Janet Currie on Improving Our Children’s Futures

There is a natural desire on the part of governments to ensure that their future citizens — i.e. their nation’s children — are happy, healthy and productive, and that therefore governments have policies that work to achieve that. But good intentions never guarantee good policies.

Here’s where economist Janet Currie steps in. Currie is the Henry Putnam Professor of Economics and Public Affairs at Princeton University, where she co-directs, with Pascaline Dupas, the Center for Health and Wellbeing. In this Social Science Bites podcast, the pioneer in assessing the nexus of policy and parenting explains to interviewer David Edmonds how programs like Head Start in the United States and Sure Start in the United Kingdom provide real benefits over time to both their young clients as youths and later on in life.

After looking at a variety of programs and interventions, she details that “the general conclusion [is] that the programs that were spending more money directly on the children tended to have better outcomes.”

Her findings suggest this holds true even when similar approaches don’t have the same effect on adults. “[I]n the United States,” she says, “if you give health insurance to adults who didn’t have health insurance, they use more services, and they are happier about that, that they get to use services. But it doesn’t actually seem to save very much money. On the other hand, when you cover children from a young age, that is cost effective, that does save money, and in fact, the costs of the program probably pay for themselves in terms of the reduction in illness and disability going forward.”

In addition to her work at Princeton, Currie is also co-director of the National Bureau of Economic Research’s Program on Families and Children. She has been president of the American Economic Association for 2024 and has also served as president of the American Society of Health Economics, the Society of Labor Economics, the Eastern Economic Association, and the Western Economic Association. Two years ago, she received the Klaus J. Jacobs Research Prize “for her foundational work on the influence of context such as policy decisions, environment, or health systems on child development.”

To download an MP3 of this podcast, right-click this link and save. The transcript of the conversation appears below.

David Edmonds: How much do socio-economic circumstances affect a child’s future life? Janet Currie teaches economics at Princeton and is a leading expert in the economic analysis of child development and the policies that are designed to boost prospects for the most disadvantaged.

Janet Currie, welcome to Social Science Bites.

Janet Currie: Thank you. It’s lovely to be here.

David Edmonds: What factors influence how children will do in the future? That’s our topic for today, and also whether and which interventions can make a difference. So can I start with a very basic question? If we want to judge how successful a child’s life becomes as an adult, what criteria should we use? Should we use future income, educational attainment, some kind of subjective levels of happiness or what?

Janet Currie: So I think the answer is all of the above. When people are evaluating programs, they tend to look at the measures that they have at hand, which might be something like income or education. But I also think it’s important to think about people’s happiness. In my own work, I’ve been doing increasing amount of research looking at mental health and how we can measure that as well.

David Edmonds: OK, we’ll come on to mental health later. Another definitional issue, I guess, is what counts as childhood when childhood ends, and that might vary a bit from place to place, from culture to culture. Is it generally the case that policies or interventions are more successful the younger the child?

Janet Currie: I think what we know is that there’s a lot of successful interventions for pregnant women. That is that they have healthier babies, and their babies do better after these interventions. There’s also a lot of evaluation of programs for very young children, say, preschool children, which have been very successful. I think we know less about successful programs for, say, adolescents, but we do know that there are some, and so that’s an area where there’s increasing research, realizing that childhood doesn’t end at age 5, and there are many other children out there who need help, and there’s things that we could do to help.

David Edmonds: You mentioned pregnant women, obviously an intervention on a child can’t get earlier than that. So what’s the evidence about what works?

Janet Currie: So that is a very well-researched topic. In fact, that might be the start of some of this research on children was observations that, especially bad things that happen during pregnancy, like starvation, famines, stressful events like natural disasters, seem to have long, lasting effects on children. And so then the kind of reverse of that is, well, if you make conditions better for women while they’re pregnant, say, through income support or nutritional supplements, does that have a positive effect on the child? And there’s a lot of evidence that that’s also the case, that you can make things better.

David Edmonds: How much better?

Janet Currie: So it’s not that difficult to get a 10 percent reduction in low birth weight, which is significant because low birth weight is related to all kinds of future cognitive issues, asthma, ADHD, and so if you can reduce that at birth, you give somebody a much better chance to have a healthy life.

David Edmonds: So one thing you’re known for especially is assessing the Head Start program. Not all listeners will know what that is. In the UK we’ve got something similar the Sure Start program. Can you tell us something about those programs and how you went about analyzing, calculating their effectiveness?

Janet Currie: Yes. So Sure Start was actually modeled to some extent after the Head Start program. So what Head Start is, is an early childhood program. It initially served 3- to 5-year-olds, and now it can serve even infants. And it’s sort of a manualized program. So there’s all kinds of different requirements that a program has to meet to be a Head Start program. It’s also kind of an interesting model, because the federal government puts up the money, but the local community has to do a lot of the thinking about how to develop the program within the guidelines, and I think that’s also true for Sure Start. So the idea is that it’s supposed to reflect community assets and community goals as well.

David Edmonds: Does it tend to be a universal program? In other words, can everybody access Head Start? Or is this a program for those below a certain threshold of income?

Janet Currie: So Head Start in the United States is for people who are below a certain income threshold. It’s also supposed to serve kids who are at risk for some reason, so somebody who is of a higher income but, say, had a disability or perhaps there’s some suspicion of maltreatment, might get referred to a Head Start program.

David Edmonds: You mentioned it varies from neighborhood to neighborhood, state to state, city to city, but what sort of services are on offer through the Head Start program?

Janet Currie: So usually they have a curriculum, so they have set goals for things that they’re trying to accomplish, like maybe recognizing letters, recognizing colors, those kind of pre-kindergarten skills that you hope kids have. But they also do health checks. So all the kids are supposed to get the mandated health screenings. A lot of these kids are eligible for those screenings through other programs anyway, but the Head Start program actually helps them to get them. It provides healthy meals; it provides parent training; it provides home visiting often. So there’s a lot of different components of the program, beyond what people think of as, just say, preschool teaching.

David Edmonds: As a social scientist, it must be frustrating in a way, that it does vary from place to place, because that makes it very tricky for you to work out what’s working, or where it’s working, or why it’s working.

Janet Currie: So one thing I was able to do was to get information about the budgets of these programs, and then you could see where they actually spent money, and some of them spend more money on some things than others. And the general conclusion of that was that the programs that were spending more money directly on the children tended to have better outcomes.

David Edmonds: And governments are reluctant to spend money. Is there a good sort of cost benefit analysis of how much society gets back in return for each dollar it spends on these programs?

Janet Currie: Yes, there is actually. There are many such cost benefits, and they usually show that the benefits, no matter how you count them, whether you’re only counting them narrowly, as say, if we spend money on this program, will, as a government spend less money later? That’s kind of the narrowest definition. And then you could have a broader definition, where you actually try and count some of the benefits to the people, as well. And no matter how you cut it, these programs tend to be very cost effective. So then the question about why they aren’t being offered, or why they are being cut back, at least in the United States, I think, often comes down to politics. So unfortunately, there’s large constituencies that says they don’t care how successful the program is. They think government has no business providing these services. And so if, for ideological reasons, you believe that government should have the narrowest footprint possible, then you’re not going to be very favorable about all these programs doing all kinds of things for families.

Sort of related version, if you believe that the government should not interfere in people’s families at all, then you might also be very suspicious about these programs …

David Edmonds: … even though they might save everybody taxpayer dollars. It sounds like they’re cutting off their nose to spite their face really.

Janet Currie: Well, that’s kind of my view, but a lot of people do hold those opinions.

David Edmonds: How long does the effect last? If a child is supported through a Head Start program, can we see the effect throughout their life, and indeed, might even be passed on from generation to generation?

Janet Currie: Yes, that’s one of the really exciting developments in this type of research is that increasingly, there’s good enough data that you can follow people over long periods of time, so you can see people who were in Head Start and now they’re middle aged or even older, so you can see if they were in Head Start do they have higher incomes? Are they less likely to have been convicted of a crime? (Which turns out to be the case.) Are they more likely to have gotten college education? And all those things are benefits.

David Edmonds: You mentioned one ideological objection. Another ideological objection might be, not that one shouldn’t intervene at all in families, but that it’s paternalistic, and that maybe a better approach if we’re going to spend money on families in need would be to directly hand them, as it were, wads of cash for them to spend as they will, rather than direct it through educational programs or government agencies.

Janet Currie: So, I think that’s not an unreasonable argument, and that that could work for many families. I think there’s two issues with that. One is that it won’t benefit every child, because there are some families that are dysfunctional enough that giving them cash would not necessarily benefit the child. That may be a minority of families, but those are the most vulnerable children. So even a cash program, I think you still need some kind of safety net to catch those children.

The other main problem with cash subsidies for families is that we seem to be willing to give a lot more money in kind than in cash, and so when there are cash subsidies, at least in rich countries like the United States or the UK, they’re not really big enough to move the needle, even if you give somebody $3,000 per the year. What exactly do you expect to buy with that? It’s not going to greatly improve housing. It’s not going to allow people to get health insurance, which we have to buy here in the United States. It’s not going to pay for a quality preschool. So what exactly is it that you expect to get with a relatively small amount of cash? And I’m sure the family would like to have it, but it’s not clear what you’re going to get.

David Edmonds: So Head Start works. It means people are less likely to go to jail, they’ll get better educational qualifications. Can you put some kind of number on this so that we can see how big the effect is?

Janet Currie: Well, the number that gets bandied about a lot is that if you spend $1 on quality preschool programs, you get back $7. Now that’s for the Perry Preschool Program, which was a more intensive program, but it used the same curriculum as Head Start. And in work that I’ve done, it’s suggested that the benefits of Head Start were at least a third of the benefits of Perry Preschool. So that would be spending $1 gives you $2 or $3.

David Edmonds: And that’s measured because if people, once they’ve reached adult life, if they get better jobs, then there’s greater tax receipt but also the cost of keeping people in jail and so on is huge, so both those kinds of costs and benefits are included in that calculation?

Janet Currie: Well, that’s right. Reducing crime is huge, basically, because it not only costs a lot of money to keep people in jail, but it also inflicts costs on other people. Costs of crime are very high. Those include things like being afraid to go out at night because you might become the victim of a crime. So people change their behavior.

David Edmonds: You touched on the point that in the States, obviously not true. in the UK, you have to buy health insurance. Have you looked at whether widening health insurance to families in need also has an effect similar to that of Head Start?

Janet Currie: So that has been a huge success story in the United States that a lot of people don’t know about, which is that the government expanded health insurance to pregnant women and children in the late 80s and 90s, so that by 2000 like 40  percent of children are covered by Medicaid. So children, by and large, can get health insurance. And that’s really changed a lot of things. For example, practitioners don’t really need to worry that they’re not going to get reimbursed, because they know that a kid that comes in who doesn’t have private health insurance is probably eligible for Medicaid. That’s been huge, and there’s lots of evidence that that’s had very positive effects on people’s health. Especially when people were covered from pregnancy and early infancy, they’re less likely to have disabilities when they grow up, which is one reason why they’re more likely to be employed. And then again, you’re less likely to have to pay for people to be on disability if they’re not disabled, which is a huge cost savings to society. And this is a place where we also have the best evidence that the effects are intergenerational, so if the mothers are healthy and better off at the time that they give birth, then their own infants are going to be healthier.

David Edmonds: And the one-to-three or the one-to-seven cost benefit analysis that you talked about with Head Start, has a similar calculation been made for health insurance, because health insurance is hugely expensive. So, have those numbers been crunched?

Janet Currie: Those numbers have been crunched. The experiment has been run in different ways in the United States, if you give health insurance to adults who didn’t have health insurance, they use more services, and they are happier about that, that they get to use services. But it doesn’t actually seem to save very much money. On the other hand, when you cover children from a young age, that is cost effective, that does save money, and in fact, the costs of the program probably pay for themselves in terms of the reduction in illness and disability going forward.

David Edmonds: Health insurance is a huge part of some people’s income. I guess an even bigger part will be accommodation, rent or mortgage. What about subsidizing housing?

Janet Currie: Yes, so there’s less evidence on that, although housing is becoming even bigger portion of people’s budget in the last little while with the run up in housing prices and rents. So there’s a lot more attention to that, and eviction, unfortunately, is a very common thing in the United States. So people have been looking at the consequences of eviction on children, which are, not surprisingly, negative, and also interventions to try and keep people in their home. So some work that I did was looking at a program to provide legal representation to tenants who are facing eviction, the idea being to kind of level the playing field, because landlords almost always have legal representation, but tenants seldom do, and so this program did reduce evictions. I’m also looking at the effect of homelessness on children’s mental health, and you can see — following the same child over time — from when they enter house in court, when their family gets a negative judgment, the child is more likely to have subsequent mental health conditions, also more likely to become homeless and so on.

David Edmonds: Mental health is wrapped up with all these other factors we’re talking about. I guess people are more likely to have mental health problems if they suffer poverty. Is mental health at an early age, very predictive of future outcomes?

Janet Currie: It is, and again, it’s predictive of a very wide range of outcomes, not finishing school, having problems with the criminal justice system. Also, there’s another dimension, which is people are less likely to form families, so then they have less social support as well. It’s thought that about half of the adults who have mental health problems develop them in childhood, and so this is also predictive of just if you have mental health problems in childhood, you’re more likely to have mental health problems as an adult, which has its own negative consequences. From an economic point of view, mental health problems are the leading cause of working days lost. The UK actually keeps good track of that, and so I think it’s three times more days lost from mental health conditions as from the next biggest category, which is musculoskeletal things like lower back pain.

David Edmonds: And we think that those people who take days off in employment because of mental health problems, the chances are they would have had mental health problems when they were kids?

Kanet Currie: Yes, if not from early childhood. At least a lot of those conditions seem to first manifest in adolescence. Also, when people do lose work because of mental health, they tend to be out for a long time compared to when they lose work for a physical health condition.

David Edmonds: So is the solution to tackle the mental health per se, or to tackle the root causes, which are poverty? How does one get at this problem?

Janet Currie: So ending poverty is a great goal, and there are lots of things that we could do to move towards that goal, but I think there are things that we could do to improve people’s mental health, even without ending poverty. I was saying that there were interventions for adolescents. Some of those have to do with mental health. So, for example, putting mental health counselors in schools seems to be an effective way to address people’s mental health problems. Especially since a lot of kids find school to be very stressful, not only academically, but because of issues like bullying and things like that. So having the counselors right in the school can be helpful.

Anti-bullying programs also can be effective. There are programs to teach kids principles of cognitive behavioral therapy so that they can address their own mental health problems or distorted thinking because of mental health problems. So those are some of the things that could be done.

David Edmonds: Do you have to run randomized control trials to work out the effect of those kinds of interventions?

Janet Currie: So it’s very difficult to run randomized control trials in a lot of these cases, so researchers often rely on other types of research designs. So, for example, one of the best studies I know of about the effect of having school-based mental health clinics is using a rollout design. So, you had a program which launched first in some schools and then later in other schools. And so then you can look at the before and after repeatedly, you know, say, “Well, okay, this school that was an early adopter, if we look before and after, do we see a positive effect on mental health? And then this other school that adopted at a different time, do we see the same benefit when they adopted?” And so that can be also a pretty compelling research design.

David Edmonds: You’ve mainly focused on US data. I know you’ve done a bit on the UK as well. But is there a reason to believe that the kinds of findings that you’ve discovered are not universalizable across the developed world?

Janet Currie: No, I think these findings are very generalizable, and in fact, there’s a lot of research that’s been done in other settings, less in the UK, maybe than one might hope, because it’s often difficult to get data in the UK, but a lot in Scandinavian countries, a little bit in places like France and Italy, Germany. The findings tend to be pretty consistent about what’s beneficial for children. And in some ways, it’s not rocket science, even though I’m doing this and like working hard to make it compelling to scientists, I think it’s pretty intuitive that if kids get enough to eat and have people to care for them and have a roof over their heads and get health care, that that’s going to be good for the kids.

David Edmonds: Let me ask you one final question. With speaking a month before Donald Trump becomes president, you’re working on interventions, and you’ve shown that many of these interventions are very cost effective. But is this approach ideologically out of favor? Do you find yourself not pushing at an open door, pushing very much at a closed door?

Janet Currie: Well, I’m not sure. The coming vice president, for example, has spoken in favor of child benefits. Both Republicans and Democrats have spoken in favor of increasing child benefits in the United States. So possibly that might happen. I think it’s also important to realize that a lot of these programs are conducted at the state level, or even at the local level — it’s not only the federal government that matters, although the federal government is important. I think what may happen is that there might be increasing divergence between states that are in favor of these programs and states that are less in favor of these programs, which would be unfortunate for people that live in the latter states, but I don’t think the programs will completely disappear.

David Edmonds: Janet Currie, thank you very much indeed.

Janet Currie: Thanks.