Education, Not Knowledge, Favors Health

A recent study of HIV education in rural Ghana found that simply telling people how to prevent the spread of HIV might not do much to slow the spread of the disease. The study, published online in Psychological Science, found that people with limited formal education have not always developed the cognitive skills to understand how to stop the spread of HIV.

The study of 181 adults found that a person's level of formal education, rather than a person's knowledge of HIV/AIDS prevention, best predicted whether or not the person took steps to protect themselves from HIV infection.

"About $8.9 billion has been spent on HIV prevention in Ghana and the surrounding region since 2000, primarily through disseminating facts about the disease," stated a recent press release on the study. "But the effectiveness of these programs has never been adequately studied." The study's lead author, Ellen Peters, explained that "Our findings suggest that those effects, however well intentioned they may be, may not be sufficient without efforts to help at-risk adults to reason correctly with the facts they have been taught."

Unfortunately, the connection between health and education works the other way, too: some parasitic illnesses common in the developing world cause cognitive or physical problems that can interfere with a child's ability to attend school, an issue that I've blogged about before.

Numerous studies in wealthier countries have found a link between educational level and health behaviors: the more education someone has, the healthier they tend to be. The Ghana study looked at the developing world and found the same pattern.

The disease burden is enormous in sub-Saharan Africa, where Ghana is located. Sub-Saharan residents, who make up 11% of the world population, "suffer 24 percent of the world's disease burden -- which is addressed with less than 1 percent of the world's health care spending," Nicholas D. Kristof and Sheryl WuDunn wrote in their book Half the Sky: Turning Oppression Into Opportunity for Women Worldwide. About 2% of the population of Ghana has HIV/AIDS, and the country also contends with high rates of malaria and other health problems.

The Ghana study raises some interesting questions. For example, what role can education play in helping people to learn how to prevent or reduce their risk for these diseases? And should some portion of the limited health care budget in sub-Saharan Africa be spent providing a stronger general education to the population, rather than directly on health care services and disease education?

Texting to Save Infants

The United States ranks 30th worldwide in infant mortality rates, and one out of every eight U.S. babies is born prematurely (an expensive medical condition, as I explained in a 2008 blog post). Medical and lifestyle factors that contribute to preterm birth include inadequate prenatal care, smoking and drinking, domestic violence, stress, diabetes, high blood pressure, and being under- or overweight, according to the March of Dimes. To address the problems of both infant mortality and preterm births, the text4baby campaign was created and launched in February 2010 to improve the health of expectant mothers and their infants. 

"Hispanics and African Americans are about 2.5 times as likely as whites to put off prenatal care until the third trimester or to get no prenatal care at all," explains TIME Magazine writer Bonnie Rochman on the text4baby website. "But they are likely to be avid texters." Since 91% of Americans own cellphones, according to the wireless association CTIA, text messaging is an effective way to reach these women.

To register for this free program, participants simply text "Baby" or "Bebe" (for the Spanish version) to 511411. Once registered, they receive three text messages a week, covering relevant health topics such as prenatal care, vaccines, breastfeeding, mental health, and car seat safety.

Text4baby is an unusual public/private partnership, whose motley crew of partners include (but are not limited to) the mobile technology firm Voxiva, the health insurance company WellPoint, the U.S. Department of Health and Human Services (whose secretary, Kathleen Sebelius, just criticized WellPoint for canceling the policies of women with breast cancer), and MTV Networks (producers of the disturbing reality show 16 and Pregnant).


Voxiva is a veteran at text-messaging health campaigns, primarily in international settings. The Washington Post's Mike Musgrove explains that:

Voxiva has launched about 150 health-related text-message services around the world, mainly in developing countries where access to doctors is scarce. Such projects, typically underwritten by governments or pharmaceutical firms, have often been used as a tool to disseminate news about treating diseases such as diabetes or AIDS.

So will the text4baby program really improve maternal and infant health among the participants? It's too soon to know, but I'm curious to find out. If it does, other health-related text messaging campaigns will surely follow, as the federal government focuses on prevention and wellness to offset the cost of health care reform.