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

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. Background Education is associated with physical and mental health and life expectancy in countries around the world, and the role of education in improving health is a focus of diverse research and global policy [1-6]. However, there is vigorous debate about the causal effects of educational reforms. Because children from socioeconomically advantaged families are more likely to attend betterresourced schools, be educated longer, and gain more qualificatio ns, the association between education and health may simply reflect background advantages rather than effects of educational policy itself [4, 7-9].

Does comprehensive education reduce health inequalities?

“…3 ) but these seemed not to translate into reduced health inequalities. Similarly, recent UK research comparing outcomes in the selective system only for those who could have gone to an academic school, based on having a cognitive ability score near the cut off but some of whom did not obtain a place, found evidence of effects on education by school type but no effects on health ( Butler et al, 2020 ; Clark and Royer, 2013 ; Pastore & Jones, 2019 ). While there was evidence of educational inequalities in BMI being lower in one cohort, across the other health outcomes there was little difference between the school systems whether we assessed inequality by education or social class.…”

Associations of schooling type, qualification type and subsequent health in mid-adulthood: evidence from the 1970 British Cohort Study

“…Fewer studies have explicitly addressed this association between the type of education and subsequent health. [19][20][21][22] Using self-rated health in mid-adulthood as the main outcome measure, most studies have found a small association between attending a selective school and subsequent health, with those attending more selective schools reporting higher self-reported health. [19][20][21][22] The magnitude and direction of the associations tend to vary across different health outcomes and few used objective measures.…”

“…[19][20][21][22] Using self-rated health in mid-adulthood as the main outcome measure, most studies have found a small association between attending a selective school and subsequent health, with those attending more selective schools reporting higher self-reported health. [19][20][21][22] The magnitude and direction of the associations tend to vary across different health outcomes and few used objective measures. It was also found that attending an advantageous secondary school or a highly selective university was associated with better cognitive function in old age.…”

“…Previous British studies using the 1958 National Child Development Study or the Aberdeen Children of the 1950s birth cohort study have found a weak positive association between attending a selective school and self-rated health in later life. [19][20][21] These studies used the comprehensive reform in the UK as natural experiment, comparing those exposed to a selective or non-selective schooling system, which is equivalent to the distinction between grammar schools and comprehensive schools. An analysis of our data suggested that there was not a clear discontinuity which could be used in such a design (see online supplemental figure S2).…”

Published registered reports are rare, limited to one journal group, and inadequate for randomized controlled trials in the clinical field

“…None of the trials included was from PLOS One. To date, BMC Medicine has only published 3 Registered Reports (16)(17)(18), none concerned a clinical trial.…”