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

Elaine Unterhalter
The United Nations has declared today the world’s first International Day of the Girl Child. Events are being held around the world to publicise many aspects of girls’ lives and education features prominently.
The large global NGO Plan is publishing its annual review Because I am a Girl. This year it focuses on education, drawing on interviews with girls around the world, analysis of statistical data, and assessments of research, including some I have conducted with colleagues in a number of countries in Africa. The report brings out the challenges girls face to gain access to school, to be treated with dignity while they study, and to use their education to secure an adulthood where they are safe and have lives they value.
For example,  many girls  still struggle to have their decisions about health, sex and reproductive rights taken seriously. In many schools there is little active learning for girls or boys, and  teachers have little knowledge or training in gender equality. Teenage girls who choose unconventional careers  like Gloria Joy, the 18-year old trainee auto mechanic at Juba technical high school in South Sudan, interviewed in the Plan report, face multiple barriers. Gloria, despite her schooling and inspiration to work in this field, had to struggle  to get a loan to open a business,  be accepted as an apprentice,  and attract customers. Luck, information and persistence helped her. But for many there are not such happy endings.
The celebration of the first International Day of the Girl Child is touched with poignancy because of the headlines concerning one 14 year old girl, Malala Yousafzai, in Pakistan. She was shot in the head and neck on Tuesday, while she sat with classmates on a school bus in Mingora, in the Swat district. A spokesman for a Pakistani offshoot of the Taliban has claimed responsibility. All over Pakistan there has been an eruption of anger at this attack with many messages supporting Malala’s aspirations for schooling for girls.
Among her campaigning activities, Malala wrote a blog for the BBC’s Urdu service under the pseudonym Gul Makai (“cornflower”) and described her classmates’ fears that their educations would be abruptly stopped. She was awarded Pakistan’s first National Peace Award and had recently talked of setting up a vocational institute for marginalised girls in her area.
Malala’s bravery in speaking up, even though she had fears for her safety, is a clear reminder of the need for us to do more to help girls stay in school longer – too many of the poorest and most discriminated against leave with barely any experience of education. International Days like this are important for their symbolic significance, but they also remind us there is so much we do not know about the schooling of girls, their relations with their families and societies, the ways in which gender connects with other inequalities.
Around the world many governments, teachers’ organisations, small and large NGOs, employers, and institutions like universities are joining with UN organisations to promote gender equality and girls’ rights to education. The IOE is  part of this. This might be the first Day of the Girl Child, but it should not be the last of the enormous effort needed. On International Day of the Girl Child, please do whatever you can to support these aspirations.