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Can a Simple Intervention Improve both Health and Educational Outcomes?

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As a researcher, I have tried to understand how children’s early life experiences prepare them to meet the challenges of the elementary school classroom. I was also very interested in trying to find out why disadvantaged children consistently seemed to underperform. My ultimate goal is identifying strategies that could be used to provide these children with a better chance at success. At the same time, I have developed a growing interest in the relationship between education and health. Health economists have estimated that an improvement in educational outcomes in the population would translate in four times more lives saved than similar investments in biomedical procedures and technologies. Education provides individuals with important information to make sound health-related decisions. Education also helps individuals acquire personal and financial resources which then contribute positively to mental and physical health.

In terms of social policy, an improvement in the educational outcomes of disadvantaged individuals is likely to have important health repercussions across the population. An important question becomes, which skills, or lack thereof, explain socioeconomically based gaps in achievement? Large samples of children in Canada and the United States, I have found that cognitive-control skills, measured as early as age 5, are particularly important for student achievement. Furthermore, my colleagues and I at New York University have found that cognitive control skills, rather than general intellectual skills or speed of cognitive processing, account for the socioeconomically-based achievement gap at school entry. Finally, to evaluate the generalizability of these findings internationally, I am currently examining the importance of cognitive control skills with South African children. I expect that the findings in the South African context will mirror those from North America.

Cognitive control skills allow individuals to preside over effortful behaviors, resist internal or external distractions, delay gratification, and regulate emotions. These skills are important predictors of school readiness, achievement across the elementary and high school years, health-related-behavior, employment outcomes, risk taking, and involvement in criminal activities.  Unfortunately, the environment of children who grow up in poverty offer fewer opportunities for the development of strong cognitive control skills.

In addition to contributing to academic achievement, differences in child cognitive control may contribute to health-related disparities. Disadvantaged Canadians and Americans continue to experience significantly worse physical and mental health when compared to the general population. Health differences can be identified as early as childhood and are present at all life stages. Part of these inequities can be blamed on differences in access to health care. Other factors however, such as exposure to pollution, neighborhood safety, work conditions, stress, and health-related behaviors, are also important influences.

Cognitive control may play an important role in the adoption of positive health-related behavior. Having poor self-control can interfere with a child’s ability to be involved in organized or group-based physical activities. Poorly controlled, impulsive children have more trouble regulating their emotions in social contexts, and tend to have more trouble problem solving in social situations. Furthermore, children who are more impulsive are likely to experience difficulty following the rules and directions required for participation in organized sports and athletics. My colleagues and I have found that kindergarten students who can better regulate their behavior in the classroom tend to be more involved in organized and group physical activities and have lower BMIs by the end of elementary school.

Children with better self-control are also less likely to experience unhealthy weight gain during their transition to adolescence. Not all children who are exposed to high-calorie diets become overweight. However, those who lack cognitive control and are more impulsive are likely to have an especially hard time controlling the urge to overeat. Consequently, children with poor self-control may be at risk of becoming overweight partially because they have difficulty resisting the urge to refrain from unhealthy eating patterns, and because they lack the effortful control necessary to engage in health promoting behavior.  

Finally, there is likely to be a more intricate relationship between cognitive control and health. Much like educational disparities, the origin of health-related disparities can be partially traced to experiences during the preschool years. Children that grow up in an environment of poverty characterized by chronic stress, family conflict, instability, and violence are likely to experience poorer health in later adolescence and throughout adulthood. One reason for this is that young children that experience stress that is in excess of their coping capacity, are at increased risk of developing behaviors that are detrimental to good health. Furthermore, these children are also likely to experience disruptions in their physiological responses to stress, which then sets the stage for lifetime risk of illness and poor health. Interestingly, children who have good cognitive control skills appear to be more resilient to environmental adversity. Consequently, the reinforcement of cognitive control skills in very young children may prove to be an effective strategy for offsetting the toxic influences of stress on lifelong health.

Several preschool programs have successfully enhanced child cognitive control by providing special training to teachers. Others have shown that meditation and martial arts can also be useful for improving cognitive control. These interventions are inexpensive to implement, cost effective, and appear to provide the most benefit to higher risk children. Dropout and poor health represent costly social problems that disproportionately affect disadvantaged individuals. The inclusion of cognitive control as a focus of early education initiatives is likely to increase fairness in children’s access to education and health.

CarolineDr. Caroline Fitzpatrick was born and raised in Montreal Canada. She was a 2011-2012 Fulbright Student at NYU in applied psychology. She is currently a post-doctoral fellow at the Sainte-Justine University Hospital Research Centre in the department of social and preventive medicine. She is also a visiting research fellow at the University of Johannesburg in the Faculty of Education. Her work addressing the childhood origins of education and health inequities has been published in influential journals and has received media attention worldwide. You may reach her at caroline.fitzpatrick@umontreal.ca

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