Health Literacy: Two Reports, Time for Action

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Health LiteracyTwo Reports, Time for Action

• April 23, 2008
• Presentation to School Health 2008
• Debra Lynkowski, Canadian Public Health
  Association
• Nadine Valk, Canadian Council on Learning

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Health literacy is

• the ability to access, understand and act on
  information for health

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CPHA is

• a national, not-for-profit, voluntary association
  
• committed to universal and equitable access to
  the basic conditions necessary for the health of
  all Canadians

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Health is

• "a state of complete physical, mental and social
  well-being and not merely the absence of disease
  or infirmity.--World Health Organization
• determined by complex interactions between
  individual characteristics, social and economic
  factors and physical environments.

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Public health focuses on

• the health of the community
• social contexts
• health promotion and prevention

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Health promotion

• strengthens peoples skills and capabilities
• enables individuals to control the determinants
  of health

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Determinants of health..

• income
• social status
• social supports
• working conditions
• social environments
• education
• physical environment
• personal health practices
• genetics
• gender
• culture
• literacy

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Health and literacy

• National Literacy and Health Program (1994)
• Plain Language Service (1997)
• First Canadian Conference on Literacy and Health
  (2001)
• Second Canadian Conference on Literacy and Health
  (2004)
• Chronic Disease Prevention and Management (2007)
• Expert Panel on Health Literacy (2008)

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Health Literacy in Canada A Healthy Understanding

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Measuring Literacy

• 1980s and 1990s new way to measure adult skills
  and across different population
• 1994 International Adult Literacy survey (IALS)
  prose, document, numeracy
• 2003 Adult Literacy and Life Skills Surveys
  (ALLS) addition of problem solving, refinements
  to health-related items and self-reported health
  status

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Measuring Literacy

• The International Adult Literacy Survey (IALS)
• The U.S. National Adult Literacy Survey (NALS)
• The Adult Literacy and Life Skills Survey (ALLS)
• Large-scale direct assessments of adult skills
  administered to representative samples of adults
• Internationally comparable data available for 25
  countries, 1990-1998, and in 6 countries in 2003
• Survey based on theoretical understanding of the
  determinants of the relative difficulty of adult
  literacy and numeracy tasks

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Measuring Health Literacy

• Using 350 unique items in NALS/IALS/ALLS
• 191 items judged to measure health-related
  activities
• Health-related items assigned to health literacy
  sub-domains

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Measuring Health Literacy

• 66 tasks represent activities directly related to
  health care settings.
• 125 tasks represent activities likely to occur
  outside formal health care settings
• new 500-point health activities literacy scale
  (HALS)

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(adopted for the NALS, IALS and ALLS analysis)
The degree to which individuals have the
capacity to obtain, process and understand basic
health information and services needed to make
appropriate health decisions
The measurement definition of health literacy
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Limitations of the Health Literacy Scale

• The ALLS-based health literacy scale excludes
  several dimensions of health literacy that theory
  suggests are important, such as
• measures of oral fluency,
• reading component skills,
• problem solving, and
• scientific literacy.

While not perfect, HL measures can provide new
insights that carry implications for both policy
and further research. We now have a measurement
tool that can further identify the link between
health literacy and social and economic
determinants and outcomes.
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Health literacya composite of all basic
literacies
There are more adults with low levels of health
literacy (60) than with low levels of prose
literacy (48), suggesting that health literacy
and prose literacy are different. To master
health-literacy tasks, adults are required to
use prose literacy, document literacy and
numeracy skills simultaneously. A weakness in
any of the three skills will limit an
individuals ability to master the full range of
health-literacy tasks.
Proportion of population with low literacy
levels, by literacy type, ages 16 and older
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Health literacy . matters
After controlling for the effect of age, gender,
education, mother tongue, immigrant and
Aboriginal status, individuals with low levels of
literacy are still more likely to have fair or
poor health, rely on income support or not engage
in the community. .
Comparison of social and health outcomes, by
health-literacy level
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Health literacyimpacts population health
Prevalence of diabetes, average health-literacy
scores by health regions
The analysis of the relationship between health
literacy and health risks such as arthritis,
diabetes, heavy drinking, high blood pressure,
injuries, stress and asthma for each of Canadas
health regions is worth noting. Of the factors
analyzed, diabetes was the most significant.
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Distribution of health-literacy scores
Health Literacyvaries significantly
Percentage at Level 2 and below
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Local HL maps can identify communities where
programs or policies could be targeted
The analysis and mapping of the health-literacy
results were conducted by J. Douglas Williams,
Canada Research Chair in Human Development at the
University of New Brunswick (UNB), with the
assistance of Teresa Tang, GIS Programmer at the
Canadian Research Institute for Social Policy at
UNB
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Health literacyaffects some groups more than
others
Health Literacy Mean Scores for key groups
290
Level 3
265
Scores with 95 Confidence Intervals
Level 2
240
215
Level 1
190
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Population Size
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Comparative distributions for key groups
Health literacyvaries within key groups
While the mean health-literacy score for certain
groups, such as seniors, is well below Level 3,
there are significant percentages of the
population in these groups who are above Level 3.
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Factors predicting health literacy
Health Literacy.influenced greatly by literacy
practices at home
ages 66 and over
ages 16 to 65
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How can we improve Canadas health literacy
situation?

• Individuals
• Read every day to help keep your brain healthy
  and active, and to maintain your literacy skills.
  
• Ask questions about your health and health care
  clarify information and instructions.
• Seek out reputable sources of health
  informationuse the library and verify
  information with a health-care professional.

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What will CCL do next?

• CCL plans to undertake further work in the field
  of health literacy
• Enhance Canadas understanding of health literacy
  by commissioning research, disseminating new
  reports, and making information available on the
  CCL website.
• Work with stakeholders to develop better
  indicators and establish clear benchmarks and
  objectives for health literacy in Canada.
• Partner with other groups and stakeholders to
  develop tools and resources that will address
  Canadians health-literacy needs.

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Expert Panel on Health Literacy

• Barriers to school health literacy include
• Different philosophies about health and education
• Limited budgets
• No structured health and physical education
  curriculum
• Few professional development opportunities for
  teachers
• Lack of health and physical education specialists
• Lack of support for public health engagement with
  schools
• (Source Canadian Association for Health,
  Physical Education, Recreation and Dance)

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Expert Panel on Health Literacy

• Comprehensive school health, including a range of
  activities and services in schools and
  communities
• Introduce health information in ESL/FSL programs

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Expert Panel on Health literacy

• Suggested that health literacy be integrated into
  primary and secondary school and adult education
  curricula

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Expert Panel on Health Literacy

• A comprehensive, coordinated, cooperative and
  integrated pan-Canadian strategy on health
  literacy to improve levels and provide support
  for people trying to cope with demands

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National Symposium on Health Literacy

• January 2008
• Canadian Public Health Association
• National Collaborating Centre on Determinants of
  Health

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Principles for a national health literacy
strategy

• literacy begins early in childhood and is
  strengthened over time
• health literacy is an issue of social equality
• solutions are embedded in existing structures
• diverse needs and cultures are recognized and
  respected
• adult literacy learners are engaged in the
  development of solutions

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Priorities for action

• make health and education sensitive and
  responsive to language, culture and literacy
• establish literacy as a national priority
• better use of health services
• support practitioners and professionals as agents
  of change
• integrated, comprehensive Aboriginal strategy
• determine research and evaluation priorities

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CPHAs next steps

• raising awareness of Expert Panel report
• mobilizing policy-makers, practitioners, and
  researchers
• developing tools to facilitate health sector
  communication
• social determinants of health focus at CPHA
  national conference, June 1 4 in Halifax

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Time for Action

• Senate Sub-Committee on Population Health
  (February 2007)
• To examine and report on the impact of
  determinants of health in Canada
• To identify federal strategies to reduce health
  inequities
• Public consultations underway
• Final report, Dec. 2008

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Time for Action

• WHO Commission on Social Determinants of Health
• to address social factors leading to ill health
• nine Knowledge Networks have completed interim
  reports on
• early child development
• globalization
• health systems
• measurement and evidence
• urban settings
• employment conditions
• social exclusion
• priority public health conditions
• women and gender equity
• final report, fall 2008

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Time for Action

• Building on momentum
• Health literacy research and initiatives
• Promising family literacy programs
• e.g, Parenting and Family Literacy Centres
  (Ontario)
• Senate and WHO recommendations
• Role of literacy in health equity

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Report of the Expert Panel on Health
Literacyavailable atwww.cpha.ca
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Report Interactive Maps Available
atwww.ccl-cca.ca