Essay On Early Life Health Interventions And Academic Achievement PDF

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Name (Student ID) EC4353 Health Economics Referee Report 1 Title: Early Life Health Interventions and Academic Achievement Authors: Prashant Bharadwaj, Katrine Vellesen Løken, Christopher Neilson Source: The American Economic Review, Vol. 103, No. 5 (August 2013), pp. 1862-1891 Published by: American Economic Association The main question this paper wants to answer is whether early life health interventions (neonatal and infant healthcare) affect life outcomes later (short term: mortality, long term: academic achievement) as there is currently a huge gap in this area of healthcare between countries and efforts are made through public policies to improve early childhood health worldwide. Past research discovered that variation in educational outcomes could be explained by students’ individual initial conditions, and one of the conditions is healthcare. Other literature also revealed how early health interventions have an impact on later life outcomes but there were only a few linking said interventions and academic achievement, hence another reason to conduct this study. The literature reviews used in this paper were relevant and extensive with varied sources from different time periods, making it a credible paper. Data on births, deaths, demographics of parents and infants and academic performances from Chile and Norway, the two countries used in this paper, were taken from official ministries and national tests, and thus are largely trustworthy. Causal effect of health interventions is not easy to establish due to ethical reasons in random assignment. In order to prevent confounding, the researchers provided additional medical care only to infants with a Very Low Birth Weight status, defined as birth weight less than 1500 grams. This guideline has been set by many countries and could also be found in Chile and Norway. They adopted a regression discontinuity design as the main experimental approach, with the assumption that an infant born with a birth weight of 1490 grams is identical to one born with a birth weight of 1510 grams, except for the additional medical care the former might receive. Birth weight is unlikely to be manipulated and hence not a choice variable. Infant mortality, defined as death before the first year of life, was found to be 4.4 percentage points and 3.1 percentage points lower for children below 1500g compared to children just above 1500g in Chile and Norway respectively, and is considered to be a relatively sizeable effect. Children below 1500g also performed better compared to their counterparts above 1500g academic-wise in both countries. These results suggest that early childhood is an important period that determines life outcomes and places emphasis on the responsibility of governments to continue promoting early health interventions to achieve better outcomes in education as the researchers feel inequalities in labour market or life opportunities might stem from differences in access to these interventions. The researchers conducted many robustness checks such as density tests, discontinuities in predetermined variables and inclusion and exclusion of covariates to test the validity of assumption and empirical strategy, which are extremely critical for regression discontinuity experiments. They also recognized the limitations of this paper, such as being unable to provide details on the medical treatments and the possibility of these treatments becoming more advanced as time passes, which could have affected the results. Regardless of this, their findings on academic achievement are still relevant and applicable.

In addition, the researchers presented solutions for biasness that might arise from this experiment. Firstly, there could be composition bias as composition of children who go to school are affected if treatment is effective in lowering mortality. To get around this, they assigned counterfactual scores to children who passed away above the cutoff to see how well they would have flare to smooth out discontinuity in test scores. Secondly, bias due to selection into survival could be introduced as children who survive are likely to get different scores than those who did not survive. However, this bias is likely to cause an underestimation of the true effect as the weakest children below 1500g who survived might get the worst scores among their group while the weakest children above 1500g might pass away and raise the average scores for their group. Thirdly, parents could be influenced by the treatment and make investment decisions such as choosing a better school for their children or spend more time doing educational activities with them, which would lead to them performing better academically. It was found that parents do not invest differentially around the cutoff for the mentioned measures. The researchers contributed to this area of health economics by showing us the effect of improved neonatal healthcare on mortality and academic achievement through causal evidence. Better health in the early days enhances cognitive development and increases one’s potential to succeed in life. This regression discontinuity design experiment is comparable to a randomized controlled trial in measuring the treatment effect as it was set up and analyzed appropriately. It does not require ex ante randomization and circumvents ethical issues arising from random assignment. However, it should be noted that there might be caveats affecting the results, an example being non-linear relationships getting mistaken as discontinuities. Falsification tests could also be conducted to improve the validity of the experiment. The similar results between Chile and Norway despite being at different stages of economic development when the data was collected imply that these findings are generalizable to other countries, which would be of paramount significance when it comes to healthcare and education policy planning. Possible extensions such as studying which interventions would lead to the greatest impact were also mentioned in the paper, acknowledging that their research is insufficient and more should be done in this area. This paper opens up the gateway to the link between early childhood healthcare and education-related outcomes (e.g. schooling, job hunt, skills upgrade). Health’s pivotal role could be seen clearly as the world becomes increasingly globalized and education becomes progressively important to survive in the future. Hence it is crucial that we adopt the right interventions and implement them at the start to ensure children have access to healthcare from young....