Despite the growing life expectancy witnessed in the last decades, in many western countries, socio-economic inequalities in health persist. A voluminous body of work describing social and economic determinants of health inequalities exists, but much less is known about the impact of social policies, and specifically educational reforms, on health. In this paper, we examine whether the introduction of comprehensive secondary education in Britain has led to any change in health inequalities measured by a variety of both objective and subjective indicators. Equalizing educational opportunities is an argument for a comprehensive school system. Given that education is an important social determinant of health, it is hypothesised that a more equitable comprehensive system could reduce health inequalities in adulthood. To test this hypothesis, we exploited the change from a largely selective to a largely comprehensive system that occurred in the UK from the mid-1960s onwards and compare inequalities in health outcomes of two birth cohorts (1958 and 1970) who attended either system. We ask the following question: did the introduction of a comprehensive education system in Britain reduce health inequalities?
This paper was published in SSM – Population Health in September 2021 and can be accessed via the link below:
Types of inequalities
Sources of inequalities: People from different social classes of origin and social classes of destination
Inequalities of outcomes: relative and absolute differences in six health and wellbeing outcomes, i.e. body mass index (BMI), smoking behaviour, self-rated health, wellbeing measured using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and life satisfaction (past and future) and two education outcomes, i.e. age of leaving full-time education and highest qualification by age 38.
We used data from two UK longitudinal birth cohorts, the 1958 National Child Development Study and the 1970 British Cohort Study, and Inverse probability weighting to control confounding by socioeconomic and educational background, and ability test score taken prior to secondary school entry. Multiple imputations and inverse probability weighting was also used to adjust for missing data and attrition. We studied relative and absolute health inequalities using the concentration index with social class and achieved education as our measures of social-economic stratification.
Our results show that there are clear differences between the two cohorts in the mean of a number of outcomes, i.e. a rise in age leaving full-time education, an increase in qualification levels, increases in BMI and future life satisfaction, and a reduction in smoking. However, we found little evidence that health and wellbeing outcomes were different between people who attended the comprehensive school system compared to the selective system both in terms of average outcomes and inequality in outcomes. This was despite we found differences in the educational outcomes. On average, education outcomes were slightly higher in the selective system than in the comprehensive system but inequalities were lower in the comprehensive system. These results were consistent across the two cohorts.
Educational policies on their own are unlikely to reduce inequalities in health outcomes. A range of policies are needed which tackle economic and social inequalities in the wider society.
For further information contact Professor Cristina Iannelli