Study on Intergenerational Health Mobility Provides Strong Case for Early Childhood Interventions

Examining how children’s health compares to the health of their parents can offer valuable insight into the individual, family, and community-level factors that affect a child’s health status. This is the aim of a new Health Affairs article from Jason Fletcher and Katie Jajtner at the University of Wisconsin-Madison, which seeks to bring an intergenerational mobility perspective to children’s health. Using data from the National Center for Education Statistics’ Early Childhood Longitudinal Study, the researchers investigate whether certain demographic and economic characteristics make it more or less likely for children to be healthier or unhealthier in childhood than their parents (and compared to children and parents overall).

To measure intergenerational mobility, the authors first average the reported health status for both parents and children measured in the child’s kindergarten, third, fifth, and eighth grade school years. They then assign a percentile rank to the parents’ and children’s average health. A parent with a health ranking at the 25th percentile indicates that that parent is in relatively poor health, having better health than only 25 percent of other parents. A child of this parent with a health ranking at the 45th percentile would be considered upwardly mobile by 20 percentiles, because the child’s health is better than 45 percent of her peers while her parent’s health is only better than 25 percent of his peers. On the other hand, a parent in relatively good health with a health ranking at the 75th percentile has health that is better than 75 percent of other parents. A child of this parent with a health ranking at the 45th percentile would be considered downwardly mobile by 30 percentiles, because the child’s health is better than only 45 percent of her peers while her parent’s health is better than 75 percent of his.

If there were no relationship between a child’s health and their parent’s health, or between a child’s health and the demographic and economic variables that the authors investigate, that child’s health status should revert to the median of the 50th percentile, equally unlikely to be better or worse than any of her peers. However, the researchers find that gender, race, health insurance coverage, parent’s education level, and family income all have a significant impact on how upwardly—or downwardly—mobile a child’s health is.

Overall, children with parents whose health sits at the 25th percentile had an estimated health ranking above the 41st percentile, indicating that parents in poorer health can still expect their children’s health to be upwardly mobile by about 16 percentiles. Children with parents whose health sits at the 75th percentile were estimated to have health just below the 62nd percentile, a downward move of about 13 percentiles.

However, statistically significant differences emerge for children of different social and economic statuses, with nonwhite, uninsured, and poorer children experiencing less upward mobility and more downward mobility:

  • Black children were less upwardly mobile than white children by 7.15 percentiles and Hispanic children by 8.56 percentiles. Black and Hispanic children also saw more downward mobility than white children, by 9.37 and 8.48 percentiles, respectively.
  • Uninsured children were significantly less upwardly mobile compared to children who had insurance by 6.08 percentiles, and were significantly more downwardly mobile by 7.48 percentiles.
  • Children whose parents did not finish high school were less upwardly mobile than children whose parents finished at least four years of college by 15.57 percentiles, and more downwardly mobile by 19.48 percentiles.
  • Children in the lowest income quartile were less upwardly mobile than kids in the top income quartile by 11.2 percentiles, and more downwardly mobile by 13.36 percentiles.

These differences also persisted at the neighborhood level, with children living in communities with higher proportions of peers in lower socioeconomic status families experiencing significantly less upward mobility and more downward mobility:

  • Children living in the lowest income neighborhoods were less upwardly mobile by 5.92 percentiles, and more downwardly mobile by 6.75 percentiles, compared to children living in the highest income neighborhoods.
  • Children living in neighborhoods with the lowest proportion of students who had health insurance in kindergarten were less upwardly mobile by 4.82 percentiles, and more downwardly mobile by 5.36 percentiles, compared to children living in neighborhoods with the highest proportions of kindergarteners with insurance.
  • Children living in neighborhoods with the lowest proportion of married parents were less upwardly mobile by 4.86 percentiles, and more downwardly mobile by 7.03 percentiles, compared to children living in neighborhoods with the highest proportions of married parents

This intergenerational health framework helps shed light on how health status is passed on from parents to their children through individual, family, and community-level factors. These findings make a strong case for early childhood policy interventions, including Medicaid expansions for pregnant women and infants and SNAP access in a child’s first five years, to boost mobility for disadvantaged children and help narrow persistent health inequities.

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