Health in Britain, including life expectancy, has continued to improve in recent years, yet health inequalities have not only persisted, but widened. Those who are best off financially have the best health too. Evidence from the US has suggested that as little as 20% of the influences on health may be to do with clinical care and quality of care. Health behaviours account for a further 30% of influences and the physical environment for just 10%, while socio-economic factors have the largest impact on health – 40% of all influences. However, the wide range and inter-relatedness of socio-economic factors makes it hard to focus on just one factor to reduce health inequalities.
The British Academy has just published a collection of opinion pieces on health inequalities written by social scientists: “If you could do one thing…” Nine local actions to reduce health inequalities. Each of the authors has produced an article drawing on the evidence base for their particular field, identifying policy interventions which they think should be introduced to improve the health of the local population and reduce health inequalities.
In our chapter, we consider the scope of further and adult education for reducing social inequalities in health. Adult education practitioners have long been aware of the power that learning can have in transforming individual life paths. There is growing statistical evidence to support this, showing associations between participation in various types of adult learning and improvements in wellbeing, health, and health-related behaviours. A good deal of this evidence has been obtained by researchers using the rich data available in birth cohort studies. These data sources enable the researcher to understand the relationships between sequences of learning events and health outcomes through time.
However, the benefits of learning at individual-level do not necessarily imply that investment in education will reduce health inequality. For example, if additional investment in post-compulsory learning is heavily weighted towards higher education among young adults, this would probably be of disproportionate benefit to middle class young people. The long-term impact of such an intervention could then be to increase inequalities in health rather than reducing them. Similarly, funding for training programmes that were only available to those in work would run the risk of increasing inequalities between the unemployed and the employed.
Bearing these complexities in mind, we recommend three key interventions. Firstly, there is a strong case for the provision of financial support to those without any educational qualifications to attend further and adult education institutions and obtain qualifications. Secondly, adult learning for people who leave school without any qualifications should focus on key literacy and numeracy skills, the lack of which acts as a major barrier to obtaining employment. A policy which concentrates on learning for such economically disadvantaged groups is unlikely to suffer from the risk of increasing inequalities in health. Thirdly, as the NIACE-sponsored Inquiry into the Future of Lifelong Learning argued, there is a good case for the education budget to provide more support for older learners. Adult learning could contribute to a healthy and active old age.
Unfortunately, policy in recent years has tended to focus on young people doing full-time courses while funding for other forms of learning has been cut back. Increasing the financial barriers for adult learners will be felt particularly acutely among the socially disadvantaged and there is a real concern that this will have detrimental consequences for health equality.
This post first appeared on the NIACE blog