Comment

The benefits of educating women

Accelerating the decarbonisation of local and national economies is a profound public health imperative. As trusted voices within communities around the world, health professionals and health organisations have enormous potential to influence the social and policy landscape in support of decarbonisation. We assembled a multidisciplinary, gender-balanced group of experts from six continents to develop a framework for maximising the social and policy influence of the health community on decarbonisation at the micro levels, meso levels, and macro levels of society. We identify practical, learning-by-doing approaches and networks to implement this strategic framework. Collectively, the actions of health-care workers can shift practice, finance, and power in ways that can transform the public narrative and influence investment, activate socioeconomic tipping points, and catalyse the rapid decarbonisation needed to protect health and health systems.

Despite strong theoretical grounding, important gaps in knowledge remain regarding the degree to which there is a causal relationship between education and sexual and reproductive health, as many claims have been made based on associations alone. Understanding the extent to which these relationships are causal is important both to inform investments in education and health, as well as to understand the mechanisms underlying these relationships.

We conducted a systematic review of the evidence for a causal link between education and sexual and reproductive health (SRH) in low and middle-income countries. Education indicators included exposure to formal schooling and learning. SRH outcomes included: age at first sex, age at first marriage, age at first pregnancy/birth, contraceptive use, fertility, and HIV status and other sexually transmitted infections. When possible, we also conducted meta-analyses to estimate mean effects by outcome, and to understand sources of variation between studies.

We identified 35 papers that met our inclusion criteria. Although many of the studies report evidence of a causal relationship between education and one or more SRH outcomes, estimated effects are often small in magnitude. Our meta-analyses reveal mostly null mean effects, with the exception of small effects of increased grade attainment on lower fertility and HIV positive status. We also found inconsistent evidence supporting mechanisms linking education and SRH.

This review demonstrates that, although investments in schooling may have positive ripple effects for sexual and reproductive health in some circumstances, those effects may not be as large or consistent as expected. Further, our understanding of the circumstances in which schooling is most likely to improve SRH remains somewhat limited. An accurate picture of whether and when improvements in education lead to better health outcomes is essential for the achievement of global development goals.

We investigated the association between social and nutritional adversities in childhood and increased arterial stiffness in adulthood, according to race/skin color.

We used baseline data (2008–2010) from 13,365 adults (aged 34–75 years) from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Childhood social and nutritional adversities were assessed by maternal education and birth weight. Race/skin color was self-reported.

The lower the maternal education, the higher the cfPWV in adulthood in Whites, Browns, and Blacks. This association was no longer significant after adjusting for the participant's education level in Whites, but it persisted after full adjustment among Browns (low vs. high maternal education: β = 0.18, 95% confidence interval: 0.01; 0.34) and Blacks (low vs. high maternal education: β = 0.44, 95% confidence interval: 0.18; 0.70). On the other hand, the association between low birth weight and higher cfPWV was found only among Whites.

Our findings regarding the association between maternal education and arterial stiffness are consistent with the disproportionate burden of cardiovascular disease-related morbidity and mortality in Blacks and Browns. The fact that the association between birth weight and arterial stiffness was only present in Whites may have reflected a survival bias.

National wealth, income inequalities, and expenditures on education can profoundly influence the health of a nation's women, children, and adolescents. We explored the association of trends in national socioeconomic status (SES) indicators with trends in adolescent birth rates (ABRs), by nation and region.

An ecologic research design was employed using national-level data from the World Bank on birth rates per 1,000 women aged 15–19 years, national wealth (per capita gross domestic product or GDP), income inequality (Gini index), and expenditures on education as a percentage of GDP (EduExp). Data were available for 142 countries and seven regions for 1990–2012. Multiple linear regression for repeated measures with generalized estimating equations was used to examine independent associations.

ABRs in 2012 varied >200-fold—with the highest rates in Sub-Saharan Africa and lowest rates in the Western Europe/Central Asia region. The median national ABR fell 40% from 72.4/1,000 in 1990 to 43.6/1,000 in 2012. The largest regional declines in ABR occurred in South Asia (70%), Europe/Central Asia (63%), and the Middle East/North Africa (53%)—regions with lower income inequality. In multivariable analyses considering change over time, ABRs were negatively associated with GDP and EduExp and positively associated with greater income inequality.

ABRs have declined globally since 1990. Declines closely followed rising socioeconomic status and were greater where income inequalities were lower in 1990. Reducing poverty and income inequalities and increasing investments in education should be essential components of national policies to prevent adolescent childbearing.

Social data from census and household surveys provide key information for monitoring the status of populations, but the data utility can be limited by temporal gaps between surveys. Recent studies have pointed to the potential for remotely sensed satellite sensor data to be used as proxies for social data. Such an approach could provide valuable information for the monitoring of populations between enumeration periods. Field observations in Assam, north-east India suggested that socioeconomic conditions could be related to patterns in the type and abundance of local land cover dynamics prompting the development of a more formal approach. This research tested if environmental data derived from remotely sensed satellite sensor data could be used to predict a socioeconomic outcome using a generalised autoregressive error (GAR_err) model. The proportion of female literacy from the 2001 Indian National Census was used as an indicator of socioeconomic conditions. A significant positive correlation was found with woodland and a significant negative correlation with winter cropland (i.e., additional cropping beyond the normal cropping season). The dependence of female literacy on distance to nearest road was very small. The GAR_err model reduced residual spatial autocorrelation and revealed that the logistic regression model over-estimated the significance of the explanatory covariates. The results are promising, while also revealing the complexities of population–environment interactions in rural, developing world contexts. Further research should explore the prediction of socioeconomic conditions using fine spatial resolution satellite sensor data and methods that can account for such complexities.