The Blog

Are Universities Healthy?

No one would be brazen enough to say that universities are ever going to be ideal environments for one's health. Few would be brazen enough to expect that. But if our hospitals are places to reduce poor health, is it too much of a stretch to suggest that our universities ought to be places that protect good health?

A journalist called me during a morning meeting recently to ask if I thought university was "unhealthy". The question caught me off guard. It is not one those of us working in higher education tend to ask.

The existence of universities is such a given, and their place in society so highly valued, that to ask if they are 'unhealthy' can seem almost blasphemous. And anyhow, universities are just places of study, how can we generalise about whether they are healthy or not?

My initial response to the question was to point out that each institution is different, with differing support provisions and varied programs of study, so we can't make sweeping claims. But the words coming out of my mouth left me uneasy. While I suggested that we can't generalise the university experience, I realised that this is precisely what higher education lobbyists do.

Ministers and lobbyists speak of the value of a university education and of the higher salary one can expect. In doing so, they use what statisticians call an ecological fallacy - where the average in a group is used to wrongly infer the likelihood of something occurring for an individual. Lobbyists rarely make reference to individual differences - between institutions, between programs, between what's right for particular people. Perhaps, then, we are reasonable in employing the same sort of sweeping judgments when considering the healthiness of a university education.

To answer a question like that on numerical data alone is problematic. We are relying on case-control studies, pitting those that went to university against those that did not. Such studies are inherently flawed measures of causality because healthy, wealthy parents are likely to send their healthy, well-supported children to university. Just as those attending university tend to have a head-start in terms of wealth over their non-graduating peers, so too do they in regards to health. Quite simply, there is no suitable control group.

Another issue with case-control studies is that they draw their conclusions over extended periods of time. For a stable and standardised intervention, like a pharmaceutical drug, that's not an issue. But universities, economies and working environments are so changeable that a university education is anything but standardised. Graduating 10 or 20 years ago could be, and probably is, completely different to graduating in 2015.

If we wanted to use health related data from previous years to infer something about universities today, we might draw worrying conclusions based on rising suicide rates and demand for counselling. But to avoid making claims based on historic data that doesn't necessarily apply to institutions today, we can also break a university education down into its characteristics and constituents, and consider these against evidence-based determinants of health. When we do that, things don't look much better.

One of the most studied social determinants of health is social support. In going to university, most students are moving away from their family homes and childhood communities, removing themselves from their most sustaining support units, which offered food and shelter, emotional support and the preventive healthcare that tends to be offered by one's parents. In its place, they have access to informal support from university staff and peers, as well as formal student support services. These services consist of specific advice and guidance for students, as well as counselling services. While all universities have counselling services, waiting lists tend to be lengthy, and services have had their funds stretched since the recession - even in spite of rising tuition fees and rising demand.

In a recent publication, the Chief Executive of Universities UK, Nicola Dandridge, seemed to downplay the obligation of universities to provide adequate counselling and mental health services, saying, "institutions are academic, not therapeutic, communities".

This is troublesome for a number of reasons. Firstly, it's all very well to suggest that students ought to use community health services, as Dandridge seems to be implying, but most students are spending up to 9 months away from the communities they are familiar with. If students are expected to transition to community services in their university town, who else is going to support that transition and facilitate access to community services if not the university? To deny responsibility for that seems to show both a disregard for any adverse health events students may suffer, as well as discriminating against those students bringing existing health conditions. When we reflect on recent concerns raised by Stephen Hawking, universities hardly seem to be the progressive institutions that we like to think.

Secondly, while we might accept the claim that universities are places for growth and learning, rather than for correcting health issues, the attempt by Dandridge to disconnect academic and pastoral aspects of study suggests a worrying ignorance of what it means to be human.

As much as places of higher learning might wish to imagine humans only as 'thinking beings' without emotions or bodies, the reality is that pushing ourselves in our studies often also means pushing our mental and physical states to their limits. Extended periods of study often demand, or are at least conducive to, late nights, isolation, limited sunlight, limited exercise and poor diets, not to mention the stress of potentially having one's entire career come down to a 2 hour examination.

Support goes beyond formal services. It includes the informal support offered by professors and staff. One of the promises of a university education is access to leading academics that can provide both intellectual and emotional guidance. But where once the student-staff ratio averaged approximately 1 to 12, it's now around 1 to 22. And then there are the greater research burdens on lecturers that limit the time they can spend with students - and the quality of that time. While students being assigned a staff member as their 'tutor' on arrival would seem to be of value, the burden of obligations felt by staff elsewhere tends to make it a tokenistic arrangement consisting of minor administrative duties at best.

Then there is the informal support offered by peers. Peer networks are invaluable sources of information, emotional support, and belonging. But it's not always a good thing, as the contagion of obesity has shown. Social networks lead to social norms, and if our networks are engaging in poor lifestyles, fuelled by alcohol and late-night kebabs, we're probably more likely to do the same - particularly when struggling to make friends and settle into a new environment. And if we don't manage to fit in, we have social isolation waiting for us, with all of its ill effects. The great range of study and living options, particularly outside of collegiate institutions, are such that we can find ourselves without any particular identifiable group aside from being a member of a 30,000 strong university. For those coming from a small town or school of a few hundred, it can be a bewildering experience.

Many student unions and societies are working to address the lack of support through health promotion, but these are not core structural functions of a university education. They are not standardised for students; they serve a complementary role as fringe additions to the formalities, set up in recognition of university limitations. And the increasing attention shift by student unions away from political issues towards welfare issues shows the true extent of these limitations. For the government, that's probably quite convenient - students addressing health crises through peer-support means fewer students fighting abuses of power; although, as some students are beginning to recognise, the two are closely related.

No one would be brazen enough to say that universities are ever going to be ideal environments for one's health. Few would be brazen enough to expect that. But if our hospitals are places to reduce poor health, is it too much of a stretch to suggest that our universities ought to be places that protect good health?