Healthy lives, enriched minds: the role of physical health and mental health on educational attainment in Northern Ireland

This study found that educational attainment is influenced by both the physical and mental health of a student, thus addressing research question 1. Across all health indicators included in the analysis, a positive association between poorer health and lower GCSE outcomes was evident for students aged 15–16 years old in Northern Ireland.

Table of Contents

Physical health

As students report poor physical health, their GCSE attainment also becomes poorer. The largest difference was evident in the measure of self-report health status, specifically between students who reported very bad health and very good health (d = −1.01, 95% CI: −1.26, −0.75). This variable clearly illustrates how the grading of self-reported health status impacts educational outcomes. For example, those with good health had lower GCSE outcomes than students with very good health (d = −0.28, 95% CI: −0.30, −0.26). A positive association between very good health and higher GCSE scores is therefore evident, highlighting the important role of health status grading for our understanding and meaningful interpretation of how health impacts educational outcomes.

The overall measurement of self-reported health must be acknowledged as it could be deemed a relatively blunt indicator to understand a complex phenomenon. For example, the Census questions ask respondents how is your health in general? This measure is dependent upon an individual’s interpretation of health and could include perceptions of their physical health, mental health, or both. In addition, it may be the parent/carer of a young person who is completing the household Census on their child’s behalf. An individual’s interpretation of how to categorise their own health is subjective [18, 19], with variations reported in the approach of different social groups [20]. For example, previous research has suggested that only those with severe conditions, illnesses or disabilities are likely to define their health as poor [21]. This may be confirmed in the current study as only a small proportion of students (0.1%) report very bad health. Despite the limitations of this measure, a stark effect was observed in the analysis as students with very bad health achieved the lowest GCSE outcomes compared to those with very good health.

An association between a limiting health problem or disability and GCSE attainment was also evident. Students who were limited a lot by a health problem or disability achieved lower GCSE scores than those with no limitations (d = −0.98, 95% CI: −1.04, −0.92). However, what constitutes as limited a little and limited a lot by a health problem or disability should be considered. As above, this interpretation is subjective to an individual. As the Census question asks about health problems or disabilities that have lasted, or are expected to last, at least 12 months, it is likely those who are limited a lot represent students with the most severe health problems or disabilities. For example, only 1.7% of students reported being limited a lot in the 2011 household Census. It should also be acknowledged that some individuals may mask their limitations based on a health condition or disability to reduce stigma within social institutions such as education.

The findings from this current study on the influence of physical health on educational outcomes reiterate previous research in the UK and international context which highlights students with better health are likely to have higher academic attainment [22, 23]. One explanation suggests students with better physical health have the ability to benefit from high quality teaching through regular school attendance, which assists their ability in reaching their academic potential [12]. On the other hand, studies have suggested school attendance, concentration and an individual’s mental health can be negatively affected by poor physical health, which in turn can impact upon educational outcomes [3].

Mental health

The current study, along with previous evidence, affirms that poor mental health is associated with lower educational outcomes [12, 24], even after accounting for other explanatory indicators such as socio-economic background, parenting and school-level factors [11, 13]. However, the measure of mental health in this study is a blunt indicator which only asks respondents to report upon conditions that have lasted, or are expected to last, at least 12 months. This wording therefore suggests that only relatively severe cases of mental ill-health are captured, as evidenced by only 0.7% of students reporting a mental health condition in the 2011 Census. This is likely to be an underestimation of mental health issues among the 16-year-old population in Northern Ireland. For example, other prevalence data such as the Youth Wellbeing Prevalence Survey suggests higher rates of mental health conditions among children and young people in Northern Ireland [25]. However, the Youth Wellbeing Prevalence Survey provides a more granular exploration of specific mental health conditions than what is available in the household Census. Furthermore, the likely underestimation of mental health issues among 16-year-olds in the current study may be impacted by the fear of stigma and negative attitudes if they report having a mental health condition [26, 27].

Determining whether a student’s physical health or mental health has a greater influence on their educational attainment (research question 2) is dependent upon the indicator used. If the focus is upon the presence of a physical health condition or mental health condition (that has lasted, or is expected to last, at least 12 months), it is important to highlight the low proportion of students reporting a physical health condition (14.4%) or mental health condition (0.7%). Although these are blunt measures of physical and mental health, the analysis indicates that while both are influential on attainment outcomes, the presence of an emotional, psychological or mental health condition had a greater impact, with a stark difference observed. In summary, although the presence of a physical health condition negatively affected GCSE outcomes (d = −0.39, 95% CI: −0.41, −0.36), the impact of a mental health condition was much higher (d = −0.91, 95% CI: −1.00, −0.82).

Physical health and mental health

The influence of physical and mental health should be considered separately but also collectively to understand their reciprocal relationship [28]. The effect of physical and mental health conditions on attainment was accounted for in this study through an interaction of having a physical and mental health condition. The analysis, in some way, indicates a double disadvantage for students with a physical and mental health condition. For example, students with a physical and mental health condition had lower GCSE attainment than those with only a physical health condition or mental health condition, or none.

The attainment of particular social groups (based on socio-economic background and sex) also varied according to their physical health and mental health (research question 3). Overall, students who are not eligible for FSM have higher attainment, regardless of physical or mental health status. Within the group with no physical health conditions, females achieved higher grades than males. Of those students with a physical condition, females continued to achieve higher GCSE grades than their male counterparts. Interestingly the attainment gap between females with a health condition and males without a health condition, was in favour of the latter (as one might expect), but it was only a very small difference (d = 0.05, 95% CI: 0.01, 0.08).

Similar trends were evident in the interaction between sex and the presence of a mental health condition. Students with no mental health condition achieved better GCSE results compared to students with a mental health condition overall. Within the no mental health condition females outperformed males, and within the group of students who did report a mental health condition, females also outperformed males, after controlling for other explanatory factors (d = −0.25, 95% CI: −0.44, −0.06). Other studies have found similar trends [8, 11, 13]. For example, in England, Smith et al. [11] reported males and females with mental health difficulties were less likely to achieve the benchmark of five or more GCSEs A*-C, including English and mathematics. However, when controlling for other explanatory factors in their analysis, this relationship only remained significant for males [11]. Some studies have highlighted that trends in educational attainment vary according to the mental health condition/illness [8]. Although the present study does not look at specific mental health conditions due to the aggregation of data in the 2011 Census of the population and the available indicators being somewhat blunt measures, it is nonetheless the first analysis of its kind that reports on data from Northern Ireland. Finally, despite the known association between socio-economic background and health, the interaction between FSME and a mental health condition was not statistically significant in this study. Though some studies have highlighted that the association between poorer mental health and lower educational attainment transcends across socio-economic categories [11].

Implications for policy

Students with a physical and/or mental health condition may experience cumulative disadvantage over time. This may be reflected through consistent absenteeism and academic underachievement across the education system. However, due to the lack of available education data for research purposes at earlier timepoints of the compulsory education system in Northern Ireland (for example, primary school), it is difficult to understand, if and when, this cumulative disadvantage emerges, along with when the most effective time for interventions would be. Consequently, greater data access is required, along with greater linkage of education and health data in Northern Ireland to understand the associations between these structures, whilst also ensuring a collaborative approach between such structures is implemented moving forward.

Education and health continue to be treated as separate issues in many governments, with limited collaboration or joint up responses that account for their interaction and impact on the outcomes and trajectories of students across their life course. Despite this argument being emphasised by Bloom [29], it remains of relevance in present day. The interactions between health and education must therefore be acknowledged by leaders in both areas to ensure a collaborative approach is implemented. This collaborative approach will ensure a unified response in the future which will have a short-term reciprocal effect on the current student cohort and a long-term impact on adults [30]. In Northern Ireland, there has been recent progress in this area. For example, the Children and Young People’s Emotional Health and Wellbeing in Education Framework [15] developed by the Department of Education and Department of Health provides guidelines to assist educational settings in promoting emotional wellbeing among students.

The self-report measure of health in this study highlights the influence of health status grading and the importance of establishing targeted interventions that are implemented early, are sustained and evidence informed. Such interventions can also be aligned with longitudinal evaluations to identify the most effective approaches for particular groups of students. In summary, across all four measures of health in the analysis, the need for targeted interventions to disrupt the downward educational trajectory of students with poorer physical health and mental health is clear. This research adds to the growing evidence that the relationship between poor mental health and educational attainment outcomes must be a key policy priority as it can impact upon individual’s later life outcomes in areas such as employment, income and housing [10].

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