Health vs. Education: A Tale of Two Sectors



The history of health and education over the last half century is a tale of two sectors, one vastly more dynamic and successful than the other.

On the bright side, Latin America — and much of the world — has made immense progress in eradicating diseases that caused death, deformities and suffering, like smallpox and polio. Advances in primary health care, including vaccinations, have reduced infant mortality in the region by 80% in just the last 50 years. Life expectancy has soared from 52 to 72. Even the incidence of malaria, a once intractable disease, has dropped a remarkable 70% in the Americas in 15 years. With the development of new vaccines and drugs, prevention and treatment of other once deadly illnesses, including HIV and meningitis, is making headway.

Education has moved to a different rhythm. Gains in the education sector have been incremental at best, and, in some areas, non-existent. In 2012, the Program for International Assessment (PISA) of the Organization for Economic Co-operation and Development (OECD), ranked 65 nations for the academic achievement of students aged 15-16 in reading, math and science. The eight Latin American nations evaluated for the report ranked in the bottom 30%. Moreover results changed little over time. Only two countries showed statistically significant improvements in math in evaluations done from 2003-2012, and, with the exception of Brazil, no country improved in science between 2006-2012.

There is a plausible reason for that immense gap between the two sectors. Vastly greater investment is put into research and development in health than in education. Research in education has been characterized by theories and reasonable assumptions, reforms and counter-reforms. Research in health, by contrast, has been driven by rigorous, randomized controlled trials and meta-analyses of large amounts of data. And Latin America is not alone in that regard. Scores in reading and math for 17 year olds in the United States have not budged significantly since the National Assessment of Education Progress (NAEP) was first administered in the early 1970s. Yet the amounts of money the United States invests in empirically-oriented education research pales in comparison to the nearly $13 billion that the US government has invested in just the last 10 years in health-sector research. The result has been little progress in education on one hand and a host of new vaccines, drugs and diagnostics that have saved hundreds of thousands of lives around the world on the other.

If the costs for the US of neglecting that critical component of education are huge, they are similarly so for the region. Latin America has increased investment in education from around 3.1% of GDP in 1985 to 5.3% of GDP in 2012. Latin American governments stress the importance of education to boosting economic growth and fighting poverty and inequality. Yet the offices of research and innovation within education ministries typically do almost no experimental trials. And that makes decision-making exceedingly difficult. An education minister trying to decide whether to centralize or decentralize curriculums, decrease class size, or bring a new technology to schools has little to guide him in terms of empirical evidence of what is a waste of money and what actually works.

An example serves to illustrate the problem. In 2008, the One-Laptop-Per-Child program was introduced in Peruvian primary schools, distributing 900,000 computers across the nation. The assumption was that this would increase reading, math and computer skills. Because school would be more enjoyable for students, additional gains were expected in improved enrollment and reduced repetition and dropout rates. Yet a rigorous IDB study shows that the program had few of the intended effects. While bringing computers into schools increased computer literacy, it neither improved math and reading or significantly contributed to keeping children in school and on a steady track towards graduation. But how different the story might have been if randomized-controlled trials had been done before the program was launched.

The solution to the problem is at hand. Randomized controlled trials are easy to conduct and relatively cheap, with most pilot studies costing less than $1 million. Latin America currently spends around $79 billion a year on primary education. If it were to set aside just 1% for research, it could do hundreds of such studies every year. The resulting empirical evidence might then propel the education sector to significantly reduce poverty and inequality in much the same way that the immense gains in the health sector have allowed it to advance against disease.


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The Author

Julián Cristiá

Julián Cristiá

Julián Cristiá, a citizen of Argentina, received a Ph.D. in Economics from the University of Maryland at College Park.He is a research economist in the Research Department of the Inter-American Development Bank.

The Author

Steven Ambrus

Steven Ambrus worked as a correspondent for US and European media during two decades in Latin America, covering politics, education, the environment and other issues. He currently works in the communications and publications unit of the Research Department at the IDB.
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