Education is a powerful social determinant of health. It is recognized that people who have higher level of education have higher place in the social hierarchy, higher socioeconomic status, higher income level and better quality of life. And there is a gradient between education and health. This means the level of education influences health. People with lower level of education tend of have poor health outcomes and the health status improves as education level increases following a gradient. People with many years of schooling also tend to have better health. Therefore it is critical that governments have policies that improve access to education opportunities for as many people as possible, especially those who are disadvantaged because these people will tend to have more health problems and frequently use the healthcare system.
How exactly does education influence health? Although broadly it can be seen that a gradient exists between education and health, researchers have tried to understand exactly how education influences health. There are several ways education improves health. One way is that education improves health literacy. Health literacy enhances the ability to understand health messages allowing people to take control of their lives and make informed decisions. Education also enhances people’s ability to adapt to changing environments such as use of technology enabling them to search for information on their own if they are not sure about something that relates to their health. Education also offers more opportunities for better paying jobs.
The World Health Organisation (WHO) has published several policy documents to assist countries to improve access and quality of education to address health inequity. In the WHO report ‘Closing the gap in a generation. Health equity through action on the social determinants of health’, WHO recommends that “governments provide quality education that pays attention to children’s physical, social/emotional and language/cognitive development starting in pre-primary school”.
The Papua New Guinea (PNG) national government policies also provide guidelines for implementing initiatives. For example according to the PNG Department of Education, all young people must complete secondary and vocational levels of education. Another example is the tuition free policy to allow all children in PNG to complete year 12.
Introducing and implementing policies to address the social determinants of health will vary from country to country and each country will need to tailor their polices to local context. Each country will also have to decide the ‘entry points’ for policy implementation. This means countries will have to decide whether to implement targeted programs or comprehensive programs. Another factor that countries will need to address is potential resistance to initiatives that address the social determinants of health. Two key issues that may be a challenge in policy implementation are the ‘problem of knowledge’ and ‘question of power’. Knowledge problem refers to lack of adequate knowledge base to support action to address social determinants of health. This means more research and work need to be done to build the evidence base to support any initiatives. The power issue refers to political and economic reality in a country where those in power benefit economically from the status quo and are therefore unwilling to support policies or programs to tackle the social determinates of health. It has been noted that the issue of power has been a major barrier to policy implementation. Another potential barrier that has not been adequately addressed in PNG is the medical establishment. Indeed the WHO points out that the medical establishment may resist resource distribution to support programs to address the social determinates of health in a society. It can be seen that policy implementation to address the social determinants of health is not easy and straightforward. There are challenges and potential barriers that every country will need to consider and have a strategic plan to manage these challenges to see effective policy implementation.
Implementing the free education policy in PNG has its own challenges. The tuition free policy in PNG was implemented in 2012 and has been a key government policy since. In a study done by Walton et al (2017) it was noted that this policy resulted in challenges that were not anticipated. For example, in East New Britain (ENB) province, there was a dramatic increase in student numbers that new classrooms had to be built. However, in Gulf province the opposite was noted. Additional classrooms were not constructed and students stopped attending classes because the classes were crowded. This resulted in a drop in student numbers attending school in the Gulf province. Although education is a powerful social determinant of health, improvement in education level alone cannot improve health. Other factors such as employment opportunities, income generating opportunities to alleviate poverty and improvements in workplace conditions will also need to be addressed to see education having a positive effect on health.
Education is a powerful social determinant of health. The PNG government has developed policies to address this and started implementing the tuition fee free policy in 2012. Although this government policy has improved access to education for all children in PNG, there have been challenges as well. Implementing policies to tackle the social determinants of health has its own unique challenges that have been identified by WHO and countries can tailor policies to local context to see effective implementation.
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Walton, G., Davda, T., & Kanaparo, P. (2017). The Challenges of Providing Free Education in Papua New Guinea,. In Development Policy Centre Discussion Paper #61. https://doi.org/10.2139/ssrn.3011101
World Health Organisation. (2008). Closing the gap in a generation. Health equity through action on the social determinants of health.
World Health Organisation. (2010a). A conceptual framework for action on the social determinants of health: Social determinants of health discussion paper 2. https://www.who.int/social_determinants/corner/SDHDP2.pdfhttp://hdl.handle.net/1903/22760https://www.who.int/social_determinants/resources/csdh_framework_action_05_07.pdf
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