Essays on inequality of opportunity in health and human development

This thesis comprises four essays on inequality of opportunity in health and human development.

Chapter 2 proposes an empirical implementation of the concept of inequality of opportunity in health and applies it to data from the UK National Child Development Study. Drawing on the distinction between circumstance and effort variables in John Roemer's work on equality of opportunity, circumstances are proxied by parental socio-economic status and childhood health; effort is proxied by health-related lifestyles and educational attainment. Stochastic dominance tests are used to detect inequality of opportunity in the conditional distributions of self-assessed health in adulthood. Alternative measures of inequality of opportunity are proposed. Parametric models are estimated to quantify the triangular relationship between circumstances, effort and health. The results indicate considerable and persistent inequality of opportunity in health. Circumstances affect health in adulthood both directly and through effort factors such as educational attainment, suggesting complementary educational policies may be important for reducing health inequalities.

Chapter 3 specifies 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 jointly estimated by full information maximum likelihood with freely correlated error terms. The analysis innovates by accounting for unobserved heterogeneity, thereby addressing the partial-circumstance problem, and by extending the analysis to health outcomes other than self-assessed health, namely long standing illness, disability and mental health.

Chapter 4 explores the existence of long-term health returns to different qualities of education, and examines the role of quality of schooling as a source of inequality of opportunity in health. It provides corroborative evidence of a statistically significant and economically sizable association between quality of education and a number of health and health-related outcomes that remains valid beyond the effects of measured ability, social development and academic qualifications. The results also establish quality of schooling as a leading source of inequality of opportunity in health.

Chapter 5 exploits a natural experiment provided by the fact that cohort-members attended different types of secondary school, as their schooling lay within the transition period of the comprehensive education reform in England and Wales that commenced in the 1960’s. This experiment is used to explore the impact of educational attainment and of school quality on health and health-related behaviour later in life. A combination of matching methods, parametric regressions, and instrumental variable approaches are used to deal with selection effects and to evaluate differences in adult health outcomes and health-related behaviour for cohort members exposed to the old (selective) and to the new (comprehensive) educational systems.