Andrew Jenkins, IOE, and Tarani Chandola, University of Manchester
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

Andrew Jenkins
We live in an ageing society.  On current estimates the European population aged over 60 will continue to grow by about 2 million people a year over the next couple of decades and by 2060 over 65s will make up some 30% of the European population.  Finding ways to minimise the resulting strain on pension and healthcare systems is a major long-term challenge for policy-makers.
But older adults can also be considered a resource to society so the idea of active ageing must be central in addressing demographic change. Active ageing means growing old in good health and as a full member of society: having the opportunity to continue to participate in paid or voluntary work, remaining independent in daily life and involved as citizens. Older people have much to contribute to society and in turn will enjoy a better quality of life if they are able to do so. The EU’s designation of 2012 as the European Year of Active Ageing and Solidarity between Generations underscores this point.
So, if the objective is to maintain the wellbeing of individuals as they age, what is the contribution that participation in learning can make? Research has been growing on this topic but has been skewed towards small scale qualitative studies which, while of much interest and value, are not readily generalisable. Our study “Learning and Wellbeing Trajectories Among Older Adults in England” (pdf) aimed to strengthen the evidence base by drawing on quantitative data.
Using  data from the English Longitudinal Study of Ageing (ELSA),  a large-scale, nationally-representative survey of older adults, we focused on people in their 50s and 60s, and related a measure of their wellbeing to participation in several types of learning.
The most striking finding was that it was consistently the non-vocational and relatively informal types of learning (such as music/arts groups and evening classes) which were associated with increases in wellbeing, rather than formal, more vocationally-oriented education and training courses.
Quantitative studies also have the advantage of yielding precise estimates of the magnitude of effects.  As people grew older, their wellbeing gradually declined.  But the measured impact of participation in (non-vocational) learning was at least sufficient to offset this gradual decline in wellbeing as people became older. Another way of expressing these results is that the boost to wellbeing delivered by engagement in learning was about one-quarter of the size of moving from the bottom to the middle of the wealth distribution. These estimates, then, show very clearly that learning participation has a useful role to play as a contributor to the wellbeing of older adults.
Of course, quantitative studies of this type do not tell us very much about the reasons why participation in non-vocational learning affected the wellbeing of older adults while vocational courses did not. But previous, qualitative evidence, can help to fill that gap. It seems plausible that vocational courses would only have benefits in the longer term and only when they led on to more satisfying work or promotion. Participation in non-vocational learning activities such as music or arts groups or evening classes, on the other hand, would be more likely to be undertaken because of their intrinsic enjoyment or possibly because of opportunities for getting out and socialising. These are important reasons for learning at older ages. Older adults often appreciated learning because it helped them to be receptive to new ideas, to improve understanding and maintain a positive outlook.  Opportunities for increased social participation, for meeting up and studying with friends and the forming of new networks, were also important factors.
In general, it is not at all easy to think of policy instruments which can make an effective contribution to active ageing. If learning can play even a small part in contributing to good health and wellbeing, or helping people to live independent lives for longer, then providing relevant and interesting courses for older adults is a remarkably cheap and cost-effective intervention.
Despite the accumulating evidence of the benefits of learning for older adults in England, rates of participation in adult education have tended to decline in recent years. Some of this decline may be blamed on the recession – people having less money to spend on learning. But the decline has occurred primarily because of deliberate changes in adult education policy. Since 2004  – that is under both Labour and Conservative/Liberal governments – the policy has been to reduce the amount of money available for short courses and other unaccredited types of learning in order to concentate funding on longer-term, qualification-bearing courses aimed at 16-24 year olds.
It was no great surprise then, that when the Department for Business, Innovation and Skills recently, and rather belatedly, published the results of the 2010 National Adult Learning Survey (pdf) it showed some sharp declines in both non-formal learning (taught classes not leading to qualifications) and informal learning (involving self-study to improve knowledge). Indeed it was found that participation in learning had declined across almost all age groups with the exception of 16-19 year olds, with the decline being most noticeable among those aged 60 and over. This was a significant reversal of rising participation rates shown by earlier surveys.
Policies  channelling public funds towards accredited and vocational learning carries the risk that other forms of learning, and any benefits which derive from them, will be neglected.  Yet, in our ageing society, if adult learning can play a role in maintaining the health and wellbeing of older citizens then there must be a strong case for the state to invest in it.