Centre for Health Data Science, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK.
BMC Med. 2020 Apr 3;18(1):77. doi: 10.1186/s12916-020-01536-7.
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.
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.
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.
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.
教育与身心健康普遍相关，但由于教育与许多社会经济优势相关，因此难以确定其因果效应。一种将教育影响隔离的方法是考虑在基于客观标准的情况下，将相似的学生分配到不同的教育环境中。在这里，我们根据广泛争议的教育政策——考试分数，衡量按成绩分配到重点学校对健康的影响。
20 世纪 60 年代的英国，孩子们通过 11 岁时的考试进入中学。我们使用回归不连续性分析来衡量通过这种方式被分到重点和非重点学校的 5039 个人之间的健康差异。我们测量了重点学校对以下六个结果的影响：中年时的自我报告健康状况、心理健康状况和因健康问题导致的生活受限程度，以及从中年到晚年的慢性疾病负担和过早死亡的可能性。该分析计划在我们对健康结果数据一无所知的情况下，作为注册报告被接受。
重点学校教育的效果估计如下：自我报告健康状况差 0.1 分（4 分制，95%置信区间-0.2 至 0 分）；心理健康状况差 0.2 分（16 分制，-0.5 至 0.1 分）；因健康问题导致生活受限的可能性高 5 个百分点（-1 至 10 分）；中年时的慢性疾病诊断减少 3 例/100 人（-9 至 +4）；晚年时的慢性疾病诊断增加 9 例/100 人（-3 至 +20 人）；60 岁前死亡的风险无差异（-2 至 3 个百分点）。广泛的敏感性分析得出的结果与这些结果一致。总的来说，自我报告健康状况差 0.10-0.15 标准差，记录衍生健康状况好 0.02 标准差，差 0.07 标准差。然而，这些结果的精度不够高，无法得出选择性学校教育有害的结论。
我们发现，就读于重点中学的人具有更优越的经济背景、更高的智商、更高的获得大学学位的可能性和更好的健康状况。然而，我们并没有发现重点中学教育本身能改善健康状况。尽管对各种模型假设进行了广泛的调整，但这种重点中学教育对健康没有积极影响的情况仍然一致。
