SECOND OPINION:Qualifications work like a vaccination against ill health, writes JACKY JONES
IRISH PEOPLE are great for reinventing the wheel but are slow to attach the wheels to the vehicle to ensure it reaches its destination. I’m referring to our reluctance to apply best practice and evidence to health education programmes and the promotion of health. A report this month from the Health Research Board on alcohol-related deaths notes there is no evidence “that school-based education and information programmes reduce alcohol-related harm”.
Well yes, that has been widely known since the early 1970s. I attended an Education Against Addiction conference in Killarney in 1979 where those exact facts were presented to hundreds of people from the Irish health and education sectors. In 1989, the King’s Fund (London) summarised the international evidence on education for health and concluded that many agencies reinvent the wheel and use health education strategies that are ineffective or even counterproductive, including topic-centred school-based programmes on sex, drugs and alcohol.
A classic drug education study involving 1,000 pupils aged 14-16 in 20 schools, was carried out in 1975. Pupils were divided into four groups: Group 1 received no drug education; Group 2 received warnings on drugs; Group 3 received factual information only, and Group 4 had discussions on drug use and abuse. The findings showed that none of the programmes stopped pupils using drugs and the warnings approach actually doubled the numbers experimenting.
Similar studies have since shown the same results for alcohol, tobacco and virtually all topic-centred education. Included in this are talks by health experts which are a complete waste of everyone’s time. In spite of all this evidence, anecdotal accounts suggest that one-off talks by guest speakers are still alive and well in Irish schools. Life-skills programmes that empower children to take charge of their own lives do work to some extent, and children who receive these programmes in school are less likely to get into trouble with addictive substances when adults.
Much more important to health is educational attainment, and no life-skills programme will compensate for its absence. It doesn’t matter what the subject is, English, ancient Greek, plumbing or maths, every qualification achieved improves health and works like a vaccination against ill health.
A 2011 comparative analysis of 11 European countries, including Ireland, confirms once again that education is the most important determinant of health. The report highlights the need for more collaboration between the health and education sectors to ensure children achieve their full potential.
Readers who need to be convinced about the connection between education and health need look no further than the 2010 All Ireland Traveller Health Study, which shows the startling links between poor health and low educational attainment.
In spite of the involvement of 72 Traveller organisations and Traveller health units in every HSE area, the health of Travellers has not improved one whit in the past 25 years. The life expectancy of Traveller men is now 61, the same as the general population in 1945. Traveller women have a life expectancy of 70 years, which is similar to the general population in 1962. Travellers have poorer health than any other group in Irish society. Traveller babies are 3.6 times more likely to die than babies in the general population. Low educational attainment of Travellers is responsible for most of their health problems.
Census 2006 figures show that 63 per cent of Traveller children left school before the age of 15 compared with 13 per cent of the general population. Only 0.8 per cent of Travellers go on to third level and 92 per cent have no qualifications whatsoever.
Travellers are not the only people whose health is affected by low educational attainment. There are poor communities throughout Ireland whose children leave school with no qualifications, and they are sure to develop chronic health problems in 20 or 30 years. Every report on health inequalities in the past 50 years has identified the link between education and health, and yet we are slow to apply this knowledge to practice. This year's TASC report, A Matter of Life and Death, notes the dearth of specific policy measures aimed at addressing health inequalities and a failure to implement many health policies.
The educational attainment of poor people is just not taken seriously. If it was, the best teachers and best equipped schools would be in the poorest communities and less competent teachers and poorly equipped schools in more affluent areas. Yes, and pigs might fly.
Dr Jacky Jones is a former regional manager of health promotion with the HSE