The long-term health effects of attending a selective school: a natural experiment

Butler, J., Black, C., Craig, P. , Dibben, C., Dundas, R. , Hilton Boon, M. and Popham, F. (2020) The long-term health effects of attending a selective school: a natural experiment. BMC Medicine, 18, 77. (doi: 10.1186/s12916-020-01536-7) (PMID:32241252) (PMCID:PMC7118818)

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Abstract

Background: Education is widely associated with better physical and mental health, but isolating its causal effect is difficult because education is linked with many socioeconomic advantages. One way to isolate education’s effect is to consider environments where similar students are assigned to different educational experiences based on objective criteria. Here we measure the health effects of assignment to selective schooling based on test score, a widely debated educational policy. Methods: In 1960s Britain, children were assigned to secondary schools via a test taken at age 11. We used regression discontinuity analysis to measure health differences in 5039 people who were separated into selective and non-selective schools this way. We measured selective schooling’s effect on six outcomes: mid-life self-reports of health, mental health, and life limitation due to health, as well as chronic disease burden derived from hospital records in mid-life and later life, and the likelihood of dying prematurely. The analysis plan was accepted as a registered report while we were blind to the health outcome data. Results: Effect estimates for selective schooling were as follows: self-reported health, 0.1 worse on a 4-point scale (95%CI − 0.2 to 0); mental health, 0.2 worse on a 16-point scale (− 0.5 to 0.1); likelihood of life limitation due to health, 5 percentage points higher (− 1 to 10); mid-life chronic disease diagnoses, 3 fewer/100 people (− 9 to + 4); late-life chronic disease diagnoses, 9 more/100 people (− 3 to + 20); and risk of dying before age 60, no difference (− 2 to 3 percentage points). Extensive sensitivity analyses gave estimates consistent with these results. In summary, effects ranged from 0.10–0.15 standard deviations worse for self-reported health, and from 0.02 standard deviations better to 0.07 worse for records-derived health. However, they were too imprecise to allow the conclusion that selective schooling was detrimental. Conclusions: We found that people who attended selective secondary school had more advantaged economic backgrounds, higher IQs, higher likelihood of getting a university degree, and better health. However, we did not find that selective schooling itself improved health. This lack of a positive influence of selective secondary schooling on health was consistent despite varying a wide range of model assumptions.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Craig, Professor Peter and Popham, Dr Frank and Hilton Boon, Dr Michele and Dundas, Ms Ruth
Authors: Butler, J., Black, C., Craig, P., Dibben, C., Dundas, R., Hilton Boon, M., and Popham, F.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:BMC Medicine
Publisher:BMC
ISSN:1741-7015
ISSN (Online):1741-7015
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in BMC Medicine 18:77
Publisher Policy:Reproduced under a Creative Commons license

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
727671SPHSU Core Renewal: Informing Healthy Public Policy Research ProgrammePeter CraigMedical Research Council (MRC)MC_UU_12017/15IHW - MRC/CSO SPHU
SPHSU 13
SPHSU15