BOOKS & ELECTRONIC MEDIA
School health, nutrition and education for all: levelling the playing field
Monika Blössner*
World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
Authors: MCH Jukes, LJ Drake & DAP Bundy
Publisher: CABI Publishing, Wallingford, 2007
ISBN-13: 978-1-845-93311-1; paperback; 160 pages; price £29.95
This clearly structured textbook provides a good outline on the effectiveness of health and nutrition programmes in improving education and equity. The authors guide their reader carefully through the seven chapters providing evidence to build the argument for promoting school health, nutrition and education for all.
Pivotal to their line of thought, the authors give the readers a view from different angles exploring the interactions between education, nutrition and health. While these different views add to the comprehensiveness they come at the expense of some repetition. The reader, however, can skip a section without losing the thread and the concise summaries, which are clearly set apart as text boxes, further help the reader to obtain a quick overview.
The authors' main arguments to support health and nutrition programmes are reiterated in several places and are summarized here: (i) disease affects education throughout childhood; (ii) improving children's health and nutrition brings substantial benefits for education; (iii) improving health and nutrition brings greatest benefits to the poor and most vulnerable; and (iv) health and education reinforce one another.
Their underlying rationale is that diseases that affect education are highly prevalent. Infants, pre-school and schoolchildren face many health challenges, such as pneumonia, malaria, measles, micro- and macronutrient deficiencies. Because these young children frequently suffer one or several of these problems concurrently, health and nutritional programmes focusing on this age group are extremely valid. Many of these diseases and deficiencies are preventable and, among the schoolchildren who bear the greatest burden, the most vulnerable ones are the poor.
The authors present the aggregated evidence of the various ways in which poor health and nutrition can affect children's access to education, such as delaying enrolment, increasing absenteeism and precipitating drop-out. They argue that school-based programmes are particularly good examples of effective interventions that tackle education and health at the same time. But it's not only during this phase that young children will benefit, good nutrition in pregnancy and infancy benefits health throughout the lifecycle.
Developing this idea further, the authors consider the effects of health and nutrition on behaviour and cognitive function. They present supporting evidence to show that a critical period for the educational benefits of good nutrition does not exist. Hence interventions must not just focus on a narrow age group: health and nutrition programmes are effective in improving education throughout life - even if the childhood period is the most effective one for many reasons. For example, a sick child who receives insufficient or nutrient-poor food will score lower in his or her educational achievement. Given that many schoolchildren suffer from nutritional deficiencies and infectious diseases, multiple micronutrient supplementation could be a promising school health and nutrition intervention.
Above all, such interventions are highly cost-effective when delivered via the school system rather than the health system. To support this argument, the authors present ways to calculate the cost-effectiveness of school health and nutrition programmes as a means of improving children's education. In their view, these estimates are conservative given that they measure only short-term impact while there certainly is also a long-term impact that has yet to be monitored and evaluated.
Tackling diseases of poor health and nutrition will not only have an immediate effect on an individual's education, by reducing the number of years of schooling that are lost to poor health, but school health and nutrition interventions can have an impact on education on a global scale.
In addition, school health and nutrition has the potential to improve equity in education by helping girls and children from low-income families to attain good (or at least some) education. The latter are likely to benefit more than their peers and so this will contribute to closing the knowledge gap between children from high and low socioeconomic groups, leading to more equitable job opportunities in later life.
The authors conclude with a list of key issues that should be taken into consideration when designing school health and nutrition programmes. Readers with any doubts will be convinced after reading this book that the issues of health, nutrition and school education are best tackled with a comprehensive approach. It is a sound foundation to argue the case for health, nutrition and education for all. 
* Correspondence to Monika Blössner (e-mail: bloessnerm@who.int).
doi:10.2471/BLT.08.057562