Health at Advanced Ages

Summary And Implications For Health Policy

The literature suggests that long-run effects of early-childhood conditions are important for morbidity and mortality later in life. There are roughly two channels: direct long-run effects due to ‘programming,’ and indirect effects via education, health, and SES at different points in the life course.

Direct effects are likely to be quantitatively relevant for developing countries, where exposure to extreme conditions is more common, and where behavior later in life may be less successful in mitigating early-life effects. There are, however, some other studies that point toward the relevance of environmental insults, disease exposure and malnutrition for cohorts born in the twentieth century in developed countries. Of importance for healthcare policy is that this suggests that one can expect mortality differentials across different cohorts and that the younger cohorts do not necessarily live longer in better health. Also, policies focused on vulnerable families (those living in poor circumstances, exposed to stress, and employing bad health behaviors) can be effective in improving the health of the next generation.

Childhood conditions may affect child health, and this may persist into adulthood. The evidence on the effect of family income is mixed, at least for developed countries – although any effect that might be found is expected to be modest. Most studies point at a potentially strong role for the family-specific environment. This includes parenting skills, health behaviors, and maternal and paternal health. Maternal health is probably the most important determinant for child health. This does not mean that there is no role for health policies. Policies aimed at improving the health of young adolescents can be effective in improving the health of the next generation. These interventions may reverse the impact of a poor start early in life and improve health in adolescence and beyond.

Education is undoubtedly one of the strongest determinants of health in later life. Education increases income and labor market opportunities and positively affects health enhancing behavior. The effect of education on health behavior is causal and likely to be of core importance for health later in life. Policies focusing on educational outcomes should intervene at early ages. Recent work Heckman et al. (2006) shows that early intervention programs targeted to disadvantaged children have their biggest impact on noncognitive skills such as motivation, self-control, and time preferences . Studies cited in The Effect of Education on Later Health and Mortality show the importance of these factors for health behaviors. Heckman et al. (2006) show that these noncognitive skills strongly influence schooling decisions and later wages.

In sum, with new cohorts one should focus on early health and education interventions. It would be useful to screen babies and young children at their household circumstances, to determine whether nutrition, heating, stress levels, and other indicators are at acceptable levels. Programs targeted to children of disadvantaged households should be implemented at an early age. Among existing cohorts, it is useful to screen individuals born in particularly adverse conditions, to verify whether they are susceptible to cardiovascular disease and other diseases thought to be programmed early in life.

It is important to emphasize that even if early-life conditions have a small overall effect on the per-period morbidity or mortality rate later in life, it may nevertheless be very important from a policy point of view to intervene in the lives of individuals with an adverse starting position. After all, the benefits of such interventions will be reaped over a very long time period, and intervention is facilitated by the fact that there is a time interval in between a particular cause and the moment its effect materializes. This is quite different from the instantaneous effects of current events on the health of elderly individuals, like a summer with unusually high temperatures. Such instantaneous effects may be large, but they may be relevant only over a short period, and policy makers would have to react very quickly to prevent the negative health implications.


  1. Almond, D. V. (2002) Cohort differences in health: a duration analysis using the national longitudinal mortality study. Working Paper, University of Chicago, Chicago.
  2. Bengtsson, T. and Lindstro¨m, M. (2000). Childhood misery and disease in later life: The effects on mortality in old age of hazards experienced in early life, Southern Sweden, 1760–1894. Population Studies 54, 263–277.
  3. Bozzoli, C., Deaton, A and Quintana-Domeque, C. (2009). Adult height and childhood disease. Demography 46(4), 647–669.
  4. Case, A. C. and Deaton, A. (2003). Broken down by work and sex: How our health declines. NBER Working Papers 9821. National Bureau of Economic Research, Inc.
  5. Case, A., Fertig, A. and Paxson, C. (2005). The lasting impact of childhood health and circumstance. Journal of Health Economics 24, 365–389.
  6. Case A., C. Paxson (2006) Stature and status: Height, ability and labor market outcomes. NBER working paper 12466.
  7. Currie, J. and Stabile, M. (2003). Socioeconomic status and child health: Why is the relationship stronger for older children? American Economic Review 93(5), 1813–1823.
  8. Cutler, D. and A. Lleras–Muney (2007) Education and Health: Evaluating Theories and Evidence, NBER Working Paper 12352. Cambridge, MA.
  9. Ding, W., Lehrer, S. F., Rosenquist, J. N. and Audrain-McGovern, J. (2006). The impact of poor health on education: New evidence using genetic markers. NBER Working Papers 12304. National Bureau of Economic Research, Inc.
  10. Heckman, J. J., Stixrud, J. and Urzua, S. (2006). The effect of cognitive and non-cognitive abilities on labor market outcomes and social behavior. Journal of Labor Economics 24(3), 411–482.
  11. Lindeboom, M., Portrait, F. and van den Berg, G. J. (2010). Long-run effects on longevity of a nutritional shock early in life: The Dutch Potato Famine of 1846–1847. Journal of Health Economics 29(5), 617–629.
  12. Lumey, L. H., Stein, A. D. and Susser, E. (2011). Prenatal famine and adult health. Annual Review of Public Health 32, 24.1–24.26.
  13. Miguel, E. and Kremer, M. (2004). Worms: Identifying impacts on education and health in the presence of treatment externalities. Econometrica 72(1), 159–217.
  14. Smith, J. P. (2005) The Impact of SES on Health over the Life Course. RAND working paper.
  15. Van den Berg, G. J., Doblhammer, G. and Christensen, K. (2011). Being born under adverse economic conditions leads to a higher cardiovascular mortality rate later in life: Evidence based on individuals born at different stages of the business cycle. Demography 48, 507–530.
  16. Van den Berg, G. J., Lindeboom, M. and Portrait, F. (2006). Economic conditions early in life and individual mortality. American Economic Review 96, 290–302.
  17. Van den Berg,, G.J. and Lindeboom, M. (2007) Birth is the messenger of death – but policy may help to postpone the bad news. New evidence on the importance of conditions early in life for health and mortality at advanced ages. Netspar Panel Paper 3, Tilburg University, Tilburg.
  18. Ravelli, A. C., van der Meulen, J. H., Michels, R. P., Osmonds, C. and Barker, D. J. (1998). Glucose tolerance in adults after prenatal exposure to famine. Lancet 351, 173–177.
Advertising as a Determinant of Health
Alcohol and Health