Good education policy can improve our health

All too often we associate good education with better jobs and improved economic output. But good education is just as critical to develop a healthy nation.

The health of a country’s people is closely tied to the level of education achieved. In general, those who drop out of high school lead shorter lives. Every additional year of formal education raises earnings by 10 per cent and life expectancy by about half a year, within limits.

With greater level of education, there is a significant reduction in the risk of developing high blood pressure or diabetes. It also lowers the consequences of common ailments like heart diseases, stroke, hypertension, cholesterol and asthma.

How does education affect health outcomes? One possibility is that education leads to higher income which ensures better access to medical facilities.

Education also affects people’s behaviour on healthcare. Those with lower education are more likely to indulge in heavy smoking and drinking, and less likely to be bothered by obesity.

The higher-educated know more about picking a good diet, where to turn for preventive health and how to gain access to healthcare. They are more likely to use seat belts and turn to mammograms, vaccines and the like to stay healthy.

If we understand the close link between education and the health of a nation, we can take steps to provide better healthcare. We can introduce a more cost-effective healthcare expenditure if we can get people to improve their behaviours on health matters through better education.

CRITICAL THINKING

Although a nation may have many programmes on health promotion, it is education that leads to better and more proper use of such information: Studies show that the better-educated follow medical advice to a greater extent.

Critical thinking developed through education also leads people to make informed choices on medical matters.

Critical thinking involves two rudimentary processes, which economics Nobel laureate Daniel Kahneman refers to as Type 1 (fast thinking) and Type 2 (slow thinking). The first process is automatic, instinctive, subconscious and, from an evolutionary perspective, designed to promote survival. The second requires effort and it is cautious and slow.

Under most conditions, automatic thinking stands us in good stead in day-to-day life. But it leads to irrational biases which can lead to behaviours that undermine health. Humans do not understand complexity, and we base judgment on a small, usually self-ascertained, and certainly not representative set of facts and opinions.

When an individual can cultivate habits to recognise these biases, they lead to behaviours that can promote better health.

DO YOU REALLY GRASP THE RISKS?

One issue strongly related to decision-making is numeracy, or the ability to work with numbers. In educating people about health, individuals should be able to understand and use percentages and proportions.

But in a study done among a group of people aged 40 and above in the United States, many observers were surprised that even the highly-educated had difficulty solving simple numeracy questions correctly — in fact 20 per cent incorrectly answered even direct questions relating to risk levels.

Part of the problem is that we easily misinterpret proportions and percentages when it comes to assessing risks. If we are told that a drug increases the risk of cancer from 1 in a million to 3 in a million, that is a small absolute increase in the risk — merely 0.0002 per cent.

But if we say that it increased the risk 300 per cent or three fold — interpreting the same data differently by looking at relative risk — that makes people wary about taking that drug. The same data, presented differently, can make people think and act in different ways.

Maybe it is time for us to make sure that everyone understands proportions and percentages so as to create better understanding of risks. People can then make the right choices on how to improve their health.

In short, better education helps people to know what they should do, or not do, for the sake of their health. And by leveraging on this, we could see considerable healthcare returns from education policies.

ABOUT THE AUTHOR:

K Ranga Krishnan is Dean of the Duke-NUS Graduate Medical School Singapore. A clinician-scientist and psychiatrist, he chaired the Department of Psychiatry and Behavioural Sciences at Duke University Medical Centre from 1998 to 2009.

This is part of a series on the way we learn. To read the other articles, visit http://tdy.sg/comkrishnan.