suggest that initial differentials between the health of poor and more affluent children in the UK do not widen over early childhood. One reason may be that through the universal public funded health care system all children have access to equally effective primary care providers. This paper examines this explanation. The analysis has two components. It first examines whether children from poorer families have access to general practitioners of a similar quality to children from richer families. It then examines whether the quality of primary care to which a child has access has an impact on their health at birth and on their health during early childhood. The results suggest that children from poor families do not have access to markedly worse quality primary care, and further, that the quality of primary care does not appear to have a large effect on differentials in child health in early childhood.primary care quality, child health

The Impact of Low Income on Child Health: Evidence from a Birth Cohort Study

There is a growing literature that shows that higher family income is associated with better health for children. Wealthier parents may have more advantaged children because they have more income to buy health care or because parental wealth is associated with beneficial behaviours or because parental health is associated with both income and children¿s health. The policy implications of these transmission mechanisms are quite different. We attempt to unpick the correlation between income and health by examining routes by which parental disadvantage is transmitted into child disadvantage. Using a UK cohort study that has rich information on mother¿s early life events, her health, her behaviours that may affect child health, and her child¿s health, we examine the impact of being in low income compared to that of mother child health related behaviours and mother¿s own health on child health. We find children from poorer households have poorer health. But we find the direct impact of income is small. A larger role is played by mother¿s own health and events in her early life. No clear role is played by mother child health production behaviours.child health, income, maternal health, tranmission mechanisms

Is There an Income Gradient in Child Health? It Depends Whom You Ask

A large literature uses parental evaluations of child health status to provide evidence on the socioeconomic determinants of health. If how parents perceive health questions differs by income or education level, then estimates of the socioeconomic gradient are likely to be biased and potentially misleading. In this paper we examine this issue. We directly compare child mental health evaluations from parents, teachers, children and psychiatrists for mental health problems, test whether these differences are systematically related to observable child and parent characteristics, and examine the implications of the different reports for the estimated income gradient. We find that respondents frequently evaluate children differently and while the sign of the income gradient is in the same direction across respondents, systematic differences in evaluations mean that the estimated magnitude and significance of the health-income gradient is highly dependent upon the choice of respondent and the measure of child health.child health, income, reporting bias

Child Mental Health and Educational Attainment: Multiple Observers and the Measurement Error Problem

We examine the effect of survey measurement error on the empirical relationship between child mental health and personal and family characteristics, and between child mental health and educational progress. Our contribution is to use unique UK survey data that contains (potentially biased) assessments of each child's mental state from three observers (parent, teacher and child), together with expert (quasi-)diagnoses, using an assumption of optimal diagnostic behaviour to adjust for reporting bias. We use three alternative restrictions to identify the effect of mental disorders on educational progress. Maternal education and mental health, family income, and major adverse life events, are all significant in explaining child mental health, and child mental health is found to have a large influence on educational progress. Our preferred estimate is that a 1-standard deviation reduction in 'true' latent child mental health leads to a 2-5 months loss in educational progress. We also find a strong tendency for observers to understate the problems of older children and adolescents compared to expert diagnosis.Strengths and Difficulties Questionnaire, education, child mental health, measurement error

Is there an Income Gradient in Child Health? It depends whom you ask

A large literature uses parental evaluations of child health status to provide evidence on the socioeconomic determinants of health. If how parents perceive health questions differs by income or education level, then estimates of the socioeconomic gradient are likely to be biased and potentially misleading. In this paper we examine this issue. We directly compare child mental health evaluations from parents, teachers, children and psychiatrists for mental health problems, test whether these differences are systematically related to observable child and parent characteristics, and examine the implications of the different reports for the estimated income gradient. We find that respondents frequently evaluate children differently and while the sign of the income gradient is in the same direction across respondents, systematic differences in evaluations mean that the estimated magnitude and significance of the health-income gradient is highly dependent upon the choice of respondent and the measure of child health.Child Health, Income, Reporting Bias

Does Violent Crime Deter Physical Activity?

Crime has been argued to have important externalities. We investigate the relationship between violent crime and an important type of behaviour: individuals' participation in their local area through walking and physical activity. We use a sample of nearly 1 million people residing in over 320 small areas in England between 2005 and 2011. We show that concerns about personal safety co-move with police recorded violent crime. To identify the causal effect of recorded violent crime on walking and other physical activity we control for individual-level characteristics, non-time varying local authority effects, national time effects and local authority-specific trends. In addition, we exploit a natural experiment that caused a sudden increase in crime - the 2011 England riots - to identify the causal impact of a large exogenous crime shock on physical activity in a triple difference framework. Our results show a substantive deterrent effect of local area violent crime on walking, pointing to important effects of violent crime on non-victims. The adverse effect of an increase in local area violent crime from the 25th to the 75th percentile on walking is equivalent in size to a 6êC fall in average minimum temperature

Genetic Markers as Instrumental Variables:An Application to Child Fat Mass and Academic Achievement

The use of genetic markers as instrumental variables (IV) is receiving increasing attention from economists. This paper examines the conditions that need to be met for genetic variants to be used as instruments. We combine the IV literature with that from genetic epidemiology, with an application to child adiposity (fat mass, determined by a dual-energy X-ray absorptiometry (DXA) scan) and academic performance. OLS results indicate that leaner children perform slightly better in school tests compared to their more adipose counterparts, but the IV findings show no evidence that fat mass affects academic outcomes.Instrumental variables; Mendelian randomization; Genetic variant; Potential outcomes; Academic performance; Educational attainment; Adiposity; Fat mass; Body Mass Index; ALSPAC

Comparing subjective and objective measures of health: evidence from hypertension for the income/health gradient

Economists rely heavily on self-reported measures of health status to examine the relationship between income and health. In this paper we directly compare survey responses to a self-reported measure of health that is commonly available in nationally-representative individual and household surveys, with objective measures of the same health condition. Our particular focus is on hypertension, which is the most prevalent health condition in Western countries. Using data from the Health Survey for England, we find that there is a substantial difference in the percentage of adult survey respondents reporting that they have hypertension as a chronic health condition compared to that from repeated measurements by a trained nurse. Around 85% of individuals measured as having hypertension do not report having it as a chronic illness. Importantly, we find no evidence of an income/health gradient using self-reported hypertension, but a large (about 14 times the size) gradient when using objectively measured hypertension. We also find that the probability of false negative reporting, that is an individual not reporting to have chronic hypertension when in fact they have it, is significantly higher for individuals living in low income households. Given the wide use of such self-reported chronic health conditions in applied research, and the asymptomatic nature of many major illnesses such as hypertension, diabetes, heart disease and cancer at moderate and sometimes very elevated levels, we show that using commonly available self-reported chronic health measures is likely to lead to an underestimate of true income-related inequalities in health. This has important implications for policy advice

Genetic Markers as Instrumental Variables

The use of genetic markers as instrumental variables (IV) is receiving increasing attention from epidemiologists, economists, statisticians and social scientists. This paper examines the conditions that need to be met for genetic variants to be used as instruments. Although these have been discussed in the epidemiological, medical and statistical literature, they have not been well-defined in the economics and social science literature. The increasing availability of biomedical data however, makes understanding of these conditions crucial to the successful use of genotypes as instruments for modifiable risk factors. We combine the econometric IV literature with that from genetic epidemiology using a potential outcomes framework and review the IV conditions in the context of a social science application, examining the effect of child fat mass on academic performance.ALSPAC; Fat mass; Genetic Variants; Instrumental Variables; Mendelian Randomization; Potential Outcomes