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OCR for page 53
, - Will slower population
growthincreaseper
capita levels of schooling
and health?
HUMAN CAPITAL AND ECONOMIC DEVELOPMENT
Governments in virtually all developing countries are attempting to increase
levels of schooling and to improve levels of health. These goals are also
very important to households and other major social units. In addition to their
intrinsic value as elements of human welfare, improved health and education
contribute to improved economic performance. A better educated work force
is more skilled, more adaptable, and more entrepreneurial. The value of
education is not limited to any particular sector of the economy: better
educated farmers appear more responsive to new technical possibilities, and
better educated women seem more effective at allocating resources within the
home, including those that enhance child survival (Schultz, 1979; Mensch
et al., 1985).
The importance of an educated work force for economic performance has
been demonstrated both in studies that attempt to assign economic growth
to various components and in studies that attempt to calculate directly the
rate of return to completion of additional years of schooling. Denison (1962)
attributed 42 percent of He increase in per capita GNP in He United
States between 1929 and 1957 to higher average levels of education. A
substantial fraction of European economic grown can also be assigned to
this source. Educational upgrading contributed substantially to Japan's move
from a developing to a developed economy. Denison and Chung (19763
estimate that in He decade 1961-1971 educational advance raised the grown
rate of per capita GNP by 0.35 percent per year in Japan. In most of the
studies attributing economic grow to various factors, an important residual
53
OCR for page 54
~4
POPUI~lON GROWTH AND ECONOMIC DEVELOPMENT
remains that represents unexplained gains in output for a given level of the
factors. It is likely Mat improved education accounts for a significant part
of these improvements.
When rates of return to investment in schooling are computed in developing
countries, they invariably are very high. Psacharopoulos (1981) reviews
many such computations and finds that the mean social rate of return in
22 developing countries is 27 percent for primary schooling, 16 percent
for secondary schooling, and 13 percent for higher education. There are
reasons to believe that these figures are biased upward by, among other
things, failure to control differences in the ability and class background of
persons receiving different levels of schooling. But even when these and
over biases are taken into account, We returns to schooling are typically
very high (Psacharopoulos, 1981~.
The role of health improvements in economic growth has not received
as much detailed attention as education. (For a useful review, see Barlow,
1979.) The issue is more complex than that of education because health
improvements may also increase rates of population growth, introducing
many additional considerations. In a simulation exercise based on the Coale-
Hoover model, Barlow (1967) found that the antimalarial campaign in Sri
Lanka raised the grown rate of per capita income in the short term, largely
because of enhanced labor productivity, but lowered it in the long run, largely
because of reduced levels of physical capital per worker (see the discussion
under Question 4~. Ram and Schultz (1979) suggest that the antimalarial
campaign in India during the l950s was the major reason that income grown
rates were higher in that decade than during the widely publicized 1960s,
when new crop varieties were introduced. For Sierra Leone, Strauss (1985)
finds evidence that family nutritional intake is strongly related to family farm
ouput. Deolalikar (1984) provides direct evidence on the economic payoff
to improved nutritional status in south India, finding that each percentage
point increase in weight-for-height of agricultural workers raised their daily
wages by about 1 percent. Whatever the directly measured economic effect,
it is certain that health gains would become a larger positive contributor to
economic grown if measures of economic grown included an imputation
for the value of gains in life expectancy (Usher, 1973~.
Because of the contribution of advances in health and education to social
and economic development, it is important to identify the effect of population
growth on these variables. It should be recognized at the outset that the
postwar era of rapid population grown has also been one of rapid gains
in educational attainment and life expectancy in developing countries. In
the case of life expectancy, improvements have directly contributed to more
rapid population growth, a necessary relationship that makes it difficult to
use time-series d~ to infer the importance of We reverse causal paths. What
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SCHOOLING AND HEALTH
55
can be said is that the economic response to rapid population growth has not
been so negative as to reverse the gains in life expectancy that initiated such
growth. The Malthusian specter of population growth precipitating a rise
in mortality that restores some kind of economic-demographic equilibrium
gains little support from events occurring between 1950 and 1980. Indeed,
the incidence of famine-related mortality seems to have declined throughout
the twentieth century (World Bank, 1984; Simon, 1981), although famine
conditions in China between 1959 and 1961 that have only recently come
to light may alter this conclusion (Coale, 1984; Ashton et al., 1984~.
While time-series data are instructive in setting some broad parameters
within which these processes work, cross-sectional analyses permit a more
precise view of the consequences of population growth by taking advantage of
richer data that exhibit more independent variation among variables of interest.
Such analyses have been carried out both at the family or household level
and at the national level. These levels of analysis are not mutually exclusive-
nations consist of families and households, and national (or regional) policies
affect the decisions made at the household level~ut the distinction is widely
observed in the research literature.
FAMILY SIZE AND CHILDREN'S ~:ALTH AND EDUCATION
Family-level relationships between family size and mean education and
health of children have been widely reviewed (e.g., Wray, 1971; Terhune,
1974; Birdsall, 1977; Ernst and Angst, 1983; Rodgers, 1984; King, 1985~.
Beyond a certain family size, additional children are usually associated with
lower average educational attainment and reduced levels of child health,
as measured by nutritional status, morbidity, and mortality. In addition to
the reduced education levels, studies in Hong Kong and India show that
school grades among those enrolled tend to be lower for children coming
from very large families (Ernst and Angst, 1983:51~. However, negative
effects of family size on child-quality variables are not always found. For
example, Mueller (19843 presents evidence from Botswana and Sierra Leone
that children from larger families achieve higher average levels of schooling,
controlling over pertinent variables. In general, there are suggestions that the
typical negative relationship between family siSe and health and education
of children is larger in poorer families (Birdsall, 19803.
A good deal of recent evidence on the relationship between reproductive
patterns and child mortality has become available through the World Fertility
Survey. As reviewed by Trussell and Pebley (1984), the evidence suggests
that elimination of fourth- and higher-order birds in developing countries
could reduce infant and child mortality by about 8 percent. Universal adoption
of an "ideal', spacing pattern in which all births subsequent to He first
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56
POP UNION GROWTH AND ECONOMIC DEVEL~PMENI
are separated by at least 2 years could reduce infant mortality by about
10 percent and child mortality by about 21 percent. (Spacing patterns bear
no necessary relationship to population growth, of course, and it is these
patterns to which child mortality appears most sensitive.) While the Trussell-
Pebley study controlled for certain important socioeconomic variables, it
could not control for unmeasured "tastes" for child quality, which would
be expected to be stronger among families win few children and long birth
intervals. For this reason, the results may represent an upper bound on
the child mortality gains to be expected from reduced fertility and longer
spacing.
The commonly observed negative relationship between the number of
children and the "output" variables of levels of health and education probably
reflects a negative relationship between the number of children and various
"input" variables. Examples of studies finding negative associations between
family size and per capita health and food expenditure can be found in
Wray (1971) and Rodgers (1984~. It is possible Hat economies of scale
in larger households offset some or all of the disadvantages of lower per
capita expenditures, particularly in the area of food provision, although Here
are few studies confirming such an offset. Reviewing evidence for Kenya,
Colombia, and 11 Latin American cities, Tan and Haines (1983) conclude
that while total household expenditures on education tend to increase with
the number of children, they usually do not increase fast enough to avert a
decline in schooling expenditures per child (see Birdsall, 1980, for a detailed
discussion of this issue for Colombia). Complicating this relation is the fact
that financial support for children's schooling is often derived from older
siblings. A majority of fathers in many Asian countries expect such financial
help from older sons (Bullet=, 1979), and Caldwell et al. (1982) refer to a
common situation in tropical Africa wherein "sibling chains of assistance"
are established so that each educated child makes it more likely that the
next will be educated. In some places, parents may only have to pay for
the advanced schooling of He first child, while later ones are financed by
older siblings.
It is important to recognize that no policy implications necessarily follow
from a demonstration of a negative cross-sectional relationship between family
size and child "quality." Households vely often make childbearing decisions
win an awareness that having an additional child will entail a sacrifice of
some other household objective: leisure, consumption of goods and services,
schooling for children already bom, health of parents, investment in other
household enterprises, and so on. The financial effects of additional children
are widely cited concerns in childbearing decisions by families in developing
couches (Bulatao, 1979) as well as in developed countries. Obviously,
many couples skill consider their welfare to be increased by an additional
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SCHOOLING AND HEALTH
57
birth despite the costs entailed. Most governments rarely intercede in such
decisions, since households themselves bear the bmnt of the consequences.
And, as illustrated by resolutions passed in United Nations' world population
conferences (United Nations, 1984), governments universally proclaim the
principle of family sovereigns in reproductive decisions. However, some
nations have, in fact, intervened in childbearing processes in ways that
violate principles of family sovereignty.
It is also important to note Hat if a nation achieves lower fertility rates,
the impact on the education and heals of children will be determined
in part by the class distribution of the fertility reduction. If, as widely
observed in Latin America, the small upper income groups have the largest
proportionate reductions, then the mean levels of child health and education
would be expected to decline, other things being equal, even if there are
rising expenditures per child by those groups in which fertility declines.
To the extent that a national policy achieves lower fertility levels through
family planning programs that reduce the incidence of unwanted children,
the question of impact becomes much more highly focused. The class
distribution of unwanted births is generally highly skewed toward He lower
income groups (Brackett, 1978; Westoff, 1978; Birdsall, 1980~. For these
groups, it can be anticipated that family planning programs will enhance
the mean level of child health and education through compositional effects.
One of He few investigations of the effects of an unwanted birth on child
quality within families in developing countries is that of Rosenzweig and
Wolpin (1980~. They find that in India the bird of twins in a household
significantly reduces school enrollment levels of children in the household.
It also reduces household expenditure on consumer durables. Obviously, not
all the twins are unwanted birds, but by the nature of the event a higher-
than-average proportion are unwanted. Effects on educational enrollments
were not confined to the twins themselves but extended to other children
in the household. Related studies in India and Thailand using proxies for
"wontedness" suggest that child mortality is higher in families in which more
unwanted birds were occurring (Rodgers, 1984~.
POPULATION GROWTH AND
PUBLIC HEALTH AND EDUCATION
~ addition to their effects at the family level, levels of fertility can
also affect the allocation of government resources to education and health.
Educational attainment is produced by some combination of public and
private expenditures. At the secondary school level, private contributions
often assume greater importance because a child's forgone earnings increase,
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58
POPUl'7ON GROWTH AND ECONOMIC DEVELOPMENT
and governments are less committed to supplying that level of education to
large fractions of the population. Effects of population growth on government
expenditures can therefore differ from effects on enrollment. Not only
do private expenditures play an important and highly variable role, but
governments can alter the amount of resources spent on each enrolled child.
Most work on the subject of fertility effects on educational systems is
focused on the proposition that more children means that more places must
be provided in school systems to maintain the population enrollment ratios.
The "costs', of additional children can be readily calculated under reasonable
assumptions about per pupil costs Cones, 1971, 1975; Cochrane, 1983~.
Jones (1975) shows, for example, that 30-50 percent of the additional
governmental education expenditures "required" over the next decade in a
typical developing country is attributable to the projected grown of the
school-aged population.
These arguments are often among the most convincing to government
planning officials about the advantages of reduced fertility. But the fact
that enrollment ratios or per pupil expenditures may decline as populations
grow does not mean that they necessarily will. Governments can respond to
larger school-aged populations in many ways: by raising taxes, by shifting
expenditure from over areas, by restructuring educational systems, and so on.
Like families, governments are actors in the drama of economic-demographic
relations, and their behavior cannot be readily predicted a priori.
The most comprehensive examination of the effects of population growth
on educational systems in developing countries is that of Schulm (1985~. In a
cross-section of countries, Schultz finds that the relative size of school-aged
cohorts is negatively associated with government expenditures per school-
aged child in both primary and secondary schools. A 10 percent increase in
the ratio of the school-aged population to the total population is associated
win 11 and 17 percent reductions in expenditures per school-aged child at
the primary and secondary levels, respectively. In other words, an increase
in the school-aged population induces no increase in total school expenditure
and may reduce it. Consistent with this result, there is no association between
the relative size of the school-aged population and the share of government
expenditures that are directed toward schools.
However, Schultz finds no negative effect of the size of the school-aged
population on enrollment rates. In fact, the relationship is positive at the
primary level. These results clearly imply Nat more rapid growth produces
lower expenditures per enrolled child, and Schultz shows Nat this effect
takes the form of more enrolled children per teacher and lower teacher
salaries. Schultz's results on expenditures are roughly consistent with an
earlier cross-sectional study by Simon and Pilarski (1979) Nat finds a slight
negative effect of fertility on expenditure per child. In contrast to Schultz,
OCR for page 59
SCHOOLING AND HEALTH
59'
however, Simon and Pilarski find no effect on primary enrollments and a
sizable negative effect of fertility on secondary enrollments.
Although there is much uncertainty in these relationships, it appears that
the major effects of population growth on education are on expenditures per
pupil-especially teachers per pupil and teacher salaries-and not on enrollment
rates. Thus, it is useful to ascertain the importance of expenditures per pupil
and teachers per pupil on the quality of education. Intuition strongly suggests
that both are positively associated with quality, but the evidence has not
always confirmed this intuition. Simmons and Alexander (1978) reviewed
multivariate microlevel studies of student performance on standardized tests in
developing countries. Two of these studies found a negative or insignificant
effect on student performance of per pupil expenditure for school facilities or
teachers, and none showed a significant positive effect. Four studies showed
a negative or insignificant effect of teacher/pupil ratios, but three showed a
positive and significant effect (Simmons and Alexander, 1978:350~. These
results are similar to those typically found in the United States (Hanushek,
1981; Murnane, 1981~.
Additional evidence on this point comes from a study of science test scores
among 13- to 14-year-olds in 29 mostly developing countries. Heyneman and
Lo~ley (1983) find that 15-25 percent of the variance in test performance
within developing countries can be accounted for by variables representing
school and teacher quality. This fraction is larger than is typical for developed
countries. The list of quality-related variables is very large and varies from
country to county, and it is not possible to generalize to issues of expenditure
per child or number of teachers per child. The fact that richer countries tend
to have higher test scores in this study also points to die possible importance
of school expenditures per child, although influences in the home are also
likely to be related to this outcome.
Behrman and Birdsall (1983) examine the effect of school quality (as
measured by the mean years of schooling among teachers in one's area
during childhood) on adult earnings in Brazil. They find a higher rate
of return to investments in school quality Han to investments in school
quantity. However, they were not able to control for features of the early
home environment, which may be related to both quality and quantity of
education, and so the net bias is indeterminate.
All these studies show that the quality of schooling can be improved in
developing countries (e.g., through providing more textbooks per pupil) and
that the savings induced by slower growth of He school-aged population
can be used to improve quality. The fact that the aggregate measures of
expenditures per pupil and teachers per pupil show only a weak association
with test scores in developing countries suggests that one should not be
too optimistic that lower population growth will result in improved school
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60
POP ULAJ7ON GROW ED ECONOMIC DEVE=PME'
quality. But three of seven studies did show a significant positive effect
of teacher/student ratios on student test performance, and Schultz's (lg8S)
results suggest that improved teacher/student ratios are the principal route
through which lower grown affects education. Therefore, it is reasonable
to expect that an exogenous reduction In the growth rate of the school-
aged population will in general result in some improvement in quality of
education.
Another element in the discussion of the aggregate relation between
population growth and the average educational attainment of workers is
introduced by Leibenstein (1971:188), who argues: "To the extent that
entrants into the work force are of higher quality (i.e., higher education
and acquired skills, etc.) than those that leave through retirement and death,
the average quality of the labor force improves more rapidly if the rate
of population growth is higher (other things equal) than lower." It should
be noted that this effect operates only dunng a transitional period from
one demographic equilibrium to another. A once-and-for-all reduction in
fertility will lead to a reduced rate of labor force upgrading until a new
equilibrium is established. But if a population has constant annual upgrading
of amount K in its average endowment of human capital from one cohort
to the next (e.g., those aged 15 in 1985 are better endowed by the factor
K than those aged 15 in 1984), then regardless of its overall population
growth rate, its per capita stock of human capital will be growing at rate
K. In equilibrium, there is no relationship between the growth rate of the
population and the growth rate of per capita human capital. Even during the
transitional period to a lower fertility equilibrium, the welfare implications
of Leibenstein's argument are unclear, since all cohorts of individuals are
assumed to receive the same schooling in fast-growing populations as in
slow-growing populations. It is only the aggregate measures that show a
(temporary) deterioration.
There are almost no studies of the effect of demographic variables on
government health expenditures. A cursory glance at per capita national health
budgets shows extremely wide variations-for example, $16.96 in Mexico
and $111.88 in Venezuela (Golladay and Liese, 1980:13-which probably
have more to do with variation in the nature of items that are included in
the budgets than with real variations in expenditure. Such figures are not
a promising vehicle for empirical investigation without furler refinement.
However, Montgomery (1985) reports an insignificant, positive effect of
population grown rates on government health expenditures as a share of all
government expenditures in a cross-section of 49 developing countries.
Whatever the effect of population grown on government heals expenditures,
those expenditures are not closely related to mortality or health. Nearly all
careful studies conclude dial government health expenditures per se have
OCR for page 61
SCHOOLING AND HEALTH
61
very little to do with national health conditions (Corsa and Oakley, 1971;
Mosley, 1983~. Those health expenditures are usually dominated by urban-
based curative services that are often modeled after health systems in
developed countnes. Not only do these services often fail to reach most
of the population, but they also do not appear to improve population-based
measures of mortality in the urban populations that they do reach (Mensch
et al., 1985~. This is not to say that government programs cannot improve
health and have not done so, but only that present patterns of expenditure
are not such that population growth poses a major threat to success, except,
perhaps, in those countries such as Sri Lanka and Cuba, where government
health programs appear better constituted and more successful. One way
that population growth may actually assist governments in achieving health
objectives is by increasing rural density. It is often alleged that, especially in
Africa, the dispersed, low-density rural population is difficult to reach with
government health services Should Health Organization, 1975:17~. These
effects have not been adequately quantified.
CONCLUSIONS
We have depicted a multilayered relation between population growth and
children's levels of education and health. Several tentative conclusions seem
justified. First, larger families generally have lower levels of schooling
and health per child, which probably primarily reflects lower expenditures
on health, education, and nutrition per child in larger families. However,
these relationships are not universal, and they do not necessarily reflect a
causal impact of fertility on health and education. Rather, they may to some
extent reflect deliberate parental trade-offs between family size and per child
expenditure.
Second, family planning programs that decrease the incidence of unwanted
births are likely to raise average levels of education and health among
children, both because they increase investment within the family in child
health and education and because they reduce the fraction of births occurring
in lower income families.
Third, countries with more rapid population growth do not appear to have
lower levels of school enrollment, coterie panbus; they do seem to have
lower school expenditures per child and fewer teachers per student. Several
(but not all) studies have found that having fewer teachers per student reduces
student test performance. Therefore, some improvements in test performance
may occur as a result of slower population growth.
Finally, it is unlikely that rapid population growth is a major impediment
to the success of government health programs as Hey are presently structured.
Representative terms from entire chapter:
family size
