Adrienne Lucas, a development economist and visiting research scholar at the Center for Health and Wellbeing (CHW), has devoted much of her career to studying the connection between global health and wealth. Her research spans the world, from Kenya to Sri Lanka, Pakistan and other lower income countries, in search of a deeper understanding of the intergenerational effects of poverty on a population’s overall wellbeing.  

In a recent interview, Lucas, an associate professor of economics in the Lerner College of Business and Economics at University of Delaware, discusses her background and recent work exploring education and disease as critical drivers of prosperity, productivity and quality of life.

Q. What attracted you to the field of economics?

A. I was always a “mathy” person in high school, but I did not really like that the answer was, let’s say, “five.” Five what? What does that number mean? 

When I went to college, my 18-year-old self looked at the course catalog and found an economics class, something I had never studied before. I read the description and thought, “This is what I want to do.” There was a lot of math involved, but the answer wasn’t just “five.” It was five people or five dollars; there was actually some tangible meaning to it. I started taking economics classes my first year in college and just kept going.

Q. Where was your first stop after earning your Bachelor of Arts in Economics at Wesleyan University?

A. When I started looking for jobs, I knew that I didn’t want to be an investment banker but didn’t know what I wanted to do. I just applied to every firm that came on campus and ended up as an analyst at Charles River Associates in Boston, an economics consulting firm. That was a great place to start because it gave me the opportunity to interact with a lot of people with advanced degrees, in a corporate environment. I was there for three years, working on differentiated product mergers, until I realized that I didn’t want to be in a cubicle anymore.

So I decided to go to graduate school… where for five years I was assigned a cubicle!

Q. After receiving your A.M. and Ph.D. in Economics from Brown University, you joined the faculty of Wellesley College and later the University of Delaware. What pulled you toward higher education, and what do you find most fulfilling about the profession? 

A. I wanted more agency in the types of questions I was asking and the type of research I was conducting, and saw academia as a way of doing that. Also, I loved my undergraduate liberal arts experience. With all of that in mind, I thought my destiny was to become a liberal arts college professor.

I enjoy both aspects of the job – teaching and research. And researching the subject of education allows me to blend the two together. I bring a lot of my research into the classroom, where I have students who are great at math but have never thought about a country that is substantially poorer than the United States, and students who are really into improving education, opportunities and people’s lives but lack the analytical tools. Teaching allows me to expose them to different viewpoints and ways of thinking.

 Q. You have focused your research on the economic impact of disease and education in developing countries. Why does this space intrigue you? Also, did the specialization evolve over time, or was there a defining moment that sparked your interest in these particular areas?

A. The initial questions that sparked my interest were: “Why are some countries richer than others?” and “Why do some countries grow more quickly than other countries?” These are enormous questions and one potential answer is “health,” because the least healthy places are some of the poorest places in the world. To understand the underlying relationship we need exogenous variation in health, which is why I focused on the effects of mid-20^th century malaria eradication campaigns in my dissertation.

My research moved more towards education after a very opportune encounter over lunch. I was at a conference in Nairobi, presenting my work about the economic impact of malaria, when the lunch time conversation moved towards a discussion of whether a recent free primary education policy had ruined primary schooling in Kenya. On the one hand, more students were in school, but on the other hand, schools (at least in Nairobi) had become much more crowded. Given the importance of school for so many later life outcomes, I wanted to know the actual effect of the program. I happened to be at this lunch table with my graduate school classmate, Isaac Mbiti, who has some amazing connections to Kenyan administration data, so I turned to him and asked, “Hey, can we get some data on this?” He thought we could, and we did. We went on to write four papers on education policy, focusing on Kenya but with implications for many developing countries. That was definitely a turning point for me, shifting my research toward education and education policy.

Since then, my work has ebbed and flowed between education and health under the overarching umbrella of human capital. I like to think about the constraints that limit education or compromise physical and psychological wellbeing, along with policies that can alleviate those constraints – across countries and across generations.

Q.  One of your papers explored that subject in depth by assessing the intergenerational implications of disease and education within the context of the HIV/AIDS epidemic in Zambia. I was struck by your assertion that HIV infects one generation and affects the next. Could you shed light on that finding, addressing the impact of adult health on children’s schooling?

A. Although primary education is free almost world-wide, not all kids complete primary school. When we think about why, we can think about school-based policies – and some of my research addresses that – and then we can think about issues at home. For example, the child might have an ill parent, stemming from HIV or another debilitating disease.

When we evaluate the costs and benefits of a program, we tend to focus on adults. But we also need to look at what’s happening to other members in a household and the community. Disease can have implications for the children of those infected, forcing them to withdraw from school  or to work, and affecting future opportunities and outcomes. This research highlights the value of considering the interactions of human capital across multiple generations.

Q. Within the realm of education, your recent work highlights the importance of using existing school systems to improve student learning. Could you elaborate on this concept?

A. There are many studies that say “Policy A” is very effective in this very specific location, under these very controlled settings. If we think globally about how education and health are going to be improved beyond these small studies, we have to consider personnel, resources, hiring and firing restrictions, and other things that are already in place. So my recent research has involved partnerships with governments to study the effects of various programs implemented within existing parameters, or systems.

Q. During the 2020-2021 academic year, you are advancing research at Princeton’s Center for Health and Wellbeing, representing your second visit as a research scholar. Why is CHW a natural fit for your research and interests?

A. The attraction, for me, is all of the high quality scholars doing really great research in the health space here at CHW, and more broadly in health and education in the Department of Economics. During my first visit I was finishing up my research on malaria eradication, working on another health project that unfortunately fell apart, and completing the first draft of my paper on free primary education in Kenya. At that time I had the opportunity to interact with Anne Case and Angus Deaton, who have done a lot of research on education and poverty in Africa. During this visit I focused on projects on education in both Ghana and Pakistan and even wrote a paper on the relationship between knowledge and action early in the Covid-19 pandemic across four African countries. While the pandemic has limited my interdisciplinary collaborations, I have enjoyed the CHW seminars and brown bag lunches. Conversations with Janet Currie and other economists at Princeton have markedly improved my works in progress.

Interestingly, both of my visits have coincided with global crises. Last time I was here, in 2009, it was the financial crisis, and now we are in the midst of a pandemic. Correlation is not causation, but the timing has not gone unnoticed!

Q. From what I understand, your current research investigates how a novel learning initiative improves the education, health and wellbeing of out-of-school adolescent girls in Pakistan. Why did you choose this topic?

A. In Pakistan, girls lag behind boys in educational attainment; nearly 60 percent of them don’t reach the sixth grade and only 13 percent are still in school by ninth grade. Without a foundation of education, these girls have limited economic opportunities and face high incidence of early marriage and fertility, low-paying jobs, depression, issues of abuse, and other harmful effects.

It all goes back to existing systems. In this case, out-of-school girls are excluded from the education system and paying a high price. My newest project, currently in the data collection phase, is about finding a way for them to re-engage. The idea is to give these girls more skills and more agency so they can become equal participants in the economy. There’s also evidence that more educated women have healthier, more educated children, which brings up the level of income and long-term stability of the household and the community.

Educating out-of-school children, especially girls, is an important yet understudied aspect to increasing the health and wellbeing of marginalized populations. This is one of the first studies to look at back-to-school transition. Although it is focused on adolescent girls in Pakistan, our findings will be applicable to boys and other countries as well, providing insight that could potentially improve outcomes for millions of out-of-school children and future generations.

Q. Can you tell us more about the study itself and what you hope to learn?

We’re conducting a randomized control trial (RCT) in two districts in Punjab Province to evaluate the effectiveness of a program that provides school-like content at an out-of-school learning center. The program seeks to help two types of adolescent girls: those who never had the opportunity to go to school and those who started school, but their schooling was interrupted. Girls can fail to start school or have their schooling interrupted for a number of temporary reasons: maybe they were ill, a household member was ill, or they needed to provide care for a little sibling. But once these issues resolve, they cannot re-enter the formal schooling sector. For this experiment, both students with no school and those with some school receive the opportunity to enroll in an intense “crash course” of schooling, targeted at their relevant learning level. This program is designed to relieve both supply and demand constraints on schooling. For instance, instruction is provided in community-based locations, led by females, and requires only a few hours a day over the course of three to six months instead of full-year schooling.

We are looking at whether or not this program improves student test scores and educational attainment, as well as the girls’ agency, aspirations, mental health and empowerment. If successful, we may also study long-term effects, such as fertility and health outcomes.

Q.  How far along is your research? Did the pandemic throw a wrench into your plans?

A. The pandemic definitely affected our plans. We had to completely change our research design to comply with Covid-related regulations. For example, our enumeration teams shifted back and forth between phone surveys and in-person, outdoor, socially distanced interviews. Also, the challenges of collecting phone numbers, obtaining responses, finding households with out-of-school adolescent girls, and other issues resulted in many delays.

But we are making progress. If you think about an RCT like baking a cake, we’ve put all the ingredients in the oven and we’re waiting for it to bake. The baseline is complete, the interventions are underway, and we hope to go back in June for the endline.

Q. What else are you working on during your time at Princeton?

A. Although my pre-Covid vision was derailed, I have kept myself busy with a bunch of unfinished and unplanned projects – including two papers that were not even on my radar.

One of those papers, co-authored by Anne Karing [assistant professor of economics and public affairs, CHW affiliate], addresses health knowledge and non-pharmaceutical interventions during the Covid-19 pandemic in Africa. In this study, we found that people in the four African countries we surveyed – Ghana, Malawi, Tanzania and Sierra Leone – know a lot about Covid. And the more they know, the more likely they are to take protective measures for lowering disease risk, with the exception of social distancing. While respondents largely adhered to mask mandates and lockdowns, those with more coronavirus knowledge were more likely to come in close contact with people outside their household. This paper is in the “revise and resubmit” phase at a journal, which is very exciting.

Another forthcoming paper looks at whether school principals in Ghana evaluate teachers differently based on whether they are male or female. In short, the answer is “yes.” By comparing subjective assessments to an objective measure, gains in student test scores, we concluded that principals judge female teachers much more harshly than their male counterparts. In fact, in our study, the female teacher with the highest student test score gains received a less favorable assessment than the male teacher with the lowest student test score gains.

Then I have a third paper, recently accepted for publication, about education technology. This study revealed that providing students with brief, expert-led videos on personal tablets decreased academic achievement while similar content integrated into the classroom experience increased achievement. The contrast suggests that technology might not foster learning independent of the guidance and support of a classroom teacher.

Q. Any new projects in the pipeline?

A In the short run, I have an India-based education policy project, where we have all of the data but haven’t yet analyzed it. The study looks at whether giving teachers discretion within a program is good or bad. In other words, is it better to provide educators with a very structured, task-oriented program, or does the extra agency help to make the program more effective?

My newer work will also think about the management of schools, which is understudied. Most researchers focus on the classroom and teacher but ignore the next layer up, such as the principal or head teacher, as important determinants of student learning.

Q. When you think about your body of research and ultimately your legacy, what are your hopes about the impact of your work?  

A.  Some projects are already making a big difference. My research on targeted instruction in Ghana, for example, studied the effects of teaching students according to their learning level rather than age or grade level. After finding that this approach was very effective in improving learning outcomes, Ghana’s government scaled up the pilot program to include 10,000 primary schools and reach over two million students across the country.

In the long run, my work is about more than teaching kids to read, write and do basic math. Kids who have more education will go on to have more productive occupations and more agency. They’ll be able to protect themselves from disease and increase their contributions to society.

It all comes back to health and wealth. As countries get richer, they get healthier because they can afford more preventative and curative pharmaceuticals and non-pharmaceutical interventions, and individuals have the resources to improve all aspects of their wellbeing – from their physical and mental health to their socioeconomic status, and ultimately their quality of life.

Q. Can we wrap up the interview with a fun fact?  Do you have any interesting hobbies or passions outside the world of academia?

A.  I grew up in California, but my mother is from the Midwest and the women in my family have been bakers for many generations. So I really like baking… and making ice-cream. I’ve made chocolate ice cream from scratch every week for the past 10 years. 

I’m also an avid Peloton user and sometimes runner. There’s a whole economist community on Peloton. I’ve connected with economists around the country during Peloton rides and even made some new economist friends!