Are active citizens healthy citizens? Evaluating the health effects of community engagement and global citizenship

Original research

Nic Mattock


Global citizenship is a relatively new concept that broadly includes facets of social awareness, activism, and engagement. As a framework, global citizenship is designed to build capacity in individuals and produce social change within their local and global communities.[1] Mansouri et al. define global citizenship as a state uniquely defined by traditional concepts of nation-state citizenship in the context of progressive globalisation.[2] That is, global citizenship is an ethical framework rather than a legal construct; it recognises the limitations of traditional citizenship in a world characterised by globalisation, and instead seeks to provide a globally inclusive political and cultural environment that empowers individuals, rather than nation-states. In the context of growing social and economic inequalities as well as persisting global issues, including those specific to global health, empowering individuals is necessary to nurture change.

The Matariki Network is a group of seven international universities that are committed to supporting and developing this concept of global citizenship.[3] Ustinov College— a postgraduate college at Durham University, a member of the Matariki Network, administers a specific global citizenship program whereby a governing student body is established and tasked with the maintenance of various academic and social outreach initiatives. In 2017, a bilateral student exchange program was established between members of the Matariki Network, the McCusker Centre at the University of Western Australia and Ustinov College at Durham University; its aim to build international relationships, explore the concept of global citizenship and evaluate aspects of global citizenship as a tool for both social and personal change. Quantifying aspects of the global citizenship framework is necessary as a means of developing a more rigorous case for the implementation of similar programs beyond the network and defining the utility of this approach for broader evaluation.

Mental health is of particular concern in modern education systems, such as those detailed in this study, given well-characterised associations with academic and occupational achievement.[4,5] Evidence remains mixed with respect to the prevalence of mental health disorders in students, and the interaction between mental health and academic involvement.[6,7] It is likely that significant geographical and social variation exists; however, mental health complaints in college-aged individuals remain uniformly high.[4,7] Access to mental health services at a tertiary level, whilst improving, remains limited and typically has poor uptake.[8] Interventions designed to prevent or address mental health issues in students are necessary to ensure ongoing maintenance of an effective and capable workforce, and to mitigate the economic and social strain of mental disease in our community.[8] Indeed, recent work suggests that implementation of mental health interventions for students has benefits that persist beyond tertiary education.[9]

Volunteering is well-established as a positive determinant of health and health-related behaviours among individuals of varied demographics.[10] In particular, volunteering appears to improve mental health and, to a lesser degree, reduces all-cause mortality.[11,12] However, such findings have not been confirmed in clinical trials. Interestingly, a number of studies have found that volunteering was not related to positive mental health outcomes in those of early- to mid-adulthood.[13,14] Elias et al. suggest that volunteers experience improvements in wellbeing and mental health proportional to the duration of volunteering.[15] Other studies have noted that sustained volunteering, as opposed to intermittent volunteering, has a greater impact on health.[16,17] It is unknown whether the global citizenship framework, which includes aspects of social engagement such as volunteering, would confer similar positive health outcomes for the individual. Determining whether such benefits exist, if any, would have implications for the delivery of similar programs in education settings as a way of both addressing student wellbeing and social engagement.

The impact of activities of global citizenship, such as social activism and volunteering, are directly quantifiable at a community or global level. For example, in 2010, the economic value of volunteering in Australia was estimated to be worth $25.4 billion to the Australian economy.[18] Global citizenship is multifaceted and dynamic, but the social issues it addresses are relatively more static in category: political, economic, social and health, among others.[2] Activities of global citizenship can have a measurable impact on all such domains.[18] However, it is less clear whether a reciprocal impact exists for the individual; that is, to what degree do activities of global citizenship produce change in the individual? This evaluation postulated that individuals whom are active global citizens are, in turn, healthier global citizens in that their engagement with global issues has a positive effect on personal well-being. Such effects may be related to direct improvements in mental or physical wellbeing and/or improvement in perceptions of wellbeing. This study aimed to develop and validate a tool to investigate the effect of activities of global citizenship on individual self-perceptions of health.


This evaluation was performed in conjunction with the Ustinov College (Durham University, Durham, UK) student representative team. The aim of the survey was to assess an individual’s self-perceptions of general, physical and mental health according to their participation in activities of global citizenship. Demographic characteristics were also collected.

The survey was delivered to all residents of Ustinov College at Durham University via an online web form in January, 2018. Promotion of the survey was performed by the Ustinov College student representative board via social media platforms; the survey remained open for completion for two weeks. Ustinov College has a mixed population of live-in and live-out students,

Global citizenship is an ethical framework rather than a legal construct; it recognises the limitations of traditional citizenship in a world characterized by globalisation, and instead seeks to provide a globally inclusive political and cultural environment that empowers individuals, rather than nation-states. 35

all of whom are postgraduate students, with a considerable international contingent. There were no exclusion criteria.

For the purpose of this brief evaluation, global citizenship was defined as having three primary domains, as below. These domains were chosen in consultation with academics from both the University of Western Australia and Durham University, and are designed to parallel the structure provided by the Matariki Network for delivery of global citizenship education,[3] in a way that is measurable according to involvement in specific activities:

1) Awareness: The cornerstone of global citizenship is an awareness of the challenges faced at a global level. Global citizenship, therefore, is inclusive of activities that build this awareness (for example, lectures, seminars, etc.);

2) Engagement: Practical experience addressing the aforementioned challenges, whether in the local community or further afield (for example, volunteering); and

3) Activism: Activism is variably expressed amongst individuals. For some, this may be considered synonymous with engagement, whereas others would consider activism to have specific connotations (for example, advocacy activities, blogging, etc.).

All survey questions were structured around these core themes. Involvement in each of these domains was assessed using pre-defined activities and frequencies. The survey questions can be found in the appendix below (Online Supplement 1). Students were permitted to provide free-form answers, which were subsequently assessed for relevance to the abovementioned domains. Self-reported perceptions of health were evaluated according to 3 domains: general, physical, and mental health. Scores were recorded on visual analogue scales (range 1 – 10). Further, students who regularly participated in any of the activities were asked whether such activities improved, worsened, or were unrelated to their perceptions of wellbeing. Given the limited sample size and tendency towards capture of students involved with activities of global citizenship, a descriptive analysis was performed. Results are reported as frequencies with percentages, unless otherwise stated. Consent to publish anonymised results was obtained from participants.


Sixteen postgraduate students from Ustinov College at Durham University responded to the survey. The demographics of this population are given in Table 1. Of note, from the 16 students participating in the survey, 10 different nationalities were reported; furthermore, most of these students were involved in, or aware of, the Ustinov Global Citizenship program. The sample included a relatively wide range of ages and areas of study, given the limited number of participants. Self-reported perceptions of general, physical, and mental health were largely positive. The median scores for physical and mental health were 7 (range: 6 – 10) and 7 (range: 1 – 10) (see Table 2).

Surveyed students were typically active in extracurricular academics. This survey evaluated extracurricular activities both explicitly related and unrelated to global issues, provided that the latter was external to an individual’s area of study. Eleven of the 16 students (68.8%) attended extracurricular lectures or seminars at least once per semester, with many reporting higher rates of engagement. Similarly, 12 (75%) students reported volunteering at least a few times per year, with 4 (25%) volunteering at least monthly.

As noted previously, given the limited sample size and skewed distribution towards participation in global citizenship activities, no evaluation of the differences in self-reported perceptions of health could be performed. Despite this, however, 11 of 13 eligible respondents (85%; 3 excluded due to ‘not applicable’ response) agreed that participation in activities of global citizenship improved their perception of wellbeing. The reasons given for such improvements were varied, but largely focused on the core themes of community participation and belonging, and perspective or context building from experiencing the problems of others.


The effects of global citizenship on communities and global issues can be easily quantified; however, the reciprocal effects on the individual, in particular with respect to personal capacity-building and health outcomes, are less clear. This study found that students who engage with activities of global citizenship report improved perceptions of wellbeing and identify such activities as fundamental to these improvements.

Contrary to expectations, research suggests that current involvement in tertiary-level education may be associated with lower rates of mental health diagnoses when compared to age- and sex-matched non-students.[4] Such a finding could suggest that academic involvement, at a general level, has a positive effect on mental health. Indeed, this evaluation of Ustinov College students noted that involvement in extra-curricular activities, in particular academic pursuits unrelated to the individual’s core area of study, may be associated with wellbeing. This is consistent with the concept that wellbeing is positively affected by academic involvement; however, it is unknown whether such improvements are the product of consequent social inclusion, academic involvement, or a combination thereof. Alternatively, it is possible that such a finding reflects underlying characteristics of the population, rather than the effect of academic involvement specifically. In particular, it is likely that healthier students are more able to participate in such activities, potentially confounding the relationship between global citizenship and wellbeing. Nonetheless, extra-curricular academic pursuits, particularly those in the domain of global citizenship, appear to be related to self-perceptions of health.

Of note, the proportion of individuals involved in volunteering activities of any regularity in this study was greater than that reported in national data.[19] This reflects the aforementioned reporting bias towards those involved in the Global Citizenship Program at Ustinov College and, more generally, in activities of global citizenship. While no quantitative association between volunteering and perceptions of wellbeing could be performed in this study, all respondents felt that volunteering had a positive effect on their perception of wellbeing. Indeed, such a lack of quantitative association derives not from an insufficient relationship, but instead from the overwhelming percentage of respondents involved in volunteering of any regularity (75%), making it impractical to assess the association between volunteering and health in an isolated manner. This is considerably higher than that noted in other studies,[11] but likely reflects a reporting bias towards survey completion in those with positive responses, which is true of any self-directed evaluation. Of note, the extremely limited sample size prevented statistical analysis.

This evaluation has a number of limitations. First, the concept of global citizenship is flexible and broad, and may differ by institution and individual. Indeed, such breadth makes it difficult to identify whether specific domains are responsible for the improvements in wellbeing noted, or whether such improvements are the product of activities of global citizenship as a complete framework. Unfortunately, the sample size in this study precludes evaluation of specific activities or domains. Second, this study evaluated students from only 1 university, and from a solely postgraduate population; therefore, the small sample size and relatively narrow socioeconomic context make the findings difficult to generalize. Nonetheless, it should be noted that among the 16 respondents, 10 different nationalities were registered. Finally, given practical considerations regarding the collection of specific health information, this evaluation chose to focus on self-reported wellbeing, which fails to provide any clarity regarding the mechanisms involved in participant wellbeing.

Activities of global citizenship may be related to the self-reported wellbeing of postgraduate students. Such a framework has positive implications for local and global communities, but also for the individual, and should, therefore, be considered as a more general component of tertiary education. Questions remain regarding the mechanisms underpinning these effects, the magnitude of these effects, and the degree to which such findings can be generalized to other populations, in particular undergraduate students and those not currently engaged with such activities of global citizenship. Further research should seek to assess direct health outcomes, rather than self-reported perceptions of health in a larger population, permitting quantitative analysis of the effects of activities of global citizenship.




This piece was written and researched in with Ustinov College at Durham University and the McCusker Centre for Citizenship at the University of Western Australia. The author would like to thank the individuals in particular who participated in, and enabled, the evaluation.

Conflicts of interest

The author is currently involved in the review of manuscripts for Vector Journal. No other conflicts of interest are reported relevant to the study content.



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19. Department for Digital, Culture, Media, & Sport. Community Life Survey 2016-2017, Statistics. London: UK; 2017


Online Supplement 1- Link to Survey Questions: https://

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