MedicalForumWA 0317 Public Edition

Page 30


Drop Out and Drop Dead Keeping teenagers at school longer leads to a longer, healthier life, according to public health physician Dr Bret Hart. Prof Sir Michael Marmot in last year’s Boyer lectures urged action on the unfair social gradient in health. In 1999 I invited him to speak at a forum in Perth entitled “Is Inequality a Health Hazard?” While chauffeuring him around I asked what he considered to be the most significant determinant of health. “Education” was his instant reply. Since then the evidence affirm his view. The US National Institute of Health used Marmot’s Whitehall study cohort to compare outcomes of interventions in terms of Quality Adjusted Life Years (QALYs). The secondary prevention intervention of taking Pap smears adds a few days; mammography, about a month; identification and treatment of LDL cholesterol, six months; hypertension, eight months; tackling smoking; about six years. Those with a degree compared to those who haven’t completed high school have a 12 year difference in QALYs. If adult Americans who hadn’t completed college experienced the same health as college graduates, the resulting improvements in health status and life expectancy would translate into potential

One of the reasons for leaving school early is “failing” and this can be predicted even before a child starts school. gains estimated at more than US$1 trillion annually. While most studies emanate from the US, Dr Rosemary Korda at ANU recently found a discrepancy in the rates of CVD in those with no educational qualifications versus those with a university degree. But what can doctors do about high school students voting with their feet? One of the reasons for leaving school early is “failing” and this can be predicted early. In 2002, my Public Health Unit in North Metro Perth initiated a trial of the Canadian Early Development Index which ultimately led to the three-yearly Australian Early Development Census. Although we were banned from further involvement, others subsequently found there was a correlation between the 4500 children’s EDI scores and NAPLAN results.

This added to the evidence that before and during the first few years of life influences how well children grow and ultimately work, live and age. The message for doctors and health professionals is the importance of providing excellent preconception health promotion, exemplary antenatal care and superb child and school health services, especially for those who benefit most. Even if this is provided, there will still be some students wanting to drop out. Over 20 per cent of Australian students feel they don’t belong, aren’t happy or satisfied with school. Dr Jonathan Fielding, Commissioner of Public Health in Los Angeles, said: “If modern medicine wanted to do one thing to save lives it would be to deal with the high school dropout problem.” It is also one of the reasons why I became a board member of the newly established Wellbeing in Schools Australia. It is about building welcoming and trusting supportive relationships in schools. It helps save lives. ED: Questions? Contact the author

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28 | MARCH 2017