What one thing could teachers do to make teenage pupils smoke and drink less, avoid fighting and sex, eat more healthily and take exercise? The answer, new analysis suggests, is to encourage them to go to university.
Startling findings from the University of St Andrews suggest that all sorts of knock-on health benefits can be gained from making pupils think about their longer-term academic prospects.
The study shows how young pupils from poorer backgrounds, who might otherwise succumb to unhealthy habits, end up making entirely different choices. They eat more fruit and vegetables, exercise and brush their teeth more, and are more likely to avoid cigarettes, alcohol, cannabis, sex, fighting, crisps and soft drinks.
“Even if your current situation isn’t perhaps the rosiest, if you have this long-term plan, something to work towards, it’s going to benefit you in a wide range of ways in terms of your health behaviour,” lead researcher Ross Whitehead told TESS.
The findings, drawn from 1,834 fourth-year pupils in 113 Scottish secondary schools, have profound implications for how teachers tackle issues such as drugs and underage sex. They suggest that scare tactics and lessons explicitly about such issues are less effective than raising students’ long-term ambitions.
“Instead of focusing on individual health behaviours, it makes sense to take a step back and focus on [longer-term] life outcomes first,” Dr Whitehead said.
He agrees that the teenage years are critical for improving public health, but believes that hammering home messages about the dangers of alcohol or the benefits of eating vegetables are largely ineffectual.
“I’m fairly frustrated at the current intervention approaches – there’s often one intervention for each individual behaviour, which is not particularly cost-effective,” he said. “I think adults and adolescents alike are kind of habituated to those messages.”
The research, funded by NHS Scotland, has implications for wider policy, concluding that “encouraging adolescents to consider an academic future may achieve public health benefits, despite social factors that might otherwise precipitate poor health”.
It has an added edge since Scotland’s patchy record at sending poorer pupils into higher education has come under intense scrutiny recently.
The report says that “anticipating university attendance may maintain long-term health by instilling optimism and a sense of control over one’s destiny”. In other words, a long-term future in education may give young people a reason to think about their health in the long term, as it offers a way to “escape harsh and unpredictable socio-environmental conditions”.
The new research is striking because the University of St Andrews academics were able to control for social factors and focus their findings on students aiming for university from less affluent backgrounds.
And when teenagers from less affluent backgrounds expected to go to university, their health behaviour was similar to richer peers.
“Academic expectations may protect long-term health even among those predisposed to shorter-term pay-off,” Dr Whitehead said.
The study, which is the subject of an article in the International Journal of Public Health, is based on analysis data originally collected by the University of St Andrews for the 2010 Scottish Health Behaviour in School-Aged Children survey.
‘It’s the old question: Is it better to live fast or die old?’
Dr Whitehead acknowledges that his work echoes the “marshmallow test” made famous by the American psychologist Walter Mischel in the 1960s. Children were given one marshmallow, but told that if they could avoid eating it until a researcher came back they would get a second. Researchers ultimately found that children who controlled their impulses turned out to be healthier and educationally more successful in later life.
“It’s like the old question – is it better to live fast or die old?” says Dr Whitehead, who uses evolution, or specifically “life history theory”, to explain his findings.
The theory is that shorter-term gains are prioritised by human beings living in conditions that make long-term investment in the future seem pointless, such as morbidity or scant resources.
One consequence is that they have children frequently and regularly, in the hope that at least some will be healthy. But more stable conditions encourage longer-term approaches.
‘The pathway you’re on before age 5 mirrors health outcomes’
Inspirational teachers may help some teens aspire to higher education, with knock-on benefits for health. However, according to one expert, many factors that determine a child’s future are ingrained long before secondary school – and sometimes even before a child is born.
“The pathway you are on before you’re 5 is, to a great extent, mirrored by health outcomes throughout your life,” says Marion Macleod, policy manager at the charity Children in Scotland.
Poor antenatal health, she says, such as that caused by mothers-to-be drinking alcohol during pregnancy, can affect children’s brains.
She stresses that the most deprived 20 per cent of pupils in Scotland cover a wide range of backgrounds, and that those at the upper end may get more encouragement from families and friends to continue in education.
These young people, she believes, are the ones picked up in the University of St Andrews study. Those living in the most extreme deprivation, with less support from their families, will rarely go to university.
Although Ms Macleod downplays the impact of encouraging teenagers to look to the future, she agrees it will provide some benefits for their long-term health and educational prospects.
Cathy Howieson, of the University of Edinburgh’s Centre for Educational Sociology, says the concept of “agency” is crucial: of helping children feel that they are not buffeted by forces beyond their control.
Encouraging high aspirations and a sense of being in control of one’s life does not have to involve university – according to Dr Howieson, teaching a musical instrument, say, or setting students on the road to an apprenticeship could have a similar effect.
‘Schools hold the key’
The research findings make “complete sense”, according to a Stirling headteacher who is crusading to make Scottish children healthier.
Elaine Wyllie, who retired in October from St Ninian’s Primary, introduced the Daily Mile programme which encourages teachers to set aside 15 minutes every day for pupils to run or walk a mile (see page 8).
“There is an emergency in children’s health in Scotland, which must be addressed,” she told the Children in Scotland annual conference in Glasgow last week. “We need new thinking on how to get our children active and engaged in physical activity – and schools and nurseries across the country hold the key.”
The finding from the University of St Andrews that long-term goals improve health in myriad ways tallies with Ms Wyllie’s long experience of working with children.
“You can kind of feel that would be right – there’s hope there, there’s aspiration, there’s expectation, there’s a sense of purpose, there’s postponement of gratification. It makes complete sense,” she says.
Ms Wyllie adds: “When children have chaos and hopelessness, it’s so hard for them. What we need to do is give them that sense of purpose. Believing in every child, that they all matter and can all achieve, that’s a very powerful message.”