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Health Literacy: Two Reports, Time for Action

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. Health literacy is…. …the ability to access, understand and act on information for health.

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Health Literacy: Two Reports, Time for Action

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  1. 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

  2. Health literacy is… …the ability to access, understand and act on information for health

  3. 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

  4. 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.

  5. Public health focuses on… • the health of the community • social contexts • health promotion and prevention

  6. Health promotion… • strengthens people’s skills and capabilities • enables individuals to control the determinants of health

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

  8. 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)

  9. Health Literacy in Canada: A Healthy Understanding

  10. CCL released, for the first time in public domain, health literacy scores and levels by age, education level and health status. 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. January 2007 CCL releases a new report providing further analysis of the impact of health literacy in Canada. September 2007 February 20, 2008 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

  11. 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

  12. 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

  13. Skills-age profiles Relationship between age and proseliteracy scores by health status (self-reported) Scale scores Level 325 300 3 275 250 2 225 1 200 175 10 20 30 40 50 60 70 Age Excellent and Good Health Fair Health Poor Health Source: Adult Literacy and Life Skills Survey, 2003.

  14. 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

  15. 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)

  16. The measurement definition of health literacy (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

  17. 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.

  18. Health literacy…a 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 individual’s ability to master the full range of health-literacy tasks. Proportion of population with low literacy levels, by literacy type, ages 16 and older

  19. 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

  20. Health literacy…impacts 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 Canada’s health regions is worth noting. Of the factors analyzed, diabetes was the most significant.

  21. Health Literacy…varies significantly Distribution of health-literacy scores Percentage at Level 2 and below

  22. 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

  23. 26-35 Yrs 16-25 Yrs Employed 36-45 Yrs Not Immigrant Official Language 46-55 Yrs Male Female Canada French Minority Language Total Aboriginal 56-65 Yrs (Off reserve) Not Employed Non Official Immigrant Language Over 65 Yrs Health literacy…affects 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

  24. Health literacy…varies within key groups 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.

  25. Health Literacy….influenced greatly by literacy practices at home Factors predicting health literacy ages 66 and over ages 16 to 65

  26. 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.

  27. 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.

  28. 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)

  29. 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

  30. Expert Panel on Health literacy • Suggested that health literacy be integrated into primary and secondary school and adult education curricula

  31. 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

  32. National Symposium on Health Literacy • January 2008 • Canadian Public Health Association • National Collaborating Centre on Determinants of Health

  33. 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

  34. 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

  35. 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

  36. 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

  37. 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

  38. 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

  39. Report of the Expert Panel on Health Literacyavailable at:www.cpha.ca

  40. Report & Interactive Maps Available at:www.ccl-cca.ca

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