Module 13: Health Promotion and Education for Women and Children

Education as a Determinant of Health

In considering the determinants of health, it is important to realize that poor physical circumstances are not the only factors harmful to health.  Lack of education, for example, can lead to reduced ability to find, understand and use health information.  Thus, education is an important determinant of health status in both the developed and developing world.

The high health returns to investing in the education of women are indisputable. Well educated individuals experience better health than the poorly educated, as indicated by high levels of self-reported health and physical functioning and low levels of morbidity, mortality, and disability. In contrast, low educational attainment is associated with “high rates of infectious disease, many chronic noninfectious diseases, self-reported poor health, shorter survival when sick, and shorter life expectancy”.(1)

Women and Health Promotion in the Family

While the exact mechanism of education’s impact on health is not known, it has been suggested that educating women alters the traditional balance of power within the family, leading to changes in decision making and allocation of resources within the household. (2)(3)(4)   Therefore, educated mothers are more likely than uneducated women to take advantage of modern medicine and comply with recommended treatments. (5)

Furthermore, education may change mothers’ knowledge and perception of the importance of modern medicine in the care of their children.(6)  In a study of child nutrition in the Philippines, access to healthcare services benefited children of educated mothers more than children of mothers with less schooling, a finding which suggested that educated mothers were more likely to take advantage of available public health services.(7) 

For example, findings from numerous studies of infant and child mortality conducted in developing countries over the last decade show a nearly universal positive association between maternal education and child survival.(8)(9)(10)(11)  Education can modify women’s beliefs about disease causation and thus influences both childcare practices and the use of modern healthcare services.(12)  These facts reveal that women are important promoters of health education and practices within the home, and the benefits of their education extend to their children and others.

Teachers and Health Promotion

Just as mothers are important providers of health information in the home, teachers serve as role models and can play a valuable role in health promotion in the classroom.  In order for teachers to promote health practices, they must be “health literate”.  Teacher health literacy may be defined as "the capacity of teachers to obtain, interpret, and understand basic health information and services, with the competence to use such information and services in ways that enhance the learning of health concepts and skills by school students."(13)

While significant advances occurred in public health promotion to address traditional early childhood diseases, tremendous challenges remain for improving the health status of school-aged children and adolescents.

For example, in America, the problems of health illiteracy, low self-esteem, and youth risk-taking behavior are becoming more visible in the community and public schools.(14)(15)  Risk behaviors and social morbidities have produced alarmingly rising rates of health problems in youth.  Schools in the developed and developing world face the challenge of addressing the needs of students who may not be health literate and who have significant health needs.(16)

Health Education Strategies

School health education may be delivered in a variety of ways, with varying emphases on biological, behavioral, and pedagogical concepts. Teachers and other health professionals must be prepared to address the complex social, developmental, and health-related issues that youth bring to the classroom. Continued effort should be made to maximize the learning of critical issues and concepts in child and adolescent health.

In the developed world, school teachers are instructed in health education around several themes: 1) teach health pedagogy skills, 2) provide health information from the 10 traditional health content areas (community health; consumer health; environmental health; family health; mental health; injury prevention/safety; nutrition; personal health; diseases; and substance abuse), 3) examine the six adolescent risk behavior categories identified by the Centers for Disease Control and Prevention(17), and 4) describe the eight components of a coordinated school health program.(18)

More research must be conducted in order to identify the most effective health education strategies for students and mothers.  For example, innovative approaches may enhance traditional models for education. The best strategies will promote the four basic skills inherent in health-literate individuals: (1) the ability to be critical thinkers and problem solvers, (2) responsible and productive citizens, (3) self-directed learners, and (4) effective communicators. Health-literate students should be able to: (19)

  1. Understand health promotion and disease prevention concepts.
  2. Know how to access valid health information, products, and services.
  3. Develop positive health behaviors.
  4. Analyze the influence of culture, media, and technology on health.
  5. Use interpersonal communication skills to enhance health.
  6. Develop plans through individual goal setting and decision-making.
  7. Become advocates for good individual, family, and community health.

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(1) Feldman J., Makuc D., Kleinman J., Cornoni-Huntley J. 1989. "National Trends in Educational Differentials in Mortality." American Journal of Epidemiology. 129:919-33.

(2) Caldwell J. 1979. Education as a factor in mortality decline: an examination of Nigerian data. Population Studies 33:395–413.

(3) Caldwell J. 1990. Cultural and social factors influencing mortality in developing countries. The Annals of the American Academy of Political and Social Science 510:44–59.

(4) Caldwell J., & Caldwell P. 1988. Women’s position and child mortality and morbidity in LDCs. Paper presented to IUSSP Conference on Women’s Position and Demographic Change in the Course of Development, Oslo.

(5) Schultz T.P. 1984. Studying the impact of household economic and community variables on child mortality. Population and Development Review Suppl. 10:215–235.

(6) Barrera A. 1990. The role of maternal schooling and its interaction with public health programs in child health production. Journal of Development Economics. 32:69–91.

(7) Ibid.

(8) Cochrane S.H., O’Hara D.J., & Leslie J. (1980). The effects of education on health. World Bank Staff Working Paper No. 405. Washington, DC: The World Bank.

(9) Rutstein S.O. 1984. Socioeconomic differentials in infant and child mortality. WFS Comparative Studies No. 43. Voorburg: International Statistical Institute.

(10) Cleland J., van Ginneken J. 1988. Maternal education and child survival in developing countries: the search for pathways of influence. Social Science and Medicine. 27:1357–1368.

(11) Cleland J., van Ginneken J. 1989. Maternal schooling and childhood mortality. Journal of Biosocial Science Suppl. 10:13–34.

(12) Schultz T.P. 1990. Returns to women’s education. Economic Growth Center Discussion Paper No. 603. New Haven: Yale University.

(13) Peterson F.L., Cooper R.J., & Laird J.M. (2001). Enhancing teacher health literacy in school health promotion: a vision for the new millennium. Am J School Health. 71(4):138-44.

(14) American Medical Association. America's adolescents: How healthy are they? Profiles of Adolescent Health Series: Volume I- AMA. 1990.

(15) Carnegie Council On Adolescent Development. Turning Points -Preparing American Youth for the 21st Century. New York, NY: Carnegie Corporation of New York; 1989.

(16) Carnegie Council On Adolescent Development. Great Transitions -- Preparing Adolescents for A New Century. New York, NY: Carnegie Corporation of New York; 1995.

(17) Tobacco use; dietary patterns that contribute to disease; sedentary lifestyle; sexual behaviors that result in HIV infection, other sexually transmitted diseases, and unintended pregnancy; alcohol and other drug use; and behaviors that result in intentional and unintentional injury.

(18) Health education; physical education; health services; nutrition services; counseling-psychological-social services; healthy school environment; school site health promotion for staff and family; and community involvement in school health.

(19) Steckler A., Allegrante J., Altman D., Brown R., Burdine J., Goodman R. M., Jorgenson C. (1995). Health education intervention strategies: Recommendations for future research. Health Education Quarterly, 22, 307-329.