Chronic ill health and educational outcomes: What does the data tell us?
Dr Michael Fleming, winner of the Best Paper Award at the 4th International Conference of Administrative Data Research, describes his award-winning project which utilised Scotland-wide record linkage to investigate the educational and health outcomes of children treated for chronic conditions.
Health and education share a bidirectional relationship. Whilst targeted health promotion and education around healthier behaviours can directly improve our health outcomes, broader improvements in educational attainment, particularly in childhood and adolescence can indirectly enhance long-term health and wellbeing through increased employability, higher income, greater social mobility, and better quality of life. Yet unfortunately, poor health is one of many factors that can produce barriers to achieving a good education. It was back in 2014 that, having worked as a statistician with the NHS for almost a decade using administrative health data and record linkage for public health research projects, I felt I had a strong background to undertake a PhD in Public Health and focus on this interesting topic.
Fortunately, Scotland is well placed to carry out this type of research, owing to routinely collected and well-maintained national administrative datasets and a strong track record of performing record linkage for research purposes. I accessed several anonymised Scotland-wide national administrative health and education data sources and linked education records, for children attending school in Scotland between 2009 and 2013, to prescribing data, hospital admissions, death records and retrospective maternity records. I identified schoolchildren receiving medications for diabetes, asthma, epilepsy, attention deficit hyperactivity disorder (ADHD) and depression and compared their school absenteeism, school exclusion, special educational needs (SEN), academic grade attainment, subsequent unemployment, hospitalisation and mortality to healthy peers. I later investigated prevalence of neurodevelopmental multimorbidity (NDMM) and the impact on educational outcomes classing NDMM as existence of two or more conditions from depression, ADHD, autism or learning disability, the latter two being recorded on school records.
The bulk of this work was reported within my PhD thesis in 2017 with specific findings on diabetes, asthma, epilepsy, ADHD and depression subsequently published in peer review journals. In addition to poorer health outcomes, I observed that schoolchildren treated for these chronic conditions experienced significant educational disadvantage compared to their peers. Children with NDMM experienced poorer educational outcomes compared to those with one or no conditions and, whether in isolation or coexisting with other conditions, depression was the biggest driver of absenteeism and ADHD was the biggest driver of exclusion.
It is important that all children, regardless of background or circumstance, receive the best standard of education possible and equal opportunity to perform well at school. Since all children are different, policies ensure that school services and resources are tailored to individual pupil needs. Despite such policies, my work demonstrates, on a population level, that Scottish schoolchildren with chronic conditions still experience significant educational and health disadvantage compared to peers. Many educational policies rightly focus on health and wellbeing and social disadvantage; particularly poverty which accounts for a large part of the disparity in educational opportunities. However, chronic ill health should not be overlooked. Whilst the detrimental health effects are felt over the course of a lifetime, the impact on educational outcomes, as demonstrated, likely lead to additional adverse outcomes in adulthood. Early diagnoses and earlier intervention extending beyond the health sector into schools, including understanding the complex needs of children with multimorbidity, can minimise adverse outcomes.
Since starting my career as a statistician in 2005 I have been interested in maternal, child and early life outcomes and I continue researching this field through my current research fellowship. One challenge facing researchers is how to follow up interesting published findings with actions that can truly make a change. Public engagement, knowledge exchange, and general wider dissemination of findings play an important role and conferences such as the 4th International Conference on Administrative Data Research are of great benefit because they are attended by a wide range of experts from academic, health, educational and other governmental sectors.
I was very pleased that my research won an award for the best paper for evidence to support policymaking because first and foremost it demonstrated that my research is valued by my peers and deemed relevant, important, interesting and well conducted. We all question our ability and suffer from self-doubt at times - I can also become consumed by details and numbers, temporarily losing sight of the bigger picture. This award for me reaffirmed the importance of this topic and the benefit that this type of research can have for our society.