The time of day after school lets out is rarely a calm time in the Emergency Department. On one particularly busy night I treated a brave 8-year-old girl who, even though she had broken her arm just an hour earlier, showed not a sign of pain or tears, and held me with a stern gaze. The whole time that I set her arm in plaster, she was impervious to my best jokes and kept a steel-like expression on her face. I thought I could win her friendship by telling her that she could get a day off school. She looked shocked, turning to look at her mother, and then back at me with a look of betrayal that was dripping in scorn. That’s when the tears began. She loved school. I said she could still go if she liked to and tried to bribe her with books of stickers, but as her mother led her out, giving me a sympathetic look, I accepted I had made an enemy for life.
That young girl is one of the lucky ones who can freely and easily attend school, and her love for it underscores just what a gift education can be. Globally, however, 58 million primary school aged children and 63 million secondary school aged children, 55% of them girls or young women, still do not attend school because they don’t have the same opportunity. When children are born into an environment that does not allow them to attend school, this places a limitation on their young lives; for many, their whole lives.
Education is among a number of factors that comprise the social determinants of health: “the conditions in which people are born, grow, live, work and age[.]” Education is also key to efforts undertaken by public health professionals (I discussed what public health is in a previous post, “Why I Fell In Love with Public Health”).
Education is a crucial investment for any community, as it improves the economic opportunities of its students; increases public safety; and empowers its students to be more self-confident and believe in what they can achieve; all things that are needed with the ever-growing challenges many communities face. While it is important to educate all children, increasing access to education for girls and young women, who have been historically excluded from classrooms, yields important improvements in public health. The many barriers to educating young women include poverty, need for children to help provide for the family, early pregnancy, access to schools, unfair social norms, and in some regions terrorist groups that look to limit female education.
Education significantly bolster’s a person’s health literacy level. Health literacy describes how well a person can understand their health needs, a diagnosis, and how diseases are transmitted; and follow treatment instructions. It allows people to take appropriate measures to prevent the transmission of diseases such as Ebola or HIV. If they are able to understand how to take their medications, and the importance of remembering to take them, they are more likely to complete their course of antibiotics or anti-retroviral therapy (HIV medication) and so decrease the occurrence of resistance in the community to these often lifesaving medications. Most importantly, health literacy empowers patients and enables them to become active participants in decisions made about their health. This is particularly important for women as they are the main caregivers in many societies around the world, a role that is heightened in regions where access to medical care is limited or absent.
There are many health benefits to educating girls and young women and these benefits transcend generations. When women stay in school longer, they get pregnant at an appropriate age, have fewer children, and have an increased level of health literacy about remaining healthy in pregnancy. As a result, their likelihood of women dying in childbirth is greatly reduced. Furthermore, children born to mothers who can read have a 50% higher chance of surviving beyond the age of 5 due to their mothers’ increased health literacy, increased awareness of the importance of nutrition, ability to understand the importance of such interventions such as vaccines, and increased income resulting from education. Educating girls and young women also improves gender equality, decreases the rate of sexual and domestic abuse among young girls and women, and empowers them to leave unhealthy relationships by bolstering their economic opportunity, confidence in their importance as members of society, and providing them with direct education on healthy relationships.
The opportunities that education provides young women are documented time and time again; the inspirational film and movement Girl Rising is of particular note as it follows 9 young women growing up in impoverished settings and the transformational impact that education has on their lives. Many different organizations are trying to address this disparity in education, from global efforts such as the UN’s Girls’ Education Initiative and the World Bank and their investments in young women’s education, to national efforts such as the U.S. Let Girls Learn campaign, led by Michelle Obama and the White House. There are NGOs, such as She’s The First, that provide scholarships to young women so they can continue to pursue their education, become leaders, and create positive changes in their community. Since its founding in 2009, She’s The First has enabled almost 2000 years of education to girls across 11 different countries. Furthermore, there are the inspiring stories of young women such as Malala, who survived the Taliban’s violent attempt on her life just for pursuing an education and went on to start a fund that enables girls around the world to finish school and reach their full potential.
Other organizations prioritize improving the health literacy of young women while also enabling and empowering them to remain in school. A key example is Girls Health Champions, a rising star which works to educate and empower young adolescent females in India to become champions and peer-educators about their own health, covering issues such as anaemia and culturally taboo topics such as menstruation and depression. Another prime example is Femme International, which provides education and access to resources for young women about their menstruation, sexual health, and feminine hygiene in East Africa.
So many wonderful and passionate people and organizations are taking on this critical issue, and their ongoing efforts are bettering our world. The gap in school enrollments between girls and boys in East Asia and South America closed significantly over the end of the 20 century. In the first 15 years of this century, the number of girls out-of-school decreased by 47%, the number of children out-of-school decreased by 42%. This has improved the health of many populations. For millions of young girls, though, this progress is not fast enough.
Education is a necessary investment as well as a fundamental human right. Its benefits are reaped by the individual, their community, and the generations that follow. Education improves health directly and indirectly, and enables people to have a fairer opportunity to achieve their full potential and not be limited by the setting into which they are born.
I will continue to blog about public health and the advancements that are occurring, I hope you can come and share in my excitement again.
P.S. I would like to thank two friends who inspired this article: Christen Brandt of She’s The First who for the last 5 years, since I ran into her roller-skating, has inspired me and broadened my view about education’s role for positive change, and Priya Shankar of Girls Health Champions who as a classmate taught me how a good idea, with plenty of passion, can lead to monumental improvements in the lives of others.