Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis.
BACKGROUND
In addition to the inherent importance of education and its essential role in economic growth, education and health are strongly related. We updated previous systematic assessments of educational attainment, and estimated the contribution of improvements in women's education to reductions in child mortality in the past 40 years.


METHODS
We compiled 915 censuses and nationally representative surveys, and estimated mean number of years of education by age and sex. By use of a first-differences model, we investigated the association between child mortality and women's educational attainment, controlling for income per person and HIV seroprevalence. We then computed counterfactual estimates of child mortality for every country year between 1970 and 2009.


RESULTS
The global mean number of years of education increased from 4·7 years (95% uncertainty interval 4·4-5·1) to 8·3 years (8·0-8·6) for men (aged ≥25 years) and from 3·5 years (3·2-3·9) to 7·1 years (6·7 -7·5) for women (aged ≥25 years). For women of reproductive age (15-44 years) in developing countries, the years of schooling increased from 2·2 years (2·0-2·4) to 7·2 years (6·8-7·6). By 2009, in 87 countries, women (aged 25-34 years) had higher educational attainment than had men (aged 25-34 years). Of 8·2 million fewer deaths in children younger than 5 years between 1970 and 2009, we estimated that 4·2 million (51·2%) could be attributed to increased educational attainment in women of reproductive age.


CONCLUSIONS
The substantial increase in education, especially of women, and the reversal of the gender gap have important implications not only for health but also for the status and roles of women in society. The continued increase in educational attainment even in some of the poorest countries suggests that rapid progress in terms of Millennium Development Goal 4 might be possible.


BACKGROUND
Bill & Melinda Gates Foundation.
Gakidou
Emmanuela
E
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA. gakidou@uw.edu
Cowling
Krycia
K
Lozano
Rafael
R
Murray
Christopher J L
CJ
D000293:Adolescent; D000328:Adult; D000349:Africa; D000367:Age Factors; D000368:Aged; D000569:Americas; D001208:Asia; D002648:Child; D046688:Child Mortality; D004522:Educational Status; D005060:Europe; D005260:Female; D014943:Global Health; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009035:Mothers / Q000193:education*; D012959:Socioeconomic Factors; D014930:Women / Q000193:education*; D055815:Young Adult