Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115, USA.
Ann N Y Acad Sci. 2010 Feb;1186:56-68. doi: 10.1111/j.1749-6632.2009.05340.x.
An association between higher educational attainment and better health status has been repeatedly reported in the literature. Similarly, thousands of studies have found a relationship between higher income and better health. However, whether these repeated observations amount to causality remains a challenge, not least because of the practical limitations of randomizing people to receive different amounts of money or schooling. In this essay, we review the potential causal mechanisms linking schooling and income to health, and discuss the twin challenges to causal inference in observational studies, in other words, reverse causation and omitted variable bias. We provide a survey of the empirical attempts to identify the causal effects of schooling and income on health, including natural experiments. There is evidence to suggest that schooling is causally related to improvements in health outcomes. Evidence also suggests that raising the incomes of the poor leads to improvement in their health outcomes. Much remains unknown beyond these crude findings, however; for example, what type of education matters for health, or whether there is a difference between the health impacts of temporary income shocks versus changes in long-term income.
受教育程度与健康状况之间存在关联，这在文献中已被反复报道。同样，数千项研究发现，收入与健康之间也存在关联。然而，这些反复出现的观察结果是否能证明因果关系仍然是一个挑战，尤其是因为随机分配人们接受不同数量的金钱或教育存在实际限制。在本文中，我们回顾了将教育和收入与健康联系起来的潜在因果机制，并讨论了观察性研究中因果推断面临的双重挑战，即反向因果关系和遗漏变量偏差。我们对确定教育和收入对健康的因果影响的实证尝试进行了调查，包括自然实验。有证据表明，教育与健康结果的改善存在因果关系。证据还表明，提高穷人的收入会改善他们的健康结果。然而，除了这些粗略的发现之外，还有很多未知的情况；例如，什么样的教育对健康有影响，或者短期收入冲击与长期收入变化对健康的影响是否存在差异。
