A good quality education is the foundation of health and well-being. For people to lead healthy and productive lives, they need knowledge to prevent sickness and disease.” This declaration by the United Nations Educational, Scientific and Cultural Organisation (UNESCO) further affirms that “education is a catalyst for development and a health intervention in its own right.” The Incheon Declaration of 2015 on Sustainable Development Goal 4 affirms that education endows the skills, values and attitudes that enable citizens to lead healthy and fulfilled lives, and make informed decisions. Contrariwise, ill health impedes access to education and attainment of knowledge and skills.
A wealth of evidence, from comparisons within and across countries, testifies to the positive impact of education on health status of individuals and populations. Higher levels of education usually provide greater access to health-related information which, when assimilated and stored as knowledge, can promote and sustain healthy behaviours. Education also increases opportunities for higher income employment. Better economic status, in turn, enables a person to afford more nutritious and safe food, live in better housing with assurance of clean water, sanitation amidst healthier physical and climatic surroundings.
Higher income, coupled with good education, also enables one to access better healthcare. Health seeking behaviours, insurance literacy, ability to engage in participatory decision making with the doctor, adherence to treatment and capacity for self-care are all better with higher levels of education. Worldwide, unhealthy behaviours like tobacco consumption and alcohol abuse are inversely correlated with educational status. Such social gradients, across the levels of education, are most evident within individual countries while other differences dilute the association in inter-country comparisons.
While education and income often go together as positive determinants of health, education has a greater impact on health than income. Even a financially well-off person will not make healthy choices related to food, exercise or addictive behaviours, if education does not provide the requisite knowledge. On the other hand, an educated person is more likely to adopt healthy behaviours and make healthy food choices, even within the constraints of limited income. At any given level of income, higher education offers better health protection. Ideally, healthy behaviours are most likely to be adopted when health literacy provided by education is supported by lowering of financial and access barriers to health promoting agents and environments.
However, these relationships are not wholly independent, always linear or universal. The many centenarians of Hunza Valley are healthy not because of high educational attainment but because of a pristine environment and healthy traditional diets. Other communities too derive health benefits from traditional diets and herbal medicines. In such cases, it is not the knowledge gained through formal education which promotes and protects health but tacit knowledge and experiential wisdom that provide the health benefit. While knowledge is gained most easily from structured formal education, there are also other channels for acquiring health friendly knowledge. Mass media also help to quickly disseminate health relevant knowledge to a large number of persons whose formal education may be varied.
The positive relationship of education with health was clearly evident in the 20th century. However, the rapid growth of social media in the 21st century, is blurring the benefit. The best case scenario is of widespread rise in health and nutrition literacy through print, electronic and social media. While it is happening to some extent, the infiltration of fake news and anti-science propaganda into the social media has proved harmful to adoption of healthy behaviours. This has been painfully evident during the Covid pandemic. Highly educated persons became the prejudiced purveyors and deluded victims of false information, while the less educated were willing to trust health workers.
For education, formal and informal, to positively impact health behaviours of a large number of people, we need to both raise the level of formal education by improving its access and quality as well as fast track health and nutrition literacy among the general population. The content of the educational messages must be founded on science, while taking into account the specific health needs and cultural practices of the population groups being addressed. Credible agencies and individuals must be engaged to quickly counter and contain fake news.
Educational institutions can transform students into agents of health promotion. School and college students who are sensitised to health issues and motivated to adopt healthy behaviours can also become change agents in the family, neighbourhood and the wider community. Two school-based voluntary groups HRIDAY (Health Related Information Dissemination Among Youth) and SHAN (Student Health Action Network) have demonstrated high impact in Delhi, in promoting tobacco control and adoption of healthy behaviours. The former engages students of Classes 6-8 in peer led health education (“Learning The Fact”) while the latter enables students of Classes 9-12 to debate and disseminate policy recommendations that can advance health through multi-sectoral actions (“Learning To Act”).
An educated and engaged younger generation can power health transformation in the country.
K Srinath Reddy
President of Public Health Foundation of India (PHFI)