Educational attainment, functional and health literacy, and health inequities in the Philippines: a narrative review

Background Social determinants of health frameworks treat educational attainment as a structural determinant of health equity, using years of schooling as a proxy for the capability through which education is assumed to act. Most supporting evidence originates in high-income settings. This review examines how education shapes health equity in the Philippines, focusing on two processes that attainment-based accounts overlook: the conversion of schooling into usable capability, and the redistribution of educational returns within families. Methods We systematically searched PubMed, Scopus, ERIC, and Google Scholar between June 2025 and January 2026 for literature published from 1970 to 2026. We hand-searched reference lists and consulted foundational theoretical works, Philippine policy documents, and national statistical sources. Social reproduction theory, human capital theory, and the capability approach were synthesized in explicit tension and tested against Philippine national data. Results Attainment and capability diverge substantially. Drawing on national datasets, the review finds that the 2024 Functional Literacy, Education and Mass Media Survey records basic literacy at 90.0 percent but functional literacy at only 70.8 percent under a revised definition requiring inference. The first national health literacy survey found that 51.5 percent of Filipinos aged 15 to 70 had limited health literacy. Proficiency within schooling falls from about 30.5 percent in Grade 3 to 0.47 percent by Grade 12. Philippine evidence shows declining tertiary returns and sheepskin effects. Qualitative evidence on the tagapagtaguyod na anak documents a breadwinning-child role extending beyond financial provision, viewed positively by parents but experienced as pressure by many adult children. Conclusion Attainment is an unreliable proxy for health capability in the Philippines. Reproduction and liberation are concurrent processes that can be borne by the same person rather than alternative outcomes. Policy should target capability and health literacy rather than attainment alone.