Health Literacy: Two Reports, Time for Action April 23, 2008 Presentation to School Health 2008 Debra Lynkowski, Canadian Public Health Association Nadine Valk, Canadian Council on Learning
Dec 26, 2015
Health Literacy:Two Reports,
Time for Action
April 23, 2008Presentation to School Health 2008
Debra Lynkowski, Canadian Public Health AssociationNadine Valk, Canadian Council on Learning
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
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.
Public health focuses on…
• the health of the community
• social contexts
• health promotion and prevention
Health promotion…
• strengthens people’s skills and capabilities
• enables individuals to control the determinants of health
Determinants of health..
• income• social status• social supports• working conditions• social environments• education• physical environment• personal health practices• genetics• gender• culture• literacy
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)
11
January 2007
CCL released, for the first time in public domain, health literacy scores and levels by age, education level and health status.
September 2007
CCL released a special feature report providing background information on the evolution of health literacy research, measurements, Canada-US comparisons, some preliminary findings. Introduction of community health literacy maps.
February 20, 2008
CCL releases a new report providing further analysis of the impact of health literacy in Canada.
Sponsored by Health and Learning Knowledge Centre and based on evidence supported by CCL reports, the panel developed a vision for a Health Literate Canada and a set of recommendations on strategies to improve health literacy in Canada. To be released by CPHA on March 3, 2008
CPHA Expert Panel
on Health Literacy
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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
14
Skills-age profiles
Source: Adult Literacy and Life Skills Survey, 2003.
Relationship between age and prose literacy scores by health status (self-reported)
175
200
225
250
275
300
325
10 20 30 40 50 60 70
Age
Scale scores
Excellent and Good Health Fair Health Poor Health
1
3
2
Level
15
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
Health Activities Number of Items (n=191)
Health Promotion 60Health Protection 65Disease Prevention 18
Health Care and Disease Management 16
Navigation 32
16
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)
17
Health Activities FocusExamples of Materials Examples of Tasks
Articles in newspapers and magazines, booklets, brochures
Purchase food
Charts, graphs, lists
Plan exercise regimen
Food and product labels
Articles in newspapers and magazines
Decide among product options
Postings for health and safety warnings
Use products
Air and water quality reports
Vote
Referendums
News alerts [TV, radio, papers]
Determine risk
Postings for inoculations & screening
Engage in screening or diagnostic tests
Letters re: test results
Follow up
Graphs, charts
Disease Prevention Take preventive measures & engage in early detection
Health Promotion Enhance & maintain health
Health Protection Safeguard health of individuals & communities
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Health history forms Describe & measure symptoms
Medicine labels Follow directions on medicine labels
Discharge instructions
Calculate timing for medicine
Education booklets & brochures, health information on the Internet
Collect information on merits of various treatment regimes for discussion with health professionals
Access needed services
Maps Locate facilities
Application forms Apply for benefits
Understand rights Statements of rights and responsibilities, Informed consent
Offer informed consent
Health benefit packages
Health Care & Maintenance
Seek care & form a partnership with health providers
Systems Navigation
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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.
21
Proportion of population with low literacy levels,
by literacy type, ages 16 and older
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 individual’s ability to master the full range of health-literacy tasks.
Health literacy…a composite of all basic literacies
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Comparison of social and health outcomes,
by health-literacy level
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.
.
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Prevalence of diabetes,
average health-literacy scores by health regions The analysis of the relationshipbetween health literacy and health risks such as arthritis, diabetes, heavy drinking, high blood pressure, injuries, stress and asthma for each of Canada’s health regions is worth noting.
Of the factors analyzed, diabetes was the most significant.
Health literacy…impacts population health
24
Distribution of health-literacy scores
Health Literacy…varies significantly
Percentage at Level 2 and below
25The 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
Local HL maps can identify communities where programs or policies could be
targeted
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Health Literacy Mean Scores for key groups
Over 65 Yrs
56-65 Yrs
26-35 Yrs
36-45 Yrs46-55 Yrs
16-25 Yrs
Male Female
Immigrant
Not Immigrant
Non Official Language
Official Language
Not Employed
Employed
Aboriginal (Off reserve)
French Minority LanguageCanada Total
190
215
240
265
290
0 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000
Sco
res
wit
h 9
5% C
on
fid
ence
Inte
rval
s
Population Size
Level 1Level 2
Level 3
Health literacy…affects some groups more than others
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Comparative distributions for 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.
Health literacy…varies within key groups
28
Factors predicting health literacyages 16 to 65 ages 66 and
over
Health Literacy….influenced greatly by literacy practices at home
29
How can we improve Canada’s 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 information—use 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 Canada’s 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.
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)
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
Expert Panel on Health literacy
Suggested that health literacy be integrated into primary and secondary school and adult education curricula
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
National Symposium on Health Literacy • January 2008
• Canadian Public Health Association
• National Collaborating Centre on Determinants of Health
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
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
CPHA’s 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
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
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
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