Health Education covers a broad range of interventions, from HIV awareness and prevention to hygiene improvement. Whilst health education can be a very cost-effective intervention, we also know that providing education is not equivalent to ensuring that people take the necessary preventative measures. However, this is an intervention that has seen great success in the past, and it is therefore one we are keen to continue researching, particularly to identify the best organisations in this field.
The World Health Organisation (WHO) has defined health education as “any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes”.
The most common focus areas, as described below, are education about HIV/AIDS, hygiene promotion and micronutrients.
Three promising examples
While there is no known cure for HIV, it is a preventable virus for the majority of people, with the exception of those who are forced into unprotected sex or in cases of unprevented mother-to-child transmission. Education appears to be the most effective way to reduce the number of people that will die from HIV/AIDS, providing guidance on prevention and antiretroviral treatment, which not only keeps those with HIV alive, but also makes them less likely to pass on the virus to others.
HIV prevention education may include explanations for how the virus is spread, promotion of safe sex and demonstration of condom use, and women’s empowerment. It can take place in the classroom or the home, in healthcare settings such as clinics or hospitals, or through mass media, such as newspaper advertisements, billboards, television or radio. HIV education can also lead to a decrease in the incidence and transmission of other sexually transmitted diseases, as well as of tuberculosis.
Hygiene promotion, which primarily promotes hand-washing with soap (HWWS), appears to be the most cost-effective aspect of Water, Sanitation, and Hygiene (WASH) programmes. HWWS reduces the prevalence of diarrheal disease and there is some evidence to suggest that it also reduces Acute Respiratory Infections (ARIs). These two disease groups are the most important causes of child mortality worldwide and ARIs also cause significant adult mortality.
Micronutrients are substances needed only in minuscule amounts by the human body but are critical components for the production of enzymes, hormones, and other substances essential for proper growth and development. The consequences of their absence are severe. Iodine, vitamin A, and iron are the most important micronutrients in global public health terms; their lack presents a major threat to the health and development of populations the world over, particularly children and pregnant women in low-income countries.
Micronutrient education may include educating salt producers about iodizing their salt, or educating federal governments about the same.
WHO-CHOICE (Choosing Interventions that are Cost Effective) gives a cost-effectiveness estimate for mass media HIV education of $18 per Disability Adjusted Life Year (DALY) in countries in South East Asia with high adult and child mortality and only $3/DALY in countries in sub-Saharan Africa with very high adult and child mortality.
However, we are unsure how much confidence to place in these figures as they are dated, preceding both the spread of the Internet and mobile phones, and there is at least some countervailing evidence.
The Disease Control Priorities Project (DCP2) estimates that HIV peer education for high-risk groups specifically costs $37/DALY, while WHO-CHOICE estimates that peer education and treatment of sex workers specifically costs $3-4/DALY.
In other words, according to WHO-CHOICE, it would cost $1,000 to extend 125 people's lives by two years if spent on peer education and treatment of female sex workers. (Comparatively, the same $1,000 could be spent on extending one HIV-sufferer’s life for at least two years through antiretroviral therapy.)
In addition to saving lives, reducing the prevalence of HIV/AIDS has major economic and social benefits not taken into account by the DALY numbers, as it keeps men and women of working age alive and healthy and their children cared for and fed.
DCP2 gives hygiene promotion a cost-effectiveness estimate of $3.35/DALY; however, this is likely an underestimate, given that it only takes into account the effects of reducing diarrheal diseases.
For school or community health and nutrition programs, DCP2 gives estimates ranging from $20/DALY to $250/DALY.
More specifically, the Copenhagen Consensus ranks community-based nutrition promotion as more cost-effective than malaria prevention and treatment or tuberculosis case finding and treatment, but lower than direct supplementation or fortification of micronutrients.
In fact, some research suggests that nutrition education is approximately 10 times less cost-effective than micronutrient supplementation/fortification.
A lack of room for more funding may also be an issue with health education, as it is performed in a variety of ways by governments, volunteers, healthcare workers, development organizations, and countless small and large groups and individuals.
Education appears to be the most effective way to reduce the number of people that will die from HIV/AIDS. Although we can’t place great confidence in the figures referred to above, if they are even correct to within an order of magnitude, then peer education programmes for sex workers and, especially, mass media education, are hugely cost-effective, or at least have been in the past.
Hygiene promotion, too, is a very strong candidate as a top-tier intervention. However, it may be more effective to improve hygiene at the sources of contamination.
Micronutrient promotion appears to be a very cost-effective intervention, but direct supplementation/fortification seems to be an order of magnitude more cost-effective. See Micronutrients for more information.
With health education, there is a big difference between successful passing on of knowledge and usability of knowledge. Just because you are aware that hand-washing with soap improves health doesn’t mean it is possible for you to obtain soap, and it doesn’t mean that you will make any effort to use what soap is available. Knowledge does not always equal power in many cases. But mass media in particular allows for education to theoretically spread far and wide in a relatively short period of time and has had a great impact in the past. Education therefore continues to carry great potential. We will be looking further into identifying specific organisations with room for funding and a focus on cost-effective education.
- http://www.who.int/choice/results/hiv_seard/en/index.html, http://www.who.int/choice/results/hiv_afre/en/index.html.
- Jane Bertand et al., 2006. 'Systematic review of the effectiveness of mass communication programs to change HIV/AIDS related behaviours in developing countries', Health Education Research 21:567–97.
- http://www.dcp2.org/page/main/BrowseInterventions.html, http://www.who.int/choice/results/hiv_seard/en/index.html, http://www.who.int/choice/results/hiv_afre/en/index.html.
- http://files.dcp2.org/pdf/DCP/DCP56.pdf, http://files.dcp2.org/pdf/DCP/DCP58.pdf.