Health policy and education最新文献

How education and health are linked in developing countries and what educational activities produce change are quite uncertain. Questions for research on these concerns are noted, and it is suggested that prospective longitudinal studies, household surveys, and field observations might well be added to the more usual multivariate analyses of records. Analyses of educational program implementation alternatives are also suggested.

The extent of childhood malnutrition-deprivation throughout the world is indicated and its nature and the forms it takes are described. An account is given of several studies carried out by the author and his colleagues in Lebanon. An investigation of failure to thrive in young children revealed that in an apparently homogenous low socioeconomic group there was a wide spectrum of physical growth which correlated closely with a number of home environment variables. Another study of the mental development of some of these children carried out over several years showed that children with even mild growth failure had a statistically significant impairment of mental development as compared with their apparently healthy siblings, also living in a home environment characterized by deprivation. The far reaching consequences are emphasized. In a third study which investigated the formal education of mothers, their nutritional knowledge and practices and the growth of their children, the indices were found to be interrelated to some extent. Finally, a small study gave some indication, perhaps contrary to general belief, that the rapid social change undergone by families who migrate from the country to an urban slum may be associated with an improvement in nutrition of the children.

In this paper we compare various models for estimating the covariates of childhood mortality from the type of data commonly available in developing countries. Specifically, we examine how much precision is lost as various pieces of information, such as dates of birth and death for each child, are discarded. The conclusion which we reach is that even incomplete mortality data of the type collected in household surveys or censuses can yield estimates which are very close to those based on the much richer wealth of data collected in detailed maternity histories. Two substantive conclusions of interest are that in the two countries (Sri Lanka and Korea) we examined, the education of the father has a significant and pronounced effect on childhood mortality even when the mother's education is controlled, and once other covariates are controlled, there is no difference between urban and rural childhood mortality.

The statistical evidence on the relationship between education and health is impressively strong, but a causal link remains to be established. Despite this weakness, however, the evidence is much more solid than that on which policy decisions concerning health and education are normally made. Although further research is needed, the findings currently available are adequate to support advocacy of a higher priority to education in development and health improvement strategies.

This paper stresses that the relationship between education and health cannot be meaningfully analysed in isolation from the economic and cultural matrix of society of which it is an integral part. An examination of the different kinds of education available to Third Worlders shows that formal schooling is generally regarded as a passport to urban employment. It therefore accentuates socioeconomic differentiation. Altogether, education for the sake of increased knowledge and/or improved welfare is a luxury only the wealthier can afford. Moreover, an examination of the culture-specificity of health concepts is taken to show how Western health care is inappropriate in settings where health is seen as an indicator of morality. Numerous case materials are used as evidence for the argument presented here. The final section of the paper devoted to “policy implications” emphasises that low levels of education and health are symbolic of under-development. Formal education or Western type health care are no panacea, nor even palliatives for the poverty syndrome. Appropriate education associated with appropriate health measures may help to alleviate the worst evils of disease.

Education involves the transmission of information within a cultural context. The mechanisms of interaction between education and health must therefore be analyzed somewhat differently in each unique cultural setting. The preceding papers by Drs. Epstein and McLaren are discussed from this point of view.

Socioeconomic effects are supposed to have a fairly long time delay in regard to health development. Taking into consideration time lags, correlation and regression analysis are executed to explain the difference in health levels which exist among countries. The infant mortality rate, life expectation at birth, adult literacy rate, proportions of school enrolment and GNP per capita are taken as variables and their characteristics are discussed. In addition, countries are divided into three groups, i.e., low income, middle income and industrialized countries, to show that the educational and economic effects on health development vary according to the economic level of the countries.

Data from the World Fertility Survey in ten Third World countries are used to test the conclusion, based on a Nigerian study, that maternal education is important in reducing child mortality.

The analysis confirms the major importance of parental education, the impact of which is probably greater than both income factors and access to health facilities combined. Rural/urban differentials are of small importance once parental education has been controlled. The findings of the Nigerian study are modified in that paternal education is also shown to be important, though not as important as maternal education, and the step from primary to secondary schooling is more important than that from illiteracy to primary schooling.

The massive declines in child mortality during the last third of a century have been the result not only of technological and economic change but also of social change, of which the most important component for the survival of children through the first years of life has been parental education.

It is suggested that schooling introduces parents to a global culture of largely Western origin and loosens their ties to traditional cultures. Age and sex differentiations in power, decision-making and benefits within the larger family are reduced when schooling brings about a new family system in which women and children are allocated higher priorities in terms of care and allocation of food and in which parents can make decisions about health and child care without reference to their elders.