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Promoting health and wellbeing through children’s education

 In a recent series in the Journal of the Royal Society of Medicine, a group of education and health experts from across Europe and the UK explored the links between education and children’s long-term health, proposing solutions that could strengthen both the health and education sectors’ ability to promote health and wellbeing.  

Writing for RSM Engage, lead authors Dr Anant Jani, researcher at the Heidelberg Institute for Global Health, and Chloe Lowry, a Masters student at the Institute of Education, UCL, introduce this important series of papers, which are all free to access. 

After the Second World War, policymakers introduced a compulsory increase in schooling, which was enacted at different times across different states of Germany. This produced a natural longitudinal experiment that allowed for the study of the impact of additional schooling. The findings are striking. Additional schooling, for women in particular, was associated with causal effects in reducing their children’s smoking and overweight in adolescence that persisted into adulthood. These results are corroborated by studies across the world, which find that cumulative disadvantage from lower levels of education can increase the risk of poor health in early life, which can then lead to follow-on effects into adulthood for both the individual and their children. The implications of these findings are clear:1  

Education can have intra-, inter- and trans-generational impacts on health

The exact causal mechanisms linking increased basic education to health are not well understood though different theories suggest that better educated individuals have greater opportunities to be healthy because of, among other factors, access to income and knowledge that can support them and their children to engage in healthier behaviours.1 Alongside these pathways, we know that children's mental and physical health is directly impacted by their school environment and their teachers.2,3 

Differences in school environments can explain up to 40% of the variance in children's substance misuse, and children's physical activity levels are linked to their school's physical education provision.2 Schools that provide health education improve their students' physical health, mental health, sexual health, fitness and diet.4 Furthermore, a longitudinal study found that the strongest protective factor for decreasing substance misuse, violence, early sexual initiation and risk of injury was children feeling connected to their school. For vulnerable children the impact is even greater with school connectedness being linked to fewer emotional and behavioural problems.2

Teachers and their impact on physical and mental health

For children's long-term health outcomes, the most influential dimension of school connectedness is their relationship with their teachers. The quality of this relationship predicts general health, risk of cardiovascular disease, depression, smoking, and binge drinking in adulthood. Strikingly, individual teachers have as much impact on their students' mental health as they do on their academic outcomes. For those struggling with their mental health, teachers provide frontline support as Tier 1 Children and Adult Mental Health Service (CAMHS) professionals. In England, only ~25% of children with a mental disorder receive specialist support and a national survey revealed that teachers were the primary access point for children with a mental disorder. This dramatically increased in 2020-21, when teachers were contacted for mental health support at nearly double the rate of health services. Yet the crucial public health and primary care roles played by schools and teachers have been largely ignored.3 

Investment urgently needed to address the gaps

Despite our knowledge of the essential role the education sector plays in impacting health intra-, inter- and trans-generationally, our investment in this sector is shockingly inadequate – in the UK, less than 1% of COVID-19 relief funds went to the education sector.1 There is also little evidence-based practice or professional training for teachers in promoting healthy child development, delivering health education, or supporting children with mental health issues. Furthermore, like frontline healthcare professionals, teachers experience poor mental health themselves with 10% reporting feeling suicidal due to work and 50% considering quitting due to pressures on health and wellbeing.3, 4

The need to address the gaps in the education sector has intensified due to the COVID-19 pandemic, which has affected over 1.6 billion learners across 190 countries (94% of the world’s student population). World Bank models suggest that five months-worth of school closures could lead to a loss of $10 trillion in working-life earnings for students currently in school.5 

A call for novel education-inclusive models of care

Given the undeniable impact education has on current and future health, the shifts towards integrated care across healthcare systems globally and a commitment to population health, the healthcare community needs to look beyond artificial silos, boundaries, timelines and toxic fee-for-service models to innovate and create novel models of care and commissioning pathways that fully incorporate the education sector.     

In our series in the Journal of the Royal Society of Medicine, we propose a variety of solutions that could strengthen the education sector's ability to promote health and wellbeing intra-, inter- and trans-generationally, including:1-4 

  • Allocating more resources to high value education-related activities, including by disinvesting from low value/wasteful healthcare activities; 
  • Ensuring all children receive high-quality health education; 
  • Improving training and support for teachers on health-related areas and boosting schools’ infrastructure to become health promoting schools 
  • Incorporating all of the above into Learning Education Systems, akin to Learning Healthcare Systems, with built-in feedback loops that use data to catalyse continuous improvement 

Stewards of healthcare systems

As stewards, healthcare professionals are committed to leaving their healthcare systems in better shape than when they received them. There is no better way to do this than supporting education systems.  

References

  1. Jani A, Lowry C, Haylor E, Wanninayake S, Gregson D. Leveraging the bi-directional links between health and education to promote long-term resilience and equality. J R Soc Med. 2022 Mar;115(3):95-99. doi: 10.1177/01410768211066890.  
  2. Lowry C, Stegeman I, Rauch F, Jani A. Modifying the school determinants of children's health. J R Soc Med. 2022 Jan;115(1):16-21. doi: 10.1177/01410768211051718.  
  3. Lowry C, Leonard-Kane R, Gibbs B, Muller LM, Peacock A, Jani A. Teachers: the forgotten health workforce. J R Soc Med. 2022 Apr;115(4):133-137. doi: 10.1177/01410768221085692.  
  4. Lowry C, Rees J, Gregson D, Bailey L, Muller LM, Peacock A, Jani A. The poor relation: health education in English schools. J R Soc Med. 2022 Feb;115(2):52-57. doi: 10.1177/01410768211067187.  
  5. Lowry C, Jani A. Re-exploring the nexus between the health and education systems in the time of COVID-19. J R Soc Med. 2022 Mar 30:1410768221089019. doi: 10.1177/01410768221089019.  
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