Hans van Kippersluis

Long Run Returns to Education: Does Schooling Lead to an Extended Old Age?

While there is no doubt that health is strongly correlated with education, whether schooling exerts a causal impact on health is not firmly established. We exploit a Dutch compulsory schooling law to estimate the causal effect of education on mortality. The reform provides a powerful instrument, significantly raising years of schooling, which, in turn, has a significant and robust negative effect on mortality. For men surviving to age 81, an extra year of schooling is estimated to reduce the probability of dying before the age of 89 by almost 3 percentage points relative to a baseline of 50 percent.

Socioeconomic Differences in Health Over the Life Cycle in an Egalitarian Country

A strong cross-sectional relationship between health and socioeconomic status is firmly established. This paper adopts a life cycle perspective to investigate whether the socioeconomically disadvantaged, on top of a lower health level, experience a sharper deterioration of health over time. Data are drawn from the Dutch Central Bureau of Statistics (CBS) Health Interview Surveys covering the period 1983-2000. The analysis focuses on the self-rated health and disability of persons aged 16-80. We show that in the Netherlands, as in the US, the socioeconomic gradient in health widens until late-middle age and narrows thereafter. The analysis and the available evidence suggests that the widening gradient is attributable both to health-related withdrawal from the labor force, resulting in lower incomes, and the cumulative protective effect of education on health outcomes. The less educated appear to suffer a double health penalty in that they begin adult life with a slightly lower health level, which subsequently declines at a faster rate.

Health and Income Across the Life Cycle and Generations in Europe

An age-cohort decomposition applied to panel data identifies how the mean, overall inequality and income-related inequality of self-assessed health evolve over the life cycle and differ across generations in 11 EU countries. There is a moderate and steady decline in mean health until the age of 70 or so and a steep acceleration in the rate of deterioration thereafter. In southern Europe and Ireland, where development has been most rapid, the average health of generations born in more recent decades is significantly better than that of older generations. This is not observed in the northern European countries. In almost all countries, health is more dispersed among older generations indicating that Europe has experienced a reduction in overall health inequality over time. Although there is no consistent evidence that health inequality increases as a given cohort ages, this is true in the three largest countries--UK, France and Germany. In the former two countries and the Netherlands, at least for males, the income gradient in health peaks around retirement age, as in the US. In most European countries, unlike the US, there is no evidence that income-related health inequality is greater among younger than older generations.

Long-Term and Spillover Effects of Health Shocks on Employment and Income

We use matching combined with difference-in-differences to identify the causal effects of sudden illness, represented by acute hospitalizations, on employment and income up to six years after the health shock using linked Dutch hospital and tax register data. An acute hospital admission lowers the employment probability by seven percentage points and results in a 5 percent loss of personal income two years after the shock. There is no subsequent recovery in either employment or income. There are large spillover effects: Household income falls by 50 percent more than the income of the disabled person.

Self-employment and Health: Barriers or Benefits?

The self-employed are often reported to be healthier than wageworkers; however, the cause of this health difference is largely unknown. The longitudinal nature of the US Health and Retirement Study allows us to gauge the plausibility of two competing explanations for this difference: a contextual effect of self-employment on health (benefit effect), or a health-related selection of individuals into self-employment (barrier effect). Our main finding is that the selection of comparatively healthier individuals into self-employment accounts for the positive cross-sectional difference. The results rule out a positive contextual effect of self-employment on health, and we present tentative evidence that, if anything, engaging in self-employment is bad for ones health. Given the importance of the self-employed in the economy, these findings contribute to our understanding of the vitality of the labor force. Copyright

A Theory of Socioeconomic Disparities in Health Over the Life Cycle

Understanding of the substantial disparity in health between low and high socioeconomic status (SES) groups is hampered by the lack of a sufficiently comprehensive theoretical framework to interpret empirical facts and to predict yet untested relations. The authors present a life-cycle model that incorporates multiple mechanisms explaining (jointly) a large part of the observed disparities in health by SES. In their model, lifestyle factors, working conditions, retirement, living conditions and curative care are mechanisms through which SES, health and mortality are related. Their model predicts a widening and possibly a subsequent narrowing with age of the gradient in health by SES.

Health Inequalities through the Lens of Health Capital Theory: Issues, Solutions, and Future Directions

We explore what health-capital theory has to offer in terms of informing and directing research into health inequality. We argue that economic theory can help in identifying mechanisms through which specific socioeconomic indicators and health interact. Our reading of the literature, and our own work, leads us to conclude that non-degenerate versions of the Grossman model (1972a;b) and its extensions can explain many salient stylized facts on health inequalities. Yet, further development is required in at least two directions. First, a childhood phase needs to be incorporated, in recognition of the importance of childhood endowments and investments in the determination of later-life socioeconomic and health outcomes. Second, a unified theory of joint investment in skill (or human) capital and in health capital could provide a basis for a theory of the relationship between education and health.

Why the Rich Drink More but Smoke Less: The Impact of Wealth on Health Behaviors

Wealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by developing a theory of health behavior, and exploiting both lottery winnings and inheritances to test the theory. It distinguishes between the direct monetary cost and the indirect health cost (value of health lost) of unhealthy consumption. The health cost increases with wealth and the degree of unhealthiness, leading wealthier individuals to consume more healthy and moderately unhealthy, but fewer severely unhealthy goods. The empirical evidence presented suggests that differences in health costs may indeed provide an explanation for behavioral differences, and ultimately health outcomes, between wealth groups.

The Wear and Tear on Health: What is the Role of Occupation?

Although it seems evident that occupation affects health, effect estimates are scarce. We use a job characteristics matrix linked to German longitudinal data spanning 26 years to characterise occupations by their physical and psychosocial burdens. Employing a dynamic model to control for factors that simultaneously affect health and selection into occupation, we find that manual work and low job control both have a substantial negative effect on health that gets stronger with age. The effects of late-career exposure to high physical demands and low job control are comparable to a health deterioration due to ageing 12 and 19 months, respectively.

Pleiotropy-robust Mendelian randomization

Background The potential of Mendelian randomization studies is rapidly expanding due to: (i) the growing power of genome-wide association study (GWAS) meta-analyses to detect genetic variants associated with several exposures; and (ii) the increasing availability of these genetic variants in large-scale surveys. However, without a proper biological understanding of the pleiotropic working of genetic variants, a fundamental assumption of Mendelian randomization (the exclusion restriction) can always be contested. Methods We build upon and synthesize recent advances in the literature on instrumental variables (IVs) estimation that test and relax the exclusion restriction. Our pleiotropy-robust Mendelian randomization (PRMR) method first estimates the degree of pleiotropy, and in turn corrects for it. If (i) a subsample exists for which the genetic variants do not affect the exposure; (ii) the selection into this subsample is not a joint consequence of the IV and the outcome; (iii) pleiotropic effects are homogeneous, PRMR obtains unbiased estimates of causal effects. Results Simulations show that existing MR methods produce biased estimators for realistic forms of pleiotropy. Under the aforementioned assumptions, PRMR produces unbiased estimators. We illustrate the practical use of PRMR by estimating the causal effect of: (i) tobacco exposure on body mass index (BMI); (ii) prostate cancer on self-reported health; and (iii) educational attainment on BMI in the UK Biobank data. Conclusions PRMR allows for instrumental variables that violate the exclusion restriction due to pleiotropy, and it corrects for pleiotropy in the estimation of the causal effect. If the degree of pleiotropy is unknown, PRMR can still be used as a sensitivity analysis.