The impact of health and health behaviours on educational outcomes in high-income countries: a review of the evidence.

While the importance of education is widely appreciated as a public policy priority in industrialized countries and cross-country comparative rankings of educational performance typically provoke major national debates, comparably little attention, outside of health, is paid to the impact of child and adolescent health on education. Part of the reason could be the perception that child health is but a by-product of education rather than a factor that could determine educational outcomes. This report casts doubt on this perception by critically examining the evidence on the effect of health on education in industrialized countries. Based on seemingly under-recognized evidence, our overall finding is that there is reason to believe health does have an impact on education. This finding should serve as a basis for raising the profile of child health in the public policy debate, and by illustrating the potential for mutual gains, it should help stimulate cross-sectoral collaboration between the health and education sectors. Education and health are known to be highly correlated – that is, more education indicates better health and vice versa – but the actual mechanisms driving this correlation are unknown. The effect of health on education has been well researched in developing countries, as has the effect of education on health in both developing and industrialized countries. Such imbalance could signal lack of attention not only in research but also in the public policy debate. While children in developing countries face more serious health challenges than those in industrialized ones, the potentially relevant effect of health on their educations (and perhaps on labour force participation) cannot be ruled out. The analytical framework we used to guide our research posits a path leading from health behaviours (e.g. smoking) and health conditions (e.g. asthma) to educational attainment (level of education) and educational performance (e.g. grades). We searched literature in the fields of health, socioeconomic research, and education and ultimately narrowed our selected publications to 53, all of them based in countries belonging to the Organisation for Economic Co-operation and Development. Based on the evidence reviewed, some of our more important findings are the following. • Overall child health status positively affects educational performance and attainment. For example, one study found that very good or better health in childhood was linked to a third of a year more in school; another concluded that the probability of sickness significantly affected academic success: sickness before age 21 decreased education on average by 1.4 years. • The evidence indicates that the negative effect on educational outcomes of smoking or poor nutrition is greater than that of alcohol consumption or drug use. • Initial research has found a significant positive impact of physical exercise on academic performance. • Obesity and overweight are associated negatively with educational outcomes. • Sleeping disorders can hinder academic performance. • Particularly under-researched, especially considering their growing significance, is the effect of anxiety and depression on educational outcomes. • Asthma on average has not been shown to affect school performance. • The preponderance of research was based in the United States of America, but overall this field has grown markedly since 2001, including in Europe. • From a methodological perspective it is important to note that several papers undertake serious efforts to tackle the challenge of proving causality in the relationship.