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How do we improve the region’s health? Education and opportunity


“If you could only do one thing to improve health in the region, what would you do?” That is a question I have been asked regularly since my family and I moved to the Tri-Cities area a dozen years ago.

When I was first asked this question, my answer was simple and straight-forward. I knew that the major factors impacting our health are our behaviors — smoking, poor diet, lack of physical activity and, increasingly, substance abuse. My advice in those early years was that we needed to change our behaviors, especially as they relate to smoking.

Smoking is the leading preventable cause of death in the United States, and Tennessee has one of the highest smoking rates in the nation. Smoking rates in Central Appalachia, including Northeast Tennessee and Southwest Virginia, are much higher than the country as a whole. The cost to the region—in health care, lost productivity and, most importantly, in the incredible devastation of families and communities—is hard to fathom.

Over the years, I realized my initial answer was short-sighted. While smoking, and other unhealthy behaviors, are clearly the major contributors to early disease and death in our country and our region, there are factors that lead people to smoke, to be less active and even factors that lead to substance abuse.

We know people with lower levels of education and less economic opportunities are more likely to smoke, less likely to eat healthy diets and more likely to engage in less physical activity. With that in mind, a few years ago, I changed my answer to suggest the most important thing we could do to improve health in the region is improve educational achievement and enhance economic opportunity.

These two factors, of course, go hand-in-hand.

To get a better job, people often need more education. It takes a robust tax base — which results from a strong economy — to support the types of programs schools need to help students succeed. We know that when they occur together — more educational achievement AND more economic opportunities — people’s health and well-being improve. Importantly, we know communities with greater educational achievement and higher income typically have lower smoking rates, lower obesity rates and more physical activity. They are, in short, healthier.

So many of the challenges facing our region persist from one generation to another. A child’s educational achievement often reflects the parents’ level of education. A child born into a poor family is very likely to remain poor for his or her entire life. Parental smoking is one of the factors that predicts a young adult’s decision to start smoking — and the list goes on-and-on.

The inter-generational cycles of poor health, poverty and lack of education are pervasive and well-documented. With this fact in mind, I have come to believe the most important thing we can do to improve health in the region is launch a concerted regional effort to disrupt the inter-generational cycles that limit the lifetime opportunities of so many children in our region.

With the merging of our region’s health systems, and the desire by both states to assure this merger has a long-lasting impact on the health status of the region, we have a remarkable opportunity to truly impact health in the region.

If we pool all of our regional efforts, and combine them with additional support from the states, the federal government as well as from regional and national foundations, and then apply a laser-like focus on disrupting the inter-generational cycles that significantly damage the children of our region, we have a unique and unprecedented opportunity to dramatically impact the health of this region.

This will require more focus on these issues than is currently anticipated. It will require the many community-service organizations in our region to work together on a small number of high impact priorities and it will require regional businesses to work together toward the common goal of giving every child in this region a better chance at a healthy and productive life.

If all of us work together to assure that, from the time a woman becomes pregnant to the time her child is ready to enter school, both of them have the knowledge, skills and opportunities to live the healthiest, most productive and most rewarding life possible, then we all benefit as our region becomes healthier, richer and more productive.


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What kind of school education and health development interventions do Indian adolescent girls require?

Indian/March 13, 2018/By: Dr. Lalit Kishore/Source:

The education and development of adolescent children in India has been most neglected and most interventions had been beamed at either at the primary or higher education level. Adolescent period has been the most important transitional period from childhood to adulthood but least attended to and more so for the girls in our country.
According to UNFPA-India – an agency of the United Nations that works with the government and partners to advocate for adolescents and youth’s rights and investments, including education, livelihood skills and health, including sexual and reproductive health, India has its largest ever adolescent and youth population and a  demographic window of opportunity, a ‘youth bulge’ that will last till 2025.
India’s youth population faces several development challenges, including access to education, gainful employment, gender inequality, child marriage, youth-friendly health services and adolescent pregnancy. Yet, with investments in their participation and leadership, young people can transform the social and economic fortunes of the country, informs the agency that  works with the government and partners to advocate for adolescents and youth’s rights and investments, including education, livelihood skills and health, including sexual and reproductive health.»The practice of gender-biased sex-selection in India has manifested in highly skewed sex ratios over past few decades. The preference for a son over a daughter is rooted in socio-economic and cultural factors: sons are seen to provide economic security in old age, perform the religious last rites and carry on a family name, whereas a daughter is considered a burden due to the practice of dowry. Further, the practice of gender-biased sex selection has increased with a decline in fertility and preference for at least one son, and the misuse of modern technology,» writes UNFPA-India on its website.

Since, currently, India has its largest ever adolescent and youth population, as mentioned in various reports and on different forums, but young people often face barriers in trying to get the information, education, skills or care they need; the right kind of adolescent education, health issues arising out of biological changes in them, and learning life and employable skills need to be the key focus areas for the adolescent and the youth.

I feel research based curriculum adjustments need to be done so as to have at least one third of language, life sciences and physical education content geared around life skills education with focus on employable communication skills, reproductive health issues and human rights. A mix of rights and life-skilled based education integrated with various upper-primary and high school subject areas can be answer. Some projects and experiments which have successfully done with adolescents need to be mainstreamed and contextualized to vulnerable and marginalized population and carried out.



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Need more social spending on health, education: Survey


Spending on social services in India grew by 11.5 per cent to Rs 11,18,094 crore in 2016-17, but the country needs to strengthen social infrastructure by investing in health and education as it is emerging as a knowledge-based economy, Economic Survey said today.

The mid-year survey, tabled in Parliament, also said that although India’s social policies have focused on welfare of the people, challenges remain in overcoming social and economic barriers to advance capabilities of the marginalised, women and other weaker sections of the society.

The total expenditure on social services, including art and culture, family welfare, housing, urban development, welfare of SCs, STs and OBCs, besides health and education, was Rs 10,02,591 in 2015-16, it said.

Expenditure on education has grown from 2.8 per cent in 2014-15 to 3.2 per cent of the GDP in FY17, while health sector saw it going up up from 1.2 per cent in 2014-15 to 1.5 per cent in the last fiscal, Economic Survey said.

«The expenditure on social services by the Centre and States as a proportion of GDP which remained stagnant in the range of 6 per cent during 2011-12 to 2014-15, recorded an increase of 1 percentage point during 2015-16 and 2016-17,» the survey tabled said.

As percentage to GDP, the expenditure on social services was at 7.4 per cent during the fiscal.

While expenditure of education during the fiscal stood at Rs 4,74,672 crore as against Rs 4,23,171 crore previous fiscal, health sector saw expenses of Rs 2,21,466 crore compared to Rs 1,91,141 crore in FY16, as per the survey.

«India is emerging as a knowledge based economy, poised for double digit growth, and needs to strengthen social infrastructure by investing in health and education,» said the survey authored by Chief Economic Adviser Arvind Subramanian.

Stating that on the Global Hunger Index (GHI) 2016, India ranks 97 out of 118 developing countries with prevalence of stunting among children aged below 5 years at around 39 per cent, the survey said it requires effective investments in social infrastructure in order to achieve the Sustainable Development Goals (SDGs).

Besides, the survey said, India’s rank in Human Development Index (HDI) is at 131 out of 188 countries as per HDR, 2016, leaving much to be desired.

It said the government is committed to achieving SDG for health that ensures healthy lives for all at all ages by 2030. Towards this, it has formulated the National Health Policy, 2017, which aims at attaining the highest level of good health and well-being, through preventive and promotive health care orientation. PRJ RKL SA


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