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

• Published in: BMC medicine Vol. 18; no. 1; p. 77
• Main Authors: Butler, Jessica, Black, Corri, Craig, Peter, Dibben, Chris, Dundas, Ruth, Hilton Boon, Michelle, Johnston, Marjorie, Popham, Frank
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03-04-2020; BioMed Central; BMC
• Subjects: Aged; Analysis; Child; Chronic diseases; Chronic illnesses; Colleges & universities; Education; Environmental effects; Female; Health aspects; Health Behavior - physiology; Humans; Male; Medical records; Mental health; Middle Aged; Registered Report; Regression analysis; Schools; Schools - standards; Secondary schools; Sensitivity analysis; Students; Teaching methods; United Kingdom; United Kingdom > UK; England; Scotland
• ISSN: 1741-7015; 1741-7015
• 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.