Recent research has found that children who attended pre-kindergarten programs in childhood were more likely to be healthy as adults. One intuitive way of improving population health and longevity may therefore be to invest in pre-kindergarten programs. However, much of the research linking pre-kindergarten programs to health is very recent and has not been synthesized. In this paper, I review the mechanisms linking pre-kindergarten programs in childhood to adult longevity, and the experimental evidence backing up these linkages. I conclude with a critical exploration of whether investments in pre-kindergarten programs could also serve as investments in public health.
Children with fewer opportunities to obtain a high-quality education face a cascade of socio-economic challenges throughout their lives, and these challenges are thought to ultimately increase their risk of premature death (Ross and Wu, 1995). As one example of these lifelong challenges, those who do not obtain an education credential will find it extremely difficult to find a quality job that offers high pay, a safe work environment, provides health insurance, and affords a life in a low-crime neighborhood (Grossman, 1997, Kawachi et al., 2010 and Ross and Wu, 1995). While it receives relatively little attention in the media, the overall health burden associated with lower educational attainment is larger in the US than it is for obesity (Muennig et al., 2010). Moreover, the adverse health effects of having less educational attainment are increasing over time (Olshansky et al., 2012). One intuitive approach to addressing this growing mortality disparity is to improve schooling in ways that reduce a youth's chances of dropping out of school (Woolf et al., 2007).
Of all schooling enhancements that increase both educational attainment and health, pre-kindergarten programs perhaps hold the most promise. Pre-kindergarten programs have both been shown to improve high school graduation rates and to improve health in ways that are highly likely to reduce premature death in adulthood (Campbell et al., 2014, Currie, 2001, Muennig et al., 2009, Palfrey et al., 2005, Reynolds et al., 2001 and Schweinhart et al., 2005). In theory, pre-kindergarten programs could reduce the growing health disparities by educational attainment in the US, and therefore serve as a powerful policy lever for improving public health (Woolf et al., 2007). However, neither the evidence base nor the theoretical models linking pre-kindergarten programs in childhood to health and longevity in adulthood have been fully synthesized.
In this paper, I ask whether investments in pre-school programs can also serve as public health investments. Broadly speaking, the task is to simply link children's exposure to pre-kindergarten to their health in adulthood using strong (e.g., experimental or quasi-experimental) studies. If the effect seems real and reasonably large, then we can conclude that the answer is probably yes. I therefore begin this paper with a review of the literature linking exposure to pre-kindergarten programs in childhood to health in adulthood.
However, it is extremely helpful to the reader to also have a sense of how prekindergarten programs accomplish this feat. One very important clue in this sleuth work is get a sense of what it is that those who are not exposed to pre-kindergarten programs are dying from. For instance, if lung cancer were much more likely in those who did not attend pre-kindergarten programs, then we might suspect that smoking is a major risk factor for poor health outcomes. Working backwards, we would then want to show that smoking is more common in non-attendees. Finally, we would wish to speculate as to what it is about not attending a pre-kindergarten program that would put one at higher risk of smoking. Cognitively enhanced children in a pre-kindergarten program may be “promoted” into a peer group that is less likely to smoke. Likewise, it could be that non-attendees are less likely to obtain a high school diploma, and are therefore more likely to work in lower wage jobs where more people smoke. Alternatively, it could be that non-attendees have less health knowledge. While all of these possibilities are speculative, it does help the reader get a “big picture” sense of how pre-school programs work. Without this big picture (which I attempt to draw), the mechanisms remain abstract in the minds of policymakers and researchers alike.
I conclude by then drawing from the evidence base evaluating whether pre-kindergarten programs produce adult health and longevity and my speculations as to why this might be to then ask if it is reasonable to conclude that investments in pre-school programs can also serve as public health investments.
