Effects of Finnish comprehensive school reform on gender and socioeconomic inequalities in mortality and hospital utilization

As part of building Nordic welfare state, Finland adopted a comprehensive school reform between years 1972 and 1977. The main change in the reform was the increase of school tracking age of children from 10-11 years of age to 15-16 years of age. The reform was passed through the country region by region starting from northern Finland and spreading towards south. This made it possible to examine the effects of the reform on health in a quasi-experimental setting. By combining Finnish Longitudinal Census data and National Hospital Discharge records, the effects of the reform on allcause mortality analysed with Cox regression and hospital utilization with negative binomial regressions. Explanatory variables included exposure to the reform, sex, birth cohort, region, and adolescence socioeconomic status indicators (father’s education and parental income). The main findings are that the comprehensive school reform may have had a pro-female effect on mortality between sexes, which suggests that the reform should have increased the life expectancy gap between genders. As such, it does not help to explain the observed reduction in differences between period life expectancies between males and females after 1978. Secondly, the reform didn’t have a significant effect of socioeconomic distribution of health measured by mortality and hospital utilization. Third, parental income is associated adulthood mortality and hospital utilization regardless the socioeconomic status in adulthood. And finally fourth, the comprehensive school reform reduced the association of parental income on number of hospital admissions especially among lower socioeconomic groups, and reduced the importance of father’s education on hospital admissions within lowest educational group.