Essays on the economics of health and place

Higgins, Jack and Hollingsworth, Bruce and Walker, Ian (2020) Essays on the economics of health and place. PhD thesis, Lancaster University.

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Abstract

This thesis considers the connection between an individual’s health and place - that is, variation in where one lives and the process of moving itself. It comprises three selfcontained empirical chapters that are unified under this broad theme. It begins by considering the impact of moving house more generally, before moving on to look at more specific topics: living on the UK coast and living at University. The first empirical chapter asks the question: What is the effect of moving residence on health? It considers the empirical challenges in identifying causal effects for such phenomena. The main methodology for doing so, involves using spatial and inter-temporal variation in local school quality and house prices, as Instrumental Variables for changing address. These data (available publicly) are mapped to households that were interviewed as part of the British Household Panel Survey and Understanding Society providing a rich dataset containing information at the individual, household and local area level. This paper goes on to address the question of how a move affects shortterm health using a regression discontinuity-type design, considering the differences in health between those who were interviewed just before and just after they changed address. It finds, in general, that local school quality is a strong instrument for moving residence, and doing so leads to worse self-assessed health. The second empirical chapter considers a more specific question about the health of those who live on the UK coast. UK data shows that health amongst the working-age population (16-64 years) is worse on the coast than elsewhere. For example, there is a much greater prevalence of limiting long-term health conditions on the coast as opposed to the average for England and Wales. Despite this, there is a lack of literature that considers the potential reasons for these differences and how they can be identified; this paper addresses this gap. Using data on health and other characteristics from all five waves of Understanding Society, this chapter quantifies the differences in health and health-related outcomes on the coast compared to inland. Detailed geographic data are used to construct a distance to the coast measure, which is used as the main distinction between a coastal and non-coastal area. The analysis finds that most health-related outcomes are worse on the coast, including long-standing health conditions, disability benefit claimants and smoking and drinking prevalence being more likely. The final empirical chapter considers the mobility of students attending university, and their life satisfaction in early adulthood. The move to university is often the first major independent change of residence that an individual faces. At the same time, a large proportion of students live at home while they study. Data on a cohort of university attendees from the Longitudinal Survey of Young People in England (LSYPE) and the follow-up study, Next Steps, is used to assess the impact of moving away from home on early-adult life satisfaction. A random sample of children, born in 1989/1990, were surveyed annually between the ages of 13 and 19 years old, and then again when aged 25 (Next Steps wave). Life satisfaction is modelled for graduates aged 25 years, using an ordered probit approach, controlling for individual characteristics at various points in the student’s life, such as external locus of control and psychosocial health. I also partial out parental and household factors such as household income, parental education, parental occupation, and the number of siblings in the home. The analysis finds that life satisfaction of males who move away is much higher than those who do not; there is no effect for females. Instrumental variable ordered probit models address the endogeneity of moving away to university, and mediation analysis assess some potential mechanisms behind these differences. Where an individual lives, and the process of moving, is a determinant of health. More research is needed to disentangle this complex and heterogeneous relationship, with a view to identify policies with which to facilitate internal migration, and improve health outcomes.