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.Hypertension, Objective Health, Self-Reported Health, Reporting Error, Income

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 and a strong tendency for observers to understate the problems of older children and adolescents compared to expert diagnosis.Child mental health; Education; Strengths and Difficulties Questionnaire; Measurement error

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.

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

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

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 in uence 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

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

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