Canadian Journal of Public Health

, Volume 99, Issue 4, pp 344–349 | Cite as

How Health Status Affects Progress and Performance in School

A Population-based Study
  • Randall R. FransooEmail author
  • Noralou P. Roos
  • Patricia J. Martens
  • Maureen Heaman
  • Benjamin Levin
  • Dan Chateau



To assess the effects of health status at birth and health status in the preschool years on educational outcomes to age 9 in a population-based birth cohort.


Administrative data were used to follow all children born to Winnipeg mothers in 1990, and remaining in Manitoba until September 2004 (N=5,873). A structural equation model was used, incorporating latent variables to represent Health Status at Birth, Major Illness and Minor Illness during the preschool years. The model also included the child’s sex and exact age, along with a number of social, economic, and demographic characteristics of the child’s family. The outcome was a combination of marks on Grade 3 Standards Tests and enrolment in the appropriate grade for age.


Major Illness in the preschool years had a significant influence on progress and performance in school (p=0.0003), predicting 1.26% of the variation in the outcome. Minor Illness was weaker but still significant (p<0.01). Health Status at Birth was not directly related to the outcome; its effect was mediated by Major and Minor Illness in childhood. Overall, the strongest predictors were the child’s age and the area-level income, followed by the mother’s age, family receipt of income assistance, the sex of the child, breastfeeding initiation (all p<0.0001), and Major Illness.


Health status plays a statistically significant but substantively small role in explaining progress and performance in school among a population-based cohort. Major Illness was more important than Minor Illness, and these two factors completely mediated the influence of Health Status at Birth on the outcome. The strength of the social, economic, and demographic variables underscores the importance of the broader factors that affect both health and educational outcomes.

Key words

Child health health status health services social determinants health policy 



Évaluer les effets de l’état de santé à la naissance et au cours des années préscolaires sur les résultats pédagogiques jusqu’à 9 ans au sein d’une cohorte de naissance représentative.


À l’aide de données administratives, nous avons suivi tous les enfants nés de mères vivant à Winnipeg en 1990 et habitant encore au Manitoba en septembre 2004 (N=5 873). Nous avons utilisé un modèle d’équations structurelles incorporant des variables latentes pour représenter l’état de santé à la naissance, et les maladies graves et bénignes contractées durant les années préscolaires. Le modèle indiquait aussi le sexe et l’âge exact de l’enfant, ainsi que certaines caractéristiques sociales, économiques et démographiques de sa famille. Le résultat final était la combinaison des notes obtenues aux examens standardisés de la 3e année et de l’inscription dans une classe correspondant à l’âge de l’enfant.


Les maladies graves contractées au cours des années préscolaires avaient une influence significative sur le cheminement et le rendement scolaires (p=0,0003), en prédisant 1,26 % de l’écart dans le résultat final. L’influence des maladies bénignes était plus faible, mais encore significative (p<0,01). L’état de santé à la naissance n’était pas directement lié au résultat; son effet était atténué par les maladies graves et bénignes durant l’enfance. Globalement, les prédicteurs les plus forts étaient l’âge de l’enfant et le revenu dans la région, suivis de l’âge de la mère, du fait que la famille touche une aide au revenu, du sexe de l’enfant, de l’allaitement maternel (tous ces facteurs, p<0,0001) et de l’existence d’une maladie grave.


L’état de santé jouait un rôle significatif, mais tout de même assez faible, dans le cheminement et le rendement scolaires au sein d’une cohorte représentative. L’effet des maladies graves était plus important que celui des maladies bénignes, et ces deux facteurs compensaient entièrement l’influence de l’état de santé à la naissance sur le résultat. La force des variables sociales, économiques et démographiques souligne l’importance des facteurs généraux qui touchent à la fois la santé et les résultats pédagogiques.

Mots clés

santé de l’enfant état de santé services de santé déterminants sociaux politiques de santé 


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Copyright information

© The Canadian Public Health Association 2008

Authors and Affiliations

  • Randall R. Fransoo
    • 1
    Email author
  • Noralou P. Roos
    • 1
  • Patricia J. Martens
    • 1
  • Maureen Heaman
    • 2
  • Benjamin Levin
    • 3
  • Dan Chateau
    • 1
  1. 1.Manitoba Centre for Health Policy and Department of Community Health SciencesFaculty of Medicine, University of ManitobaWinnipegCanada
  2. 2.Faculty of NursingUniversity of ManitobaCanada
  3. 3.Ontario Institute for Studies in EducationUniversity of TorontoTorontoCanada

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