1. 1 Health, Aging and Socio- Economic Status in Mexico Sonia Laszlo (McGill) Franque Grimard (McGill) Wilfredo Lim (Columbia)

2. 2 Motivation – Research questions What are the long-term health effects of socio-economic status (SES) during childhood? How much persists beyond its effect on human capital investment and earnings capacity? Long term effects of education?

3. 3 Motivation - Literature Income gradient: health outcomes positively affected by income or SES  Via child health: Case et al. AER ’02; Currie & Stabile AER ’03  Child health  education (Glewwe & Miguel, HDE ’08)  Child health & education  income (large literature) But: income and health jointly determined Recently: in utero or childhood SES  Maccini & Yang (AER forthcoming), Almond (JPE ’06): long term health effects of conditions prevailing in utero  Akresh & Verwimp (’07): conditions prevailing in early childhood have long run health outcomes Review: Strauss and Thomas (HDE ’08)

4. 4 Motivation – Aging population We focus on the aging population (50+) in Mexico Developing countries:  Changing burden of disease  Pressures on medical resources and financing  Yet little literature in economics on these countries Contribution:  Build on Case et al. (JHE ’05) and Buckley et al. (JHE ’04)  Long-term effects of childhood SES on health of the elderly

5. 5 Why aging in a developing country? Epidemiological transition :  Demographic transition  shift in disease burden from infectious to non-communicable diseases. Demographic transition: Total fertility rateLife expectancy Years55-6075-8095-0055-6075-8095-00 Mexico6.805.252.6755.265.073.7 Centr Am6.314.902.9054.564.171.9 South Am5.744.272.6555.162.970.3 North Am3.721.781.9569.773.476.7 Gap w NA3.083.470.7214.58.43.0 Source: UN, ESA

6. 6 What We Do Examine Determinants of:  Good health for individuals aged 50+ in Mexico in 2001 and 2003  Conditional on good or bad health in 2001  transition (à la Buckley et al., JHE ’04) Does education matter? Does childhood SES matter?

7. 7 Directions of ‘causality’ AdulthoodChildhood‘Golden Years’ Income Health Education Health CSES

8. 8 Directions of ‘causality’ AdulthoodChildhood‘Golden Years’ Income Health Education Health CSES

9. 9 Directions of ‘causality’ Education AdulthoodChildhood‘Golden Years’ Income Health Education Health CSES Parental SES Shocks

10. 10 Modeled after the U.S. Health and Retirement Study. We use the two-year panel data set (2001 and 2003) on Mexicans born prior to 1951 No geographic location codes – limitation Self-reported health: “Would you say your health is…”  Excellent1  Very good2  Good3  Fair4  Poor5 We know self reported health measures are measured with error (Baker et al., JHR ’ 04)  We check for robustness to some sensitivity analysis in our measure Mexican Health and Aging Study (MHAS) Good Health = 1 Good Health = 0

11. 11 MHAS - We use: Childhood SES  “Before age 10…” :  Did your residence have a toilet?  Did you regularly go to bed hungry?  Did anyone sleep in the same room where you cooked?  Did you regularly wear shoes? Current SES  Education, age, gender, marital status  Per capita household assets, ‘income’ Parental background  Mom’s and dad’s education  Dad’s occupation

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13. 13 Determinants of (Unconditional) Good Health

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17. 17 Transition from health status in 2001 to good health in 2003 Follow Buckley et al. (’04) Condition on good / bad health in 2001: Conditioning to some extent controls for endogeneity of education/SES Control for remaining endogeneity in education using parental characteristics  Parental residence primarily urban, parental education, dad’s occupation (agriculture, construction, services, business, office, etc…)

18. 18 Results

19. 19 Is fertility playing a role? AdulthoodChildhood‘Golden Years’ Income Health Education Health CSES

20. 20 Is fertility playing a role? AdulthoodChildhood‘Golden Years’ Income Health Education Health CSES Fertility

21. 21 Is fertility playing a role? Cannot answer question directly – lack of data on reproductive health in MHAS Yet:  Gender differences in LR determinants of health during ‘golden years’  Stronger (>primary) education gradient for women  Weak (but negative) effects of number of children ever born on ‘golden years’ health and transition from bad health And:  CSES strongly significant effect on number of children ever born

22. 22 Robustness checks Education endogenous? CSES endogenous? Number of children ever born endogenous? Use parental background as IV Results

23. 23 Conclusions Childhood SES  Education  adult health  Poverty during childhood matters above and beyond its effects on education (and income) Effect pronounced for transition from good to good health Find differential gender effects Policy?

24. 24 Validity of Subjective Health Measure