EAEA POLICY PAPER

ADULT EDUCATION & HEALTH

This paper will highlight the connection between adult education and health, focusing on three main topics: health literacy, adult education and health and well-being and health courses in adult education. EAEA1 believes that adult education can play a key role in improving health systems but also people’s individual health and wants to provide recommendations for policy-makers but also adult education and health providers in order to achieve this.

1 TheEuropeanAssociationfortheEducationofAdults(EAEA)isthevoiceofnon-formaladulteducationinEurope.EAEAisaEuropeanNGOwith137memberorganisationsin44countriesandrepresentsmorethan60millionlearnersEurope-wide.

INTRODUCTIONis agreat sourceofpersonalempo-werment and increases one’s senseof well-being, mental health andpersonalhappiness2.

Anumberofstudiesshowthatweal-thierpeoplearealsohealthier.Adulteducation can help to equalize thissituationandempowerpeoplewithlower incomes and lower educa-tional levels. Many people do nothaveaccesstohealtheducationand/or information. Policy-makers haveakeyroletoplayinensuringaccessto health education for everyone.Health literacy is the first step topreventingillnessandtakingcareofone’shealth.

2 www.bell-project.eu

The topic of health concerns bothindividuals and society as a whole:everyonewillwanttobehealthy;therisingcostsofhealthcare, includingfor diseases that could actually beprevented or bettermanaged, suchasdiabetes,meanthatsocietiesandeconomieshaveaninterestinhealth.To be and to stay physically andmentally healthy is linked toknowledge about living a healthylifeatallstagesoflife,havingaccessto health care and understandinghealthinformation.Non-formaladulteducationplaysa key role inequip-ping people with health compe-tences.Adulteducationislinkedwithhealthprevention,healthylifestyles,and health literacy. Learning itself

Adulteducationoffersafantasticallydiverse provision of courses in thefield of health education, for indi-viduals but also for practitioners.Health education on a global levelis also essential and there again,adult education can do a lot. Lear-ningisalsoacreatorofwell-beingassuch: research proves that learningisbeneficialforone’swell-beingandpersonalhappiness.

Thispaperisbasedonaconsultationof EAEAmembers in Europe and onsome further research and projectsources, especially the projects thatweresubmittedfortheEAEAGrundt- vig Award 2015 (see www.eaea.org/en/eaea/eaea-grundtvig-award.html).

ctious diseases. Lifestyle-relateddiseases are responsible for 70–80%of deaths in developed countriesandforabout40%inthedevelopingworld.”

There is a strong need to improvehealth literacy levels inEurope(and

beyond), so that indi-viduals can take careof their health in anappropriate way.Health literacy is abasiccompetencyandneedstoberecognisedassuchbyincludingit

inofficialmentionsofbasic compe-tenciesofallcitizens.

Health literacy benefits societyHealthliteracylevelshaveanimpacton the efficiency of healthcaresystems.Peoplethathavelowhealthliteracytendtogotothedoctormoreoften,tobehospitalizedmoreoftenor to take inappropriate treatmentor prescriptions. Furthermore, theyarelessinclinedtotakepreventativemeasures. Fostering health literacyofallcitizensisbeneficialforsocietyat large as it reducescostsforpublichealthsystems which can,then, work more effi-cientlyforthosereallyinneedof it. Inorderto emphasise thebenefits of health education morestrongly, more research related tohealthandadulteducationisneededthat documents good practices andpresentsnewtheories.

Tacklingthehealthliteracyissuealsomeansfightingpoverty,socialexclu-sion,racismanddiscrimination,and

promoting social justiceandgenderequality. It provides a very strongbasistoimprovethesocio-economicsituationofmanypeople as a heal-thier population in all stages of lifecan contribute better to the social,culturalandeconomicdevelopmentof itscommunityandcountry.Thus,itisnotonlyabouteducatingpeopleinhealthissuesbutaboutempowe-ring them to attain a better life forthemselves and society as awhole.When working on these issues,policy-makersneed tokeep inmindthatadulteducationandhealthlite-racyprovidesolutionswithlowinputcostsontheonehandandveryhighefficiencyandthereforeabigoutputontheotherhandthatisbeneficialtoallparties involved. It is crucial thatthe support for adult education onhealth courses increases in Europesothatmorecoursesareofferedandbetteraccessisensured.

Learning about healthKnowledge and information abouthealth are essential to take care ofone’shealthandpreventdiseases.Itstartswith taking careof thebasics

as sleep, nutrition,movementandmentalhealth. Providing anddisseminating infor-mation about theimportanceofhealthylifestyles is the first

way toempower individuals to takecareoftheirownhealth.

Adulteducationprovidesasafeenvi-ronment in which individuals canlearn about health with someonewho knows the right answers andis available to respond toanyques-tions or concerns. Research proves

Health literacy in EuropeHealth literacy is the capacity ofpeople to access, understand andapply information related tohealth,so that they can make informedchoices related to their health. Itmeans that they understand theexplanationsofadoctor, instructionleafletsonmedication, informationleafletson illnesses,etc.andalso know how to applythem. It relates todecisions taken ineveryday life concer-ning healthcare andhealth prevention to maintain orimprove quality of life. Health lite-racy is at the very centre of beingand remaining healthy, preventingillnesses and diseases, and givinginformation about potential healthrisksandpreventivebehaviour.

According toa recent study, analar-ming“47%ofthepopulationineightEuropean countries is estimated tohave insufficient levelsofhealth lite-racy”3; “some 43% had difficultiesgraspingthenotionofdiseasepreven-tion and 51% struggled with healthpromotion–ortheabilitytoadvanceone’s own health.”4 A CONFINTEAreport5 said already in 1997 that“developing countries are also expe-riencing an increase in lifestyle- related health problems, on top oftheir already high incidence of infe-

3 ReportbytheEuropeanHealthForuminGastein,Austria,2014:www.euractiv.com/specialreport-resilient-innovati/campaigners-low-health-literacy-news-5309334 www.euractiv.com/specialreport-resili-ent-innovati/campaigners-low-health-lite-racy-news-5309335 www.unesco.org/education/uie/confintea/pdf/6b.pdf

HEALTH LITERACY

Health literacy is a basic competency and needs to be

recognised as such.

Fostering health literacy of all citizens

is beneficial for society at large.

thatadulteducationinfluencesposi-tively individual’s behavior: accor-ding to theBeLL study6, 76%of therespondents have experiencedpositive changes intheir health behaviorafter attending adulteducation courses.This is why healtheducation needs tobe mainstreamed inthe adult education course provi-sion. Health education needs to beaccessible, affordable and of highquality. Policy-makers on both thenationalandtheEuropeanlevelhaveabigroletoplaytheresothatmorepeoplegetaccesstothecoursesandcanbecomehealthliterate.

Access to health and health literacyIt is important to underline herethat equal access to quality healthprovision inEurope is important foreveryone.Accesstohealthprovision,asaccesstoinformationaboutnutri-tion,health,exercisemustbestreng-thenedforall,asthisisthebestwayto prevent diseases and illnesses.Adulteducationis,hereagain,averylow-costandefficientsolution.

Also, as PIAAC’s7 results on lite-racy levels inEuropeunderlined,onaverage,20%oftheEUadultpopu-lationhaslowliteracyandnumeracyskills. This is another challenge forhealth literacy,as somuch informa-tion is given in writing – and oftenin a complicated language. TheCONFINTEA report8 on adult educa-

6 www.bell-project.eu7 TheOECDSurveyonAdultSkills:www.oecd.org/site/piaac8 www.unesco.org/education/uie/confintea/pdf/6b.pdf

tion and health says that “It iswellknownthatthosewhoaremostlikelytosufferfromillhealtharenotonlythepoorest,butalsothosewiththe

lowest levelofeduca-tion. What is more,experience in bothdeveloping and deve-lopedcountriesshowsthat literacy andnon-formal education

programmes can lead to significantimprovementsinhealthandgeneralwell-being.”

Specificmethodsneedtobeadoptedin order to reach out to margina-lisedanddisadvantagedgroups.TheIROHLA researchproject9 (EuropeanwinneroftheEAEAGrundtvigAward2015) underlines that: “Within theEuropean Union, there is a largeheterogeneity of cultures, ethnicgroups, socio-economic conditionsand health care systems. Migrantsoftenfinditdifficulttofindtheirwayin health services. Tobe effective, healthliteracy policies haveto take this diversityinto account. Eviden-ce-based interven-tions, tested locally,should be given prio-rity in the array ofpossibleactivities”.TheOEDproject(Outreach, Empowerment, Diver-sity)10 presents methods for adulteducators to reach out to thesepeople.

E-literacy: the need for critical thinkingNowadays,theinternetprovidesnot

9 www.irohla.eu10www.oed-network.eu

only a vast array of health relatedwebsites, but increasingly alsobecomes the first informationpointforhealth issues. Iteventually leadsto self-diagnoses of illnesses anddiseases based on this information.However, the information providedin fora and on online consulta-tion websites has to be dealt withcarefully, as not all information ondiseases, illnesses, their symptomsor their treatment is correct andcorresponds to the scientific stateof theart inmedicine.There isalsoalotofesotericand/orcommerciallydriven information that can cost alotofmoneyorpossiblyevenharmpeople.

Therefore, there is a need for lear-ning to develop a critical eye onthe information related to healththat is present on the Internet andto put this information in perspe-ctive. Developing a critical unders-tanding of information, learning to

compare and analyseinformation is a basicskill acquired notonly through specificcourses but throughnon-formal adulteducation in general.Some adult educationcoursesonthissubject

alreadyexistaspilotcoursesinordertodevelopcriticalthinkingondigitalhealthinformation.

Policy-makers could adopt a regu-lation on wrong advertisementson health issues on the Internet,or, as the IROHLA project suggests,“introduce quality seals for reliablewebsites”. It is their role to protecttheconsumersintheareaofhealth.

Health education needs to be

accessible, affordable and of high quality.

There is a need for learning to develop a critical eye on the

information related to health.

ADULT EDUCATION AND HEALTH

patient associations, health profes-sionals, organisations dealing withmigrants,tradeunions(forthequalityof theworkplace), schools and alsofamilies. A cross-sectorial collabora-tion between theseproviders is crucial toensure and constantlyimprove the qualityof provision. Workingtogether and sharingexperiences betweenproviders is an effec-tive way to improvethe quality of the courses offered.Collaborationimprovestheefficiencyofthework.

Adulteducationenablespartnershipswith diverse sectors and has brid-ging functions. It also enables andpromotes a cross-sectorial approachon all levels of policy-making, thelocal,regional,national,andEuropeanlevel. This cross-sectoral approachis also needed as further skills areneeded to understand health infor-mation,astheIROHLAprojectunder-lines: “Organisations and institutions

in the welfare, educa-tion or the commer-cialsectorcanenhancehealthliteracyofolderpeople, for exampleby improving readingand writing skills, by

introducing computer skills or byproviding access to understandableinformation.”

Adult education on health happensin many various places. However,not all these providers call thecourses they give “adult educa-tion”–although it isevident that itactuallyisadulteducation.Hospitals

andotherhealthcareprovidersorga-nise forexamplecoursesonhowtomanagechronicdiseases.Wewouldliketoraiseawarenessaboutthefactthattherearemanydifferentplaces

where and methodshow health educationhappens.

Community learningCommunity lear-ning is one of thebestmethods used inadult education for

healthissues.Indeed,it iseasierforpeople with low levels of (health)literacy to open up and share theirconcerns with a group of personsthat share their experience andfeelings. Working with the targetgroup inabottom-upapproachandcreating small communities to talkabout health issues is therefore anefficient and low-threshold wayof learning. Peer-learning groupsoffer mutual support and learning.In these groups, patients and theirfamiliescanhearstories fromotherpatientsandlearnmoreabouttheirdiseases or illnesses and successfultreatments. Embedding health lite-racyandeducation inothercourseswithin community learning is alsoa successfulway of reaching out tomoredisadvantagedlearners11.

There is littletimeduringadoctor’sappointment to talk about fearsandgettheanswerstoalltheques-tions. Community learning can helpalotinthatregard.Havingsomeonethat can explain more about somediseases, answer questions, take

11See,forexample,NIACE’scitizenscurriculum:www.niace.org.uk/our-work/life-and-society/citizens-curriculum

Course provision on health in adult educationAdulteducationprovidesmanydiffe-rent courses on health. Cookingcourses, for example, are excellentways to learn how to eat and cookinahealthyway.Thesecoursescanbeverybasicandaimtoencouragehealthy eating as with “basics forcooking” or deal more specificallywith health issues as “how to cookwithout gluten”. Other courses asyoga coursesorfitness coursesalsoallowadultstodealbetterwiththeirphysicalandalsomentalhealth.

Adult education courses can alsoprovide informationondiseases thatmightappearatsomestageoflife,asforexamplediabetes.Therearesomemeasurespatientscantaketoreducethe chance of developing diabetes,as doing sports regularly, eating in ahealthyway, etc. Furthermore, infor-mation provision on diabetes helpspatientsdealwiththediseaseanditseffects every day. Courses translatehealth information into a languagethat is easy to understand andpresents the informa-tion in a pedagogicalway.Coursesalsotargetpeople that accom-panypatients,andhelpthemlearnhowtodealwith a family memberthathasAlzheimer, forexample,andtherebyalsohelptodevelopnetworksofconcernedpeople.

Providers of non-formal education on healthManyadulteducationcentresprovidenon-formal education on health.There are also other providers ofhealtheducation,suchasemployers,

Many adult education centres

provide non-formal education on health.

Community learning is one of the best

methods used in adult education for health

issues.

thetime,havingagroupthatsharesthe same experience is very useful.This is also the casewhen it comestoaccompanyingapersonandtheirfamily in learning how to deal witha disease - as for example learningto live with someonewho has Alzheimeror dementia. TheCONFINTEA report12 on adult educationand health under-linedaswellthat“Itisconsidered extremelyimportanttobuildonlocalinitiativesand people’s own experience, e.g.by involving local health specialistsand community committees. Therole of the health educator or theadult educator is to be a facilitator,aresource,acatalyst foractionandsometimesalinkforcommunitiestoapproach other structures, such asgovernmentservices.”

Adult education for health practitionersSometimes patients cannot read orunderstand properly medical indi-cations and it is important thatthey know how to respond in anappropriateway.TheIROHLAprojectstates: “Health literacy activitiesshould be part of a quality systemin health institutions. Professionalsshould have profound knowledgeof health literacy issues and shouldmaintaintheircompetenciesthroughinstitutional arrangements andnetworks. There should be regular

12www.unesco.org/education/uie/confintea/pdf/6b.pdf

follow-up and refresher courses.Training in effective communicationhas to be part of pre-service andin-servicehumanresourcesdevelop-ment.”Theneedforjobsinthefieldof health will increase in the upco-

mingyears,alsoastheEuropean populationages, and provision inadulteducationneedsto be strengthenedto respond to theseneeds.

Professionals, in particulardoctors, need to be available forthe patients and take the time toexplainthehealthsituationoftheirpatientswelland inanappropriatelanguage. Speaking to the patientsalso requires profound empatheticskills from health professionals, ashealth issues often create strongemotions. A better relation withhealth professionals would alsoempower the patient and increasetheirtrustinthehealthcaresystem.The IROHLA project suggests usingteaching mate-rial which simulatesinterviews betweenpatients and profes-sionals to improvethe communicationbetweenbothparties.TheAustrianAlpha-Powerproject13 (nationalwinneroftheEAEAGrun-dtvig Award 2015) provided work-shops for health professionals inorder for them to detect people

13www.vhsktn.at/projekte/detail/C34/alpha-power-die-kaerntner-volkshochschu-len-starten-projekt-im-bereich-gesun

with low basic skills and to workwiththeminanappropriateway.

Therearemanypeopleworkinginthehealthsector,inmanycasessupportpersonnel, whose training is not aregulatedprofessionsuchasdoctorsornurses,andveryoften,theirtrai-ning or professional developmentis organised by adult educationcentres. Adult education thereforecontributestothefurtherprofessio-nalizationinthehealthsector.

Health education on the global levelOn the global level, strategies forhealth education vary very muchdepending on the national context.Healtheducation–thatisfreefrompoliticalandreligious ideologies– iscrucialtofightthespreadofdiseasesas AIDS, tuberculosis or malaria,epidemics as Ebola, and diseasesthat could easily be prevented byvaccinations, a healthier lifestyleor other prevention strategies thatlead to behavioural change. Infor-mingpeopleabouthowdiseasesare

transmitted,howtheycan be treated, curedor prevented andproviding the tools togive this informationfurthertofamiliesandpeers is at the centre

ofhealtheducationstrategies.

Girls and women are very oftenleft in chargewith the reproductivehealthofthemselvesandtheirfami-lies, but in many countries there isa lack of access to adequate repro-

Adult education contributes to

the further professionalization in the health sector.

On the global level, strategies for health education have to be

improved.

ductive, child and maternal healthservices,underlinesUNICEF14.Empo-wering them by increasing theiraccess to education contributes toimproving the health of their fami-lies and society. The project Comp-rehensive Abortion Care15 (interna-tionalwinnerEAEAGrundtvigAward2015)givesyoungwomensexualandreproductive education, informingthemaboutsafeandunsafeabortionmethods–itemergedtofillinagapinhealtheducation.

Theneedforimprovedhealtheduca-tion strategies as well as universaland better access to health educa-tion and healthcare is addressed inthedraftpapers for theSustainableDevelopment Goals of the UnitedNations. However, building up andimplementing non-formal adulteducation courses in health needadequate financing by the publicsector. In order to put into practiceall the benefits of health educationoutlined in this paper, more publicfundingisessential.

On the global level, strategiesfor health education have to beimproved. In various policy fieldssuch as poverty alleviation, socialjustice, gender equality, combat-ting racism,andmanymore,healtheducationisakeyissueandneedstobeelaboratedassuch.

14www.unicef.org/esaro/7310_Gender_and_health.html15www.hffg.org/index.php/comprehensive-abortion-care-cac

yees and therefore improve theirwell-being. In some countries adulteducation centres offer coursesduring lunchbreaks, so thatemplo-yeescanjoin.

Adult education helps people with mental health issuesAdult education has also a big roleto play in mental health issues.Several projects, as NIACE’s project“MentalHealth in Further Education(MHFE) e-network”17 underline thatcommunity learningcanhelppeoplewithmental health issues.With thisproject, community learning hasproven to be an efficient treatmentforpeoplewithmentalhealthissues.Thismethodisnotatherapymethodassuchbutalearningactivity.HeadoftheprojectCatinaBarrettfromNIACEexplainsthatitleadstoafeelingthatcan be expressed as in “I make me

feel better” whereastherapy is seen as“The therapist makesme feel better”. Adulteducation is thereforea great way to avoid

or reduce medication and counsel-ling formental health problems andshouldbeconsideredmoresystema-tically by practitioners to cure theirpatients.

17www.mhfe.org.uk

Health and well-being as benefits of adult learningAdulteducationisnotonlyacomple-mentary method to develop moreknowledge but also a proactiveapproachintermsofempowermentandmentalwell-being.Adulteduca-tion is a way for people to lead amorefulfilledandhappier,thusheal-thier life, as research shows. In theBeLLstudy16,84%oftherespondentshave experienced positive changesinmentalwell-being,and83%haveexperiencedpositivechangesintheirsense of purpose in life when lear-ninginadultlife.

Learning, especially in non-formaladult education that uses participa-tiveand innovativemethods,makespeople more self-confident andaware of their own capacities andskills.Coursesalsogetpeopleoutofthehouse,bringthemtogether with otherpeople and thereforestrengthentheirsocialnetworks, which iscrucial for well-being.These benefits not only contributeto their personal development andfulfilment,butalsohaveaveryposi-tiveimpactontheirworklife.Emplo-yers play a crucial role in fosteringnon-formal learning of their emplo-

16www.bell-project.eu/cms/?page_id=10

HEALTH AND WELL-BEING

Learning makes people more

self-confident.

Mentalhealthisalsotheareawherethegendergapinhealth(education)becomesmostobvious. Participantsin health-related provision tend tobe mainly women. Participants innon-formal adult education tend tobe more women. Women are alsomorelikelytoseeadoctor,whichareallreasonsthatcontributetothefactthatwomenhaveahigherlifeexpe-ctancy than men. Adult educationhas created specific projects thattarget men who would otherwisenot participate in learning, such asmen’s sheds (An objective ofMen’sSheds18istoenhanceormaintainthewell-beingoftheparticipatingmen).TheseinitiativesdeservetobemorewidespreadacrossEuropeandneedsupport.

18menssheds.ie

Adult education has a key role to play in the field of health. Health education has high outputs in terms of increased health level of the population and lower costs for public health systems, as well as financial revenues as a healthier population works better and longer. Health education and literacy concern everybody, not only recipients’ side (e.g. patients or learners), but also donors’ side (e.g. health professionals, educational staff etc.). Health education and literacy don’t stand alone per se but are cross-cutting issues and part of other policy fields and need to be recognised as such.

We need to do more in order to ensure that more people have access to health literacy courses and can take care of their health. Health education must be accessible and affordable for everyone and of high quality. It is even more crucial in times of the Internet, with internet-based consultations that create tendencies to self-diagnoses.

Adult education needs to be supported so that more people can access it, as learning has been proven to create a sense of well-being and personal happiness for the learner. It is a great way to remain healthy and happy, but also to fight mental illness in a natural way.

CONCLUSION

RECOMMENDATIONS FOR...

POLICY-MAKERSEnsure a health education that is accessible, affordable and of high quality for all.• Fosteradulteducationcoursesonhealthand

mainstreamhealtheducationintheadulteducationprovision;

• ImprovehealthliteracylevelsinEurope;• Makesurehealthinformationisaccessible;• Relatehealtheducationtocross-cuttingissuesas

fightingpoverty,socialexclusion,racismanddiscri-mination,andpromotingsocialjusticeandgenderequality.Healtheducationisnotonlyabouteducatingpeopleinhealthissuesbutaboutempoweringthemtoattainabetterlifeforthemselvesandsocietyasawhole;

• Onthegloballevel,improvestrategiesforhealtheducation;

• Encouragecollaborationbetweenstakeholdersinthefieldofhealtheducationandhealthcare;

• Supportinformationandtrainingforhealthstaffandraisetheirawarenessaboutpatient’spotentiallylowliteracylevels;

• Inthefieldofe-health: ◦Supportthecreationofcoursesdeveloping criticalthinkingone-health; ◦Adoptregulationsonwrongadvertisementson healthissuesontheInternet;

• Supportnon-formaladulteducationanditsmethodsastheyworkbesttoaddressmarginalisedanddisad-vantagedgroupsthatneedthemostsupport;

• MakehealthliteracyapriorityoftheEuropeanUnionanditsMemberStatesintheambitiontoachievesustainablehealthsystems;

• Ensurebetteroutcomesofhealthliteracyinterven-tionsthroughacollaborativeeffort,especiallyalsobycooperationbetweendifferentministriesanddepart-ments,suchashealth,educationandsocialaffairs;

• Addressinghealthliteracyissuesrequiresbehaviouralchangeofcitizens,communitiesandprofessionals.

EDUCATION PROVIDERSUse non-formal education methods as the best approach to health education.• Useparticipativeandinnovative

methodsthatmakepeoplemoreself-confidentandawareoftheirowncapacitiesandskills;

• Encouragetheinvolvementofthetargetgroup,withrolemodelsandpeer-learning groupsinabottom-upapproach;

• Usethesemethodsinparticulartoaddressmarginalisedanddisadvantagedgroupsthatneedthemostsupport;

• Embedhealthliteracyandeducationinotherprovision,especiallybasicskillsprovision.

HEALTH PROVIDERS• Raisehealthstaff’sawareness

aboutpatients’potentiallowliteracylevels;

• Makesurethatdoctorsareabletosimplifythelanguagetheyusewithpatientsandoffertrainingsforimprovedcommunication;

• Cooperatewithadulteducationproviderstoimproveteachingandoutreachmethodologies.

European Association for the Education of Adults (EAEA)Mundo-J, Rue de l’Industrie 10, B-1000 Brussels

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