Health 2020: education and health through early development: sector brief on education

Synergy between sectors: fostering better education and health outcomes The Health 2020 policy framework has been adopted by all Member States of the WHO European Region in order to address Europe’s great social and health challenges, calling upon the health sector to reach out to, and work with, all the various sectors and parties in the continuous work of im- proving people’s health and well-being. In the 21st century, education and health can no longer afford to work in separate silos. Robust evidence shows that children with environments that support their health demonstrate better education outcomes, and better-educated children become healthier adults. Together with the home and family environment, the educational environment – from nursery through tertiary education – is vital for children. By working together, the health and education sectors can create synergy between the two and create environments that enable children to perform to their greatest potential, allowing them to grow into healthier adults. The education sector can help create healthier people and communities by: • ensuring access to education for all, because education level is a key determinant of health • training its professionals to understand the health dimension of their work, because teachers can help create the foundations that build healthy and resil- ient populations • enhancing health literacy, because people’s capacity to access, understand and use information to improve their health and well-being is a key determinant of health • working with the health sector as anoth- er employer of women, to ensure that both sectors remain high on the agenda of national governments and address gender inequities in participation in the labour market. Summary Health 2020: Education and health through early development May 2015 Sector brief on Education 5 Social progress is best mea- sured by objective indicators of health, health equity and well-being, and this includes the conditions in which people are born, live and work. 1 Health and wellbeing are public goods and assets for human development that contribute to strong, dynamic and creative societies. 2 Health and well-being are best achieved if the whole of government works together, and Health 2020 promotes whole- of-government and whole-of- society approaches. 3 Health and well-being can be improved and health inequalities reduced, through the right policies and working with other sectors. 4 Different countries, cities and communities are at different starting-points; each is unique and can pursue common goals through different pathways. Key messages The goal of Health 2020 is to significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are universal, equitable, sustainable and of high quality. 2 Health 2020: Education In 2012, all 53 Member States in the Euro- pean Region adopted Health 2020, the new common European health policy- framework, and committed themselves to developing integrative policies that engage with all sectors in addressing the social and economic determinants of health and well-being. Studies show, for example, that similar socioeconomic factors affecting families and communities determine both the educational and health outcomes of children. Children from poorer backgrounds are more likely to experience poor parent- ing, receive inadequate support in schools and health services, live in hazardous envi- ronments and live shorter and less healthy lives as adults. These inequalities form a gradient, with the highest socioeconomic quintile doing the best and the next a bit less well, and therefore comprise a challenge across society and not just for the most disadvantaged. Using education policies and the school setting to help address these inequalities has been shown to go a long way to fostering better education outcomes and health and well-being in a population. Students who participate in physical activity are less absent from school, and students who eat breakfast at school perform better academically and are able to concentrate and participate better in class. Increasing such healthy behaviour early in childhood can mitigate some of the effects of disadvantages from socioeconomic conditions and has been shown to result in better physical and mental health in adulthood. Furthermore, children affected by poor health experi- ence many difficulties in schools and in obtaining good education outcomes. Strengthening the link between good health and better educational outcomes World Health Organization 3 All Member States of the WHO European Region have agreed to monitor progress against six common targets: 1. Reduce premature mortality in the European Region by 2020 2. Increase life expectancy in the European Region 3. Reduce health inequalities in the European Region 4. Enhance the wellbeing of the European Region population 5. Ensure universal health coverage and the right to the highest attainable level of health 6. Set national goals and targets related to health in Member States. Health 2020: a framework for action What makes societies prosper and flourish can also make people healthy, and policies that recognize this have more impact. Building awareness and capacity to make health objec- tives part of society’s overall socioeconomic and human development is essential. All policy fields, including health, need to reform their ways of working and use new forms and approaches to policy at the global, national and local levels. The goal of Health 2020 is to significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are uni- versal, equitable, sustainable and of high quality. 4 Health 2020: Education Strengthening the link between education and better health It is well understood that the family and home conditions of children are a crucial determinant of their health. Once children enter education, the influence of peers, the school and the community grows and adds to determine their development and health. Education has a central role as a determi- nant of health and health literacy: it is a major determinant of health in its own right and it shapes other determinants through- out the life-course. The child’s educational journey starts at home and continues through preschool, with children already demonstrating the effects on inequality by the time they start school. Children who access early child education are likely to do well at school, attain better paid employ- ment and enjoy better physical and mental health in adulthood. High-quality education is increasingly important in today’s glo- balized economy, with knowledge societies and job markets that increasingly require intellectual and academic skills. Exclusion from high-quality education leads to people becoming vulnerable to subsequent adversi- ty and ill health. Children need a good start, which includes a health-promoting home environment as well as high-quality childcare and early education. Reinforcing a good start requires equitable education and social support Synergy between sectors: improving education outcomes to create healthy adults for boys and girls and good systems for developing competencies and work skills throughout childhood and adolescence. Health 2020 identifies that the most effec- tive policies are those that actively involve education, labour, employment and social welfare systems and agencies as well as par- ent, community leaders and young people themselves. Strengthening people’s health literacy and the health literacy–friendliness of systems and empowering communities and young people are essential to create the conditions for maintaining health and well-being. Enabling people to exercise more control over their health and its deter- minants builds communities and improves their health. Schools provide a crucial setting in which to improve the health and well-being of chil- dren and young people. Health-promoting school programmes, for example, focus on a whole-school approach such as actively involving whole school communities in iden- tifying ways to make school environments more health promoting. This can build resilience and benefits by: • facilitating a participatory and action-ori- ented approach to health education, taking into account the students’ own concepts of health and well-being; • developing community-wide endorsement for health-promoting school policies; • developing the physical and social environment of the school, such as by enabling more physical activity; • developing life competencies; • making effective links with home and the community; and • making effective use of health services in and around the school setting. Health 2020 provides a platform for such joint work between the education and health sectors. Working together, the two sectors have the power to intervene to address avoidable differences in children’s experiences, to compensate for unequal situations and to ensure that the most vul- nerable children receive the extra services they need. World Health Organization 5 How can education make a difference in health? Health 2020 provides a platform for such joint working between the education and health sectors. Working together to support the health of children requires commitment from everyone involved. There are different and complementary roles for the family, for educational institutions, for the education sector, for medical, nursing and public health schools and for communities and civil society. Synergy between sectors: learning and collaboration to support children and their communities KEY AREAS TO EXPLORE TOGETHER INCLUDE: • how the health and education sectors can work together in times of economic or external pressures; • how to pursue the shared goal of tackling health and educational inequities through the integrated efforts of the health and education sectors; • how to optimize outcomes in health and education equity by strengthening the partnerships between the health, social and education sectors. • Ensure that all children have basic skills, especially reading skills, and complete secondary education • Ensure that primary education is conducted in small groups with skilled teachers • Mix affluent and disadvantaged children and actively motivate those who need particular attention • Provide options for secondary education with a focus on practical learning • Reduce the dropout rate through a socially, educationally and individually supportive environment • Give priority to physical activity and sport, especially among girls • Where possible, ensure that the food and beverages provided are healthy and not high in sugar, salt and fat • Ensure the provision of healthy meals free of charge in a sensitive way that does not cause stigmatization How can the sectors work together? 6 Health 2020: Education How can health make a difference in education? Collaborating to improve children’s well-being THE CHALLENGE For the most vulnerable children, educational and health problems coexist with other social challenges Vulnerable children may be forced to deal with chaotic and transient family situations, allowing them to fall through the gaps in services Education may reinforce gender inequalities and exposure to high-risk behaviour The burden of noncommunicable diseases is growing throughout European populations; young people are vulnerable to marketing pressure and taking up of behaviour that increase their risk of noncommunicable diseases • Provide robust antenatal and child health services that support the develop- ment of language and social skills among preschool children • Provide early referral to parenting support for children who are struggling • Work to ensure that public health care is accessible and available for all school-age children • Work with schools to provide high-quality health and counselling services • Work to ensure that children have decent living conditions such as high- quality, safe and adequately sized housing that allows them to stay well and perform at school THE RESPONSE NEEDED Health and education providers can take action to identify children at higher risk early in life. They can work together to ensure the development of clear protocols for reporting and follow-up Information sharing, seamless referral procedures and outreach and follow-up between sectors – for example, schools, health services, child protection, social services – can help prevent children from missing out Using the opportunities levered by education as a setting for reducing inequalities and addressing specific risks such as injuries, mental health, sexually transmitted infections, violence, pregnancy and substance use Using the school setting to improve healthy behaviour, such as sup- porting regulatory frameworks that provide nutritious school food and access to high-quality drinking-water and restrict the availability of high-sugar beverages Supporting the adoption of health literacy (including media literacy) programmes, including programmes to empower and build confi- dence among young people Supporting the adoption of government policies to reduce food and alcohol marketing targeting children and adolescents World Health Organization 7 The Health 2020 policy framework has a political mandate. It has been adopted by all European Member States and can be adapt- ed to the different settings and realities that make up the European Region. It describes how health and well-being can be advanced, sustained and measured through action that creates social cohesion, security, a good work–life balance, good health and good ed- ucation. It calls on the health sector to reach out to the many different actors within and outside government and provides inspiration and direction on addressing the complex health challenges of the 21st century. The framework confirms values, is informed by evidence and identifies strategic directions and essential actions. It builds on the expe- riences gained through previous Health for All policies and guides the actions of both Member States and the Regional Office. The framework addresses Europe’s great social and health challenges, including inequalities, noncommunicable diseases and infectious disease threats. Health 2020 has been informed by an unprecedented research and review process and distils the world public health knowledge. Considerable evidence supports the claim that education and health are correlated. Data indicate that the number of years of formal schooling completed is the most im- portant correlate of good health. According to the 2003 Human development report (United Nations Development Programme): “Education, health, nutrition and water and sanitation complement each other, with investments in any one contributing to better outcomes in the others.” Governments that invest in education also invest in health. A growing body of empirical research suggests that, when countries adopt policies to improve education, the investment also pays off in terms of healthier behaviour and longer and healthier lives. Studies of compulsory schooling reforms adopted in several countries in the European Region conclude not only that the reforms leads to additional years of completed schooling but also that the additional schooling reduces the population rates of smoking and obesity. When countries consider the return on investment in education and other social determinants of health, the analysis should include the potential health gains. This is particularly pertinent during periods of fiscal consolidation, economic challenges or changing political priorities, promoting the co-benefits brought by education and health investment. Health 2020 sees the education sector as a co-producer of health; a setting in which healthy behaviour is learned and promoted; an employer of a key workforce for children’s health and well-being; a trainer of profes- sionals who play a vital role in the health and well-being of the future society; and a partner in striving for investment in sectors that contribute to developing social capital and gender equity. Using Health 2020 as a platform for joint work: a political mandate and evidence base LIFE-COURSE STAGE • Social protection for women, mothers- to-be and young families • Universal, high-quality and affordable early-years education and care system • Eradication of unsafe work and access to employment and high quality work • Coherent and effective intersectoral action to tackle inequalities at older ages WIDER SOCIETY • Improved social protection, according to need • Co-creation and partnership with those targeted, civil society and civic partners • Action to reduce social exclusion • Gender equity approach BROADER CONTEXT • Promoting equity through tax and trans- fer payments • Long-term planning through links with other policies SYSTEMS • Greater coherence across sectors • Comprehensive responses • Regular reporting and public scrutiny Reducing health inequalities To reduce health inequalities, addressing the following is a good start: WORLD HEALTH ORGANIZATION | REGIONAL OFFICE FOR EUROPE UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 E-mail: contact@euro.who.int Web site: www.euro.who.int Document number: WHO/EURO:2015-6160-45925-66189 © World Health Organization 2015. 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