Public defence in Economics, M.Soc.Sci. Maarit Olkkola

Title of the thesis: Essays on Health Policy and Human Capital

Doctoral student: Maarit Olkkola
Opponent: Prof. Miriam Wüst, University of Copenhagen, Denmark
Custos: Prof. Matti Sarvimäki, Aalto University School of Business, Department of Economics

Maarit Olkkola’s dissertation demonstrates that the evaluation of public policies targeting children should also consider potential long-term benefits, such as human capital formation. The dissertation consists of three essays, two of which focus on the introduction of a network of child health centers in Finland. The third essay addresses a mass vaccination campaign against measles in the United States.

The public child health centers were established in Finland in the 1940s. In the 1930s, one in nine Finnish children died before age five, and child mortality was almost twice as high as in Sweden. In the 1940s, Finland's child mortality rate more than halved, but micro-level data has not previously been used to examine how the establishment of child health centers in rural areas contributed to this mortality decline. According to the first essay of the dissertation, child health centers established in rural municipalities significantly reduced child mortality: the mortality of children over one month but under one year old (post-neonatal mortality) decreased by more than 25%, and the mortality of boys aged one to four decreased by over 60%.

The documented decrease in mortality among infants is consistent with similar findings from the establishment of child health services in other Nordic countries around the same time. However, in other Nordic countries, children's health services initially did not extend to children over one year old. Therefore, the dissertation provides new information, especially regarding the impact of public health services on mortality rates for children over one year old. The research has not yet been published in a peer-reviewed journal.

According to the second essay, rural children who had access to child health centers in the 1940s attained more education and income as adults compared to children living in municipalities that had not yet established a child health center. The effects on education and income levels were positive for those children who were under four years old when the health center was established in their municipality. Thus, it appears that the child health center network contributed to the human capital formation of rural children.

The effects of the establishment of health services for children under one year old on human capital have varied across other Nordic countries. Some studies have found no positive effects, while others have demonstrated results similar to those of this essay. The findings thus complement existing knowledge on the subject and expand it, particularly concerning children over one year old. The research has not yet been published in a peer-reviewed journal.

The third essay of the dissertation indicates that the first nationwide measles vaccination campaign increased educational attainment in the United States. Measles was a very common disease in the 1960s, affecting nearly all children, primarily in elementary school age. During the campaign in 1967–1968, almost 12 million doses of the measles vaccine were distributed in the U.S., leading to a 90% reduction in the reported incidence of the disease. According to the research findings, the vaccination campaign slightly increased educational attainment among U.S. birth cohorts that were either targeted by the campaign or beneficiaries of reduced prevalence of the disease. This study is the first to document a positive impact of measles vaccination on educational attainment, and it has been published in the leading health economics journal (Journal of Health Economics).

Key words: public policy, health policy, human capital, health care, child mortality, immunization

The dissertation research was funded by Yrjö Jahnsson Foundation, OP Research Foundation, the Finnish Cultural Foundation, Alfred Kordelin Foundation, Otto A. Malm Foundation, the Helsinki School of Economics Support Foundation, and the Research Council of Finland.

Thesis available for public display 10 days prior to the defence at:
https://aaltodoc.aalto.fi/doc_public/eonly/riiputus/