Addressing the unnatural divide: why health and education are the necessary foundations of equitable child outcomes

Around the world, the outlook for children and young people is troubling: health outcomes are declining, inequities are widening, and opportunities for a good life are narrowing.1,2,3 The 2024 Australian Early Development Census shows that one in four children start school developmentally vulnerable, the highest level ever recorded. Alarmingly, 23.5% of children are developmentally vulnerable on one or more domains. There were 12.5% of children vulnerable on two or more domains, which is the highest ever recorded with substantial inequities (20.3% of children in the most socio‐economically disadvantaged communities are developmentally vulnerable on two or more domains compared with 7.6% in the least disadvantaged communities).4

Globally, there has been virtually no improvement in the learning outcomes of students in the Western world since 2010.5 For example, the Organisation for Economic Co‐operation and Development (OECD) reports that the average reading literacy performance of 15‐year‐olds has fallen by the equivalent of a year of schooling since 2018, while learning and employment gaps between advantaged and disadvantaged students continue to widen.6 These findings tell the same story: children’s wellbeing is deteriorating, their sense of belonging in school is declining, and inequities are deepening.

Yet in Australia, there is still no Minister for Children, and national approaches to wellbeing and safety remain fragmented. Although there are some positive signs for a brighter future, such as commitments to properly fund all public schools and compelling public support for government action on more equitable education and health outcomes for the young, the need for greater clarity on these commitments and actions is needed for lasting change. Against this backdrop, the Future Healthy Countdown 2030 progress report7 lands with urgency, showing both the cost of inaction and the opportunity for change.

Australia’s children and young people in 2025

We begin this Medical Journal of Australia (MJA) supplement with the first Future Healthy Countdown 2030 progress report.7 This is an important culmination of effort that began with a rigorous and pragmatic approach, developed through a consensus‐building process with input from academics, policy experts, and young people.8 The approach has resulted in 22 outcome measures spanning seven interconnected domains, with one practical policy action recommended per domain. If implemented before 2030, these policy actions could deliver substantial and lasting improvements in the health and wellbeing of children, young people, and future generations of Australians. To align these policy actions with political reality, each one is accompanied by a measure of community sentiment to identify where momentum for change is growing.

For this Future Healthy Countdown 2030 progress report, progress was assessed against a 2023 baseline, the year the Countdown was launched, using the most recent data available. Across the 22 outcome measures, the evidence points to an urgent and troubling situation: children and young people are faring more poorly. They continue to experience a trajectory of disadvantage, with measures showing either deterioration or lack of progress, worsening health outcomes, and an absence of advancement in strength measures. To date, voter enrolment rates are the only measure that shows movement in a positive direction. Three measures (ie, material deprivation, the literacy and numeracy achievement gap, and civics proficiency) have worsened, while the remaining eleven show negligible or inconsistent progress. Measurement of several domains remains a challenge due to the lack of nationally representative and population‐level data. The absence of timely, reliable data in critical domains further obscures the full scale of the challenges they face. Without decisive policy action, the wellbeing and learning of today’s children and young people and that of future generations remains at substantial risk.9

In contrast to the seemingly immutable results is the clear and compelling public support for government action on the Countdown’s recommended policy actions. This supports some clear actions that could be implemented immediately. The Countdown’s progress report shows that six of the eight proposed actions attracted support from more than 70% of respondents, reflecting a broad consensus that decisive change is supported widely. Foremost among the results is the support for the “Learning and employment pathways” domain and policy action, calling to properly fund public schools, beginning with those serving children and young people who experience the most disadvantage and often live in lower income communities. Society recognises education as a powerful determinant of lifelong health and opportunity.

Taken together, the 2025 progress report underscores that we have both an urgent need and real opportunity to make a difference to children and young people in Australia. The Future Healthy Countdown 2030 does not need to be a spectator sport. Policy actions that transform critical environments, such as supporting schools, can generate benefits that extend across education, employment, community participation, and health. Implementing these actions and improving outcome measures by 2030 will deliver tangible gains for children and young people today, while laying the foundation for a fairer and healthier future for generations to come.

Education: an undervalued determinant of health and wellbeing

Education is one of the most powerful determinants of life outcomes. This is not new. Similarly, we know that health services only have a modest role in health and wellbeing inequities, driven predominantly by the social determinants of health.10 In this context, the 2025 edition of Healthy Future Countdown 2030 has focused on learning as the critical but often neglected determinant of health and wellbeing across all childhood years.11 The relationship between education and health is iterative and deeply intertwined: higher levels of education are strongly associated with better health outcomes, while poor health can disrupt learning and reduce educational attainment. This cycle means that tackling today’s complex health challenges cannot be achieved without embedding education as a central consideration in health policy and practice.

Learning opportunities provide children and young people with cognitive, social and problem‐solving skills and knowledge that foster healthier choices and enhance their own wellbeing.8 Learning contributes to social and human capital, strengthens relationships, and supports a positive sense of identity, belonging and culture. Conversely, health inequities manifesting in reduced life expectancy, increased morbidity, or psychosocial distress are often exacerbated by educational setbacks, such as absenteeism or limited access to learning and employment opportunities. These inequities are patterned across populations and are strongly shaped by social position.12,13 A failure to address the nexus between education and health risks perpetuates cycles of disadvantage, further entrenching the barriers young people face in achieving their potential.

Importantly, education as a determinant of health is not confined to formal attainment. Schools, in particular, are critical hubs for supporting children’s and young people’s health and development. This is because schools are where children and young people spend most of their days outside their family; far more than their exposure to any health service. The contexts in which education occurs, the accessibility to diverse learning, and employment pathways and opportunities both within and beyond schools shape health trajectories across the life course.14 Yet, despite this evidence, education remains under‐recognised in health policy. Without action, the neglect of learning as a determinant will continue to undermine efforts to improve outcomes for children and young people.

Learning and employment pathways for health

To disrupt this unnatural divide between health and education, the 2025 Future Healthy Countdown 2030 MJA supplement focuses on learning, education and pathways to employment. The articles in this supplement unpack how learning — at various ages and stages across the developmental years (0–24 years) and in differing contexts — can improve health and wellbeing for children and young people while being central to their future trajectories.

Educational, health, and social inequalities are deeply entrenched and manifest across schools and communities nationwide.15 In their article in this supplement, Sahlberg and Cobbold16 offer a perspective on four concrete interventions that the federal government’s recent commitment to fully fund all public schools would make possible. These are supports to implementing full‐service school models, strengthening family engagement, providing healthy school meals in all public schools, and reducing or eliminating families’ voluntary contributions to public school.

Early childhood health and learning are widely recognised as foundations for lifelong wellbeing. In their article, Wake and colleagues17 argue that these domains are closely connected but too often treated separately in early years research and policy. Drawing on Australia’s major birth cohorts, GenV and ORIGINS, this perspective article illustrates how large‐scale studies can generate practical evidence to guide a more coherent policy and practice. The authors point to the unique role these cohorts can have in shaping reforms grounded in children’s experiences.

Narrow metrics of educational success have framed First Nations education around literacy, numeracy, attendance, and Year 12 completion, sidelining broader cultural learning ambitions. By contrast, First Nations definitions of learning emphasise justice, self‐determination, and cultural determinants of wellbeing, alongside other skills young people need to thrive, as shown by the work of the National Indigenous Youth Education Coalition (https://www.niyec.com/). Indigenous students’ learning journeys encompass cultural knowledge, community connections, and identity in ways that are often overlooked by mainstream systems. In their article, McQuire and Mann18 describe how a social lab process involving First Nations students, educators and communities co‐designed an Indigenous Nation‐Led Learning Charter to better recognise and value these diverse strengths. This framework supports belonging and wellbeing, strengthens partnerships between schools and custodians, and enhances student agency through culturally grounded recognition tools.

Redefining what counts as success in learning can substantially complement, and compensate for, other subjective wellbeing determinants. The final article, a youth co‐research and participatory design study by Connell‐Tobin and colleagues,19 explores how broader recognition of learning can support equity and wellbeing for young people. It shows that when diverse skills and knowledges are acknowledged, including those developed outside formal schooling, students experience greater agency in skill development, social connection, and subjective wellbeing, offering a pathway to better education systems that support lifelong learning.

Opportunities ahead

In Australia, children and young people are living with a growing burden of disease and declining health and wellbeing outcomes;20 all socially distributed. Within recent government roundtables and among civil society, there is a growing focus on intergenerational equity with the goal of making sure that the next generation has a fair go.21,22 The first progress report of the Future Healthy Countdown 2030 highlights both the opportunities and the challenges before us. It makes clear that we must urgently address gaps in the availability and quality of data on children and young people’s wellbeing, as this evidence base is fundamental to driving effective and accountable policy action.

This is a moment of possibility. We already know what works, and Australians are ready for change. By investing in children and young people’s wellbeing, strengthening schools, engaging children and young people themselves, and supporting families, we can shift the trajectory from disadvantage to opportunity. Every step we take now will echo across generations. With bold vision and brave resolve, we can ensure that Australia becomes a place where every child can grow, learn and flourish.