A healthy education

I wasn’t planning on blogging again so soon, as I’m extremely busy at the moment with one thing and another, but I couldn’t resist the way that my previous and current professional interests (education and public health policy) combined on Wednesday.

The BMJ published what I thought was a reasonable, clear editorial about the role of public health in education.  I have to confess I hadn’t been hoping for much – as regular readers will know, I’m quietly sceptical of public health’s tendency towards empire building.  In fact, I was pleasantly surprised.

A very strong response was then posted on the Red Head Full of Steam (RHFOS) blog, which I came across via Chris Snowdon’s Twitter feed.  Having read the original article, this post struck me as pretty odd, and links to Gerard Hastings’ (admittedly strange) presentation at Southampton University were a bit out place.

The main suggestion of the editorial was that education shouldn’t be too narrowly defined to focus exclusively on academic attainment – and it crucially pointed out that broader work can be helpful not just to health and happiness, but also to academic attainment itself.  So this needn’t be seen as a zero sum game whereby time spent on ‘health’-related work detracts from ‘academic’-related work.  In fact, there are initiatives that build things like ‘resilience’ and team-working (though I dislike both those terms) that are simply based not on the content being taught, but the ways in which it is taught.

The response on RHFOS focused on how strange it was to suggest that schools should do anything more than seek to maximise academic attainment, with Chris summing the editorial up as Public Health complaining that schools focus on education.  There was also the point made by RHFOS that if we’re concerned about people drifting off into what are often labelled ‘risky’ behaviours (drinking, smoking, drug-taking, truancy etc) then a focus on academic attainment might actually be a good idea because we know this is correlated with income later in life, and low-income is associated with all these issues – not just for the individual concerned, but also those around them including their children.

To a certain extent this misses the point: interventions like the Good Behaviour Game improve both ‘resilience’ or health and academic attainment.

However, there’s something more fundamental going on here.  The reason RHFOS and Chris are sceptical about the place of interventions to improve public health in education is that they hold of particular view of what education is, or should be.

When I suggested to Chris that he was thinking of education a bit narrowly, he countered that a narrower view would be a good idea: focusing on reading and writing.

In such a statement there’s already an understanding of what education should be, but it’s still an open question about what it’s for.  Why reading and writing specifically?  Are these skills to be used in a particular way, and to what end, or is there something inherent in having the skills that is good?

I have absolutely no time for the facile phrase ‘education for education’s sake’.  It’s meaningless, and the kind of woolly thinking that underlies it even gets to people as high up the academic tree as Stefan Collini (don’t whatever you do waste any time reading his book What are Universities For?).  Education means a leading out – and thus implies leaving something behind and moving towards something.  If you’re leading someone, you’re taking them somewhere, whether deliberately or not, so having some idea of where you’re aiming for seems to be a good idea.

Of course, the objection to interventions related to public health isn’t necessarily based on ‘education for education’s sake’.  There’s simply an assumption that academic achievement should take primacy – maybe that’s what children are being led to.  But actually academic achievement – however measured – isn’t an end in itself.  The achievement or knowledge isn’t useful or helpful in itself.  Either it’s a means to self-sufficiency or prosperity in some economic sense, or it’s about something approaching the ‘good’, or fulfilment.  (In fact, choosing the former says something about your views on the latter.)

The argument on RHFOS seems to suggest that academic achievement is a good basis for economic stability later in life.  But there’s considerable evidence that academic attainment isn’t itself what leads to that prosperity; it’s just as likely a signal of an individual’s broader attributes – perhaps that they are hardworking and disciplined, since they’ve managed to achieve so much at school or university.

To place emphasis on the signal, rather than the underlying skills, seems an odd way to go about things, and it can’t really resolve any of the issues relating to inequality or poverty that are hinted at by RHFOS if the underlying structures that produce the differences in outcome aren’t addressed.  If you improve everyone’s academic attainment without that affecting the underlying economic structure then all you get is inflation of qualifications, which is precisely the situation Britain finds itself in today, when more and more professions require postgraduate qualifications simply to distinguish the hordes of applicants from each other.

This idea of a signalling function and qualification inflation, though, mostly relates to the later stages of education, and most of the interventions the BMJ editorial is (implicitly) referring to could equally apply in primary schools.  It seems that most of the economic returns to a society from education come from the earlier years – and in fact these years make a disproportionate contribution to an individual’s success in later life.  (Just one reason why it’s strange we ratchet up spend per pupil as they get older.)  So perhaps that makes the need to focus on academic attainment in those years even more important.

This idea of an emphasis on early years and basic skills might support Chris’ point about focusing on reading and writing – so what am I complaining about?  Well, education, I would suggest, should be about something more.  Or rather, it is about something more, whether we like it or not.  Literacy and numeracy are not the only knowledge and skills one might want in life, and so if we simply select these as being the appropriate elements of schooling we are making a choice that says something about our particular priorities as a society.  Without wishing to sound like Matthew Arnold, with his idea of ‘sweetness and light’, I think this sort of selection suggests a narrow, somewhat instrumental view of a child’s future.  In any case, such a choice would reflect a specific understanding of ‘the good’, and it might be one most people can agree on – but it is in no way neutral, and to pretend it is would be to obscure some fundamental moral and cultural beliefs.

Education, if it is anything, is to prepare people for life; nothing more, and nothing less.  Whether we like it or not, any education system will betray some underlying values, so we’d better be clear and open about what those are, and debate them.

Moreover, I have a feeling that the ‘narrow measures of attainment’ Adam Fletcher talks about in the Independent article RHFOS quotes are league table metrics by which schools are judged, not pupils.  Those are misleading and, like most targets, spawn perverse incentives: to focus on those on the C/D boundary at GCSE, rather than those at either end of the spectrum.

I’d suggest you read the editorial.  It’s really rather good.

Class and minimum unit pricing

I want to preface this post with a caveat that I hope implicitly precedes every post here: I consider the reasoning and conclusions a work in progress, and I may be wrong not just in my views or opinions, but in facts or the logic of interpretation.  Please tell me by comments, email or Twitter if you think that’s the case here.

I’ve been prompted to write this week by the print version of a Sheffield article on MUP coming out in the Lancet.  (The article was originally published online in February.)  This article looks at how MUP might affect drinkers from different income brackets, and concludes that the more you drink the more you are affected, regardless of income bracket – that is, a high-income harmful drinker will be affected more than a low-income moderate drinker.

However, consumption being equal (or, rather, consumption group being equal), it’s estimated that poorer drinkers will be hit harder by MUP than more affluent ones.  (I say hit harder, but some might say ‘benefit’; that’s where the argument really needs to be played out, as I’ve said before.)  Obviously, the lower your income, the richer you are, the less likely you are to buy cheap alcohol.  So a policy that is modelled as affecting only low-priced alcohol will inevitably affect the poor more than the rich.  (There’s a separate question about whether only prices below the threshold will actually be affected, but that’s something for another day, when I’ve done more reading and thinking.)

A key reason for introducing any tax or price control is that otherwise there would be externalities or other market failures.  The stated aim of MUP is to change patterns of drinking because under current conditions we are understood to consume more alcohol than is good for us – and possibly others around us.

If the aim is to make alcohol consumption more ‘rational’ then the fact that MUP would apparently be a targeted intervention implies that particular groups are more irrational than others, in the sense that their behaviour needs more of a correction.  Or maybe they’re just easier targets.

An argument can certainly be made that current structures and environments offer different prompts and incentives to different socio-economic groups, and I’ve written before about how substance use treatment services can justifiably be targeted at particular groups or types of people.  However, the rationale for that targeting is to level the playing field.  Specialist treatment addresses the fact that ‘recovery capital’ (assets such as a strong supportive social network, financial capital, stable housing etc) is not distributed evenly.  Social policy could reasonably aim (as far as is deemed reasonably possible) to even out opportunities and incentives.

Taking such an approach to alcohol consumption would suggest that those from lower socio-economic backgrounds would be more affected if they were consuming more to start with.

[This is a slight shift to thinking about what might be called an outcome (drinking level) rather than levelling a playing field, but this is what nudging and alcohol policy of almost any kind often assumes: there is a single right mode and level of consumption (there’s plenty of commentary on that in my academic work).]

Those from lower-income groups do consume more lower priced alcohol, but they don’t particularly consume more alcohol overall than other groups – as you can see from the charts below.  Looking only at ‘harmful’ drinkers, because those are the ones the policy is supposedly concerned with, we can see that MUP has the biggest effect on the consumption of the lowest income quintile, which isn’t actually the highest consuming quintile overall.

I should note that the estimates suggest the policy would be successful in pulling people’s consumption closer together – which is exactly the sort of outcome I can imagine being welcomed by some commentators.  However, it doesn’t pull down the consumption of middle-income consumers – who are the biggest consumers overall – by anything like the lowest quintile.

This isn’t particularly a criticism of the policy in general, and certainly not of the analysis.  It is, however, a reminder of how this policy would target on the basis of price, not simply alcohol content or personal level of consumption.

The thought that occurs to me, then, since my mind is filled with ideas of liberalism and nudging, is whether such a policy suggests that low-income consumers are more irrational than middle-income drinkers – and we’re only talking about harmful drinkers here, remember; those who from a health perspective should be advised to cut down their consumption.

I’m not sure I’m entirely comfortable with that sort of policy, which also seems to view cheap alcohol as bad in itself (culturally and morally).

If you’re interested in some of these dynamics around MUP and targeting groups of people, I’ve written various academic articles about this, some of which are in the pipeline and at least one of which is already available: http://staffprofiles.bournemouth.ac.uk/display/whaydock#publications)