Understanding impact of education on health: a processual solution to an enigma-insights from India

A population’s education levels determine its health status and in turn its economic growth. Despite considerable research, the mechanisms through which education influences health seeking behaviour and the way it is operationalised is still a subject of intense debate. Consequently, considerable resources are continuing to be spent on education and health literacy without achieving the desired impact. Yet, the need to understand these mechanisms is undeniable in light of its likely significant impact on how we design our health campaigns. This study shows that populations with poor formal literacy rates show equivalent or even better health indices. These target populations have better attitudes, better access and consequently better utilisation of health interventions. This utilisation was dependent upon, first people becoming aware of existence of health conditions and understanding their impact. On being confronted with a specific health condition, this general awareness would prime specific health seeking behaviours. The success of such behaviours was crucially dependent upon access to corresponding health interventions. Thus a sequential model of general awareness-specific awareness-attitudes-access-utilisation is developed. Our understanding of these mechanisms is facilitated if Health awareness is measured not only in terms of general indicators such as formal schooling or education but also in terms of specific awareness indicators. This has immense policy implications in health care, both in terms of content of message and emphasis on education and specific health behaviour campaigns. It also crucially changes the mechanism of evaluation of health behaviour interventions.