Childhood Health and Sibling Outcomes: The Shared Burden of the 1918 Influenza Pandemic

The impacts of a negative health shock during childhood can have long term consequences for a person in terms of health, human capital formation and labor market outcomes. However, the effects of the health shock are not necessarily limited to the afflicted individual. By raising the costs of the child both in terms of health care and human capital investment, the health shock impacts a family’s resource allocation decisions. As a result, a significant negative health shock for one child can influence the outcomes of his or her healthy siblings. This paper uses the 1918 influenza pandemic to assess the ways in which a major negative health shock influences family planning and investment decisions. By linking educational and health data from military records to census information on childhood households, I show that the influenza pandemic impacted family structure and the levels of investment in not only those children born during the pandemic but also on their siblings. The results suggest that having a child born during the pandemic led families to shift educational investments to older children. Children born after the pandemic received less educational investment on average if a sibling was born during the pandemic. The magnitude of these effects are quite large: having a sibling born during the pandemic was associated with a change in educational attainment of a quarter of a year. These results suggest that the effects of childhood health shocks on siblings are an important consideration when evaluating the potential consequences of childhood health interventions.