(meal preparation and cleanup, doing laundry, ironing, dusting, and indoor home cleaning and maintenance, etc.).

However, some caution is needed in interpreting the link between mothers’ education and children’s health. First, it is not simply the completion of a certain number of years of schooling by mothers that may yield the benefits outlined earlier; rather, it is _literacy_ that appears to drive the relationship between education and health outcomes. This means that school _quality_ is what really determines the extent to which children may experience health benefits from their parents’ education (see Lloyd (2009)). Moreover, if access to infrastructure is poor, even well-educated mothers may be unable to act upon their health knowledge and take their children to health facilities—an all too common problem in SubSaharan Africa (see Box 1). Second, there is evidence that better-educated women marry better-educated men; it is thus possible that the observed effect of women's education may also, to some extent, reflect unobserved preferences of their husbands for healthier or bettereducated children (see Schultz (2002) and Duflo (2005)). A study of rural India, for instance, found that in a setting where educated women do not participate in the labor market, bettereducated men are more likely to marry better-educated women (Behrman et al. (1999)).

# **1.2 Persistence from Childhood to Adulthood**

There has been much research in recent years on the effects of early childhood influences on later life outcomes; studies include Case, Fertig, and Paxson (2005), Schady and Paxson (2007), and Smith (2008).<sup>6</sup> In particular, it has been shown that events before five years old may have a very large long-term impact on adult outcomes: child and family characteristics measured at school entry do as much to explain future outcomes as factors that economists have more traditionally focused on, such as years of education. In a study based on data for Ecuador, Paxson and Schady (2007) for instance found that health measures such as height for age and weight for age are positively related to language development, a measure of cognitive ability. Perhaps more dramatically, Helmers and Patnam (2010) found, in a study of Andhra Pradesh, India, that child health at age one influences significantly cognitive abilities at age five.<sup>7</sup> The persistent effect of health in childhood on health in adulthood appears to operate to a significant extent through its impact on educational attainment in childhood. Indeed, the available evidence suggests that protein-energy malnutrition during the early stages of a child's life can lead to permanent impairment of central nervous system functions. Folate and iodine deficiency _in utero_ , as documented earlier, and iron deficiency during infancy, may also cause permanent neurological damage. An adult’s physical work capacity is thus determined by his entire nutritional history. Consequently, health represents a key inter- and intra-generational mechanism through which poverty is transmitted: people born into poorer families experience poorer childhood health, lower benefits from investments in human capital, and poorer health in early adulthood, all of which are associated with lower

> 6See Currie (2009) and Almond and Currie (2010) for an overview of the literature on the role of health in the intergenerational transmission of socioeconomic status—with a focus, however, on industrial countries. 7They also find that child health at age one is influenced by parental care during pregnancy, consistent with our previous discussion.

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