By David Baker and William Smith
Widespread formal education is shaping population dynamics globally. From new trends in mortality and health disparities in the United States to demographic and epidemiological population transitions in less developed nations, access to schooling is proving to be one of demography’s most potent causal factors.
Research has repeatedly found education to be associated with changes in health, mortality, and fertility patterns, prompting a question central to demography: does education cause these changes and, if so, how? At a recent Robert Wood Johnson Foundation forum on Health and Society, invited demographers and epidemiologists examined the state of research on this question, and a likely three-part hypothesis is emerging:
1) Education has its greatest direct causal effect on health and related demographic processes through its ability to enhance individuals’ broad fundamental cognitive skills.
2) Because of increased worldwide emphasis on human capital formation, education also has a significant indirect effect through its influence on material resources.
3) The political, economic, and epidemiological environments of a population at a particular time can shift the balance between education’s direct and indirect effects and even cause them to function in conflicting directions.
Led by Professor David Baker of the Penn State University (PSU) Population Research Institute, a multidisciplinary, multinational team of researchers at PSU and other universities is investigating this hypothesis and how education has influenced populations over the 200-year “worldwide education revolution.” Prior demographic research focused on the primacy of education’s indirect effect through material resources but neglected its direct effect on cognition and decision making as well as what conditions might mitigate these effects. A series of recent publications by the PSU team helps fill this gap.
Educationally Enhanced Cognitive Functioning
Demography and health research often assumes that the education process only involves accruing information transferred from teachers to students or behavior modification whereby rewards and punishments shape desired behavior. Both of these images fail to see education as a dynamic process that changes how individuals view, think about, and interact with the world through enhanced decision making and problem solving. To focus on the transformative power of education, the team (including cognitive scientists) developed and tested a cognitive hypothesis, suggesting that “over the course of teaching academic material such as mathematics and reading, even in small amounts, schooling enhances fundamental skills associated with reasoning and solving novel problems” (Baker, Collins & Leon 2009, pg. 13; Eslinger et al. 2009). To better understand the neuro-cognitive process that occurs during formal schooling, Baker, Salinas, and Eslinger (2012) show that schooling “enhances not only the breadth and depth of specific content knowledge but perhaps more importantly the very nature of cognitive processing and especially the individual’s executive functioning and high order cognitive capacities” (pg. 15).
Educationally Enhanced Decision Making about Health
Investigating how education could influence health, Peters et al. (2010) conducted a naturally occurring experiment in rural Ghana and found that individuals with greater exposure to schooling generally show stronger cognitive abilities, leading to more effective decision making about their risks of HIV/AIDS infection. Analyzing Demographic Health Survey data from nine sub-Saharan African countries, Baker, Leon, and Collins (2010) expanded on Peters’ work at the population level, finding that education’s positive effect increases reasoning about health risks (far beyond knowing simple facts about the disease), which in turn increases condom use by adults participating in high-risk sex. A similar study found the same cognitive effects of education on mothers’ effective use of child health services in Ghana (Smith-Greenaway, Leon & Baker 2012). These findings also call into question the billions of dollars non-Government organizations in the region have spent spreading simplistic facts which make it difficult for undereducated populations to understand about sex and the risks of HIV/AIDS (Halabi et al. 2012).
The Education Effect and the Population’s Environment
The epidemiological history of many health risks, such as tobacco use, high-fat diets, and risky sexual behavior, consistently show that more highly educated and wealthier individuals in a population initially engage in more risky behaviors. However, as public health information improves, individuals with more education are the first to enact preventive behavior (Smith, Salinas & Baker 2012). The 30-year HIV/AIDS pandemic in sub-Saharan Africa is an intriguing case in point. Early in the epidemic, educated individuals had a higher risk of contracting HIV/AIDS, but by the mid-1990s, the education effect reversed and became its usual social vaccine. This shift from the indirect effect of education on wealth and higher risk to a direct effect on health reasoning and lower risk was caused by an accompanying shift in the political and public health environment in the region favoring different educational influences (Leon et al. under review).
Conclusion: The Demography of the Schooled Society
“The Education Effect on Population Health” in Development and Population Review suggests that the historical timing of the education revolution makes it a prime causal candidate of the extensive decline in crude death and birth rates that make up the first demographic transition in the West (Baker et al. 2011). Education enhances individuals’ cognitive decision-making capacity, making them more capable and likely to participate in healthy behavior. As more individuals are exposed to substantial amounts of schooling, a population’s health trajectory is significantly changed.
Baker, D., Collins, J. M., & Leon, J. (2009). Risk factor or social vaccine? The historical progression of the role of education in HIV and AIDS infection in Sub-Saharan Africa. Prospects: Quarterly Review of Comparative Education 38, 467–486.
Baker, D., Leon, J., Smith-Greenway, E., Collins, J., & Movit, M. (2011). The education effect on population health: A reassessment. Population and Development Review 37(2), 307–332.
Baker, D., Leon, J., & Collins, J. (2010). Facts, attitudes, and health reasoning about HIV and AIDS: Explaining the education effect on condom use among adults in sub-Saharan Africa. AIDS and Behavior 11, 1–9.
Baker, D., Salinas, D., & Eslinger, P. (2012). An envisioned bridge: Schooling as a neurocognitive developmental institution. Developmental Cognitive Neuroscience 2S, S6-S17.
Eslinger, P., Blair, C., Wang, J., Lipovsky, B., Realmuto, J., Baker, D., Thorne, S., Gamson, D., Zimmerman, E., Rohrer, L., Yang, Q. (2009) Developmental shifts in fMRI activations during visuospatial relational reasoning. Brain and Cognition 69 (1), 1-10.
Halabi, S, Smith, W., Collins, J., Baker, D. & Bedford, J. (2012). A document analysis of HIV/AIDS education interventions in Ghana.” Health Education Journal, first published on July 10, 2012 as doi:10.1177/0017896912450248.
Leon, J., Baker, D., Salinas, D., & Henck, A. (under review). Is education a risk factor or a social vaccine against HIV/AIDS in Sub-Saharan Africa? The effect of schooling across political-informational periods.
Peters, E., Baker, D., Dieckmann, J., Leon, J., & Collins, J. (2010). Explaining the effect of education on health: A field study in Ghana. Psychological Science 21(10), 1369–1376.
Smith, W., Salinas, D. & Baker, D. (2012). Multiple effects of education on disease: The intriguing case of HIV/AIDS in Sub-Saharan Africa. In A. Wiseman and R. Glover (eds.) The Impact of HIV/AIDS on Education Worldwide (pp. 77-102). United Kingdom: Emerald Publishing.
Smith-Greenaway, E., Leon, J. and Baker, D. (2012). Understanding the association between maternal education and use of health services in Ghana: Exploring the role of health knowledge. Journal of Biosocial Science 1 (1), 1-15.
 Article originally published December 6, 2012 at on the Population Research Institute website: http://www.pop.psu.edu/news/2012/the-causal-effect-of-education-on-population-dynamics