Slide 1

Report
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
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..
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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)
Health Literacy in Canada: A Healthy Understanding
CCL released, for the first time in public domain, health literacy scores
and levels by age, education level and health status.
January 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.
September 2007
CCL releases a new report providing further analysis of the impact of
health literacy in Canada.
February 20, 2008
CPHA
Expert Panel
on Health
Literacy
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
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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 healthrelated 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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Skills-age profiles
Relationship between age and prose literacy 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
Source:
Fair Health
Poor Health
Adult Literacy and Life Skills Survey, 2003.
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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 subdomains
Health Activities
Health Promotion
Health Protection
Disease Prevention
Number of Items (n=191)
60
65
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Health Care and Disease Management
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Navigation
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Measuring Health Literacy
• 66 tasks represent activities directly related to health
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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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Health Activities
Health Promotion
Focus
Enhance &
maintain health
Examples of
Materials
Articles in
newspapers and
magazines,
booklets,
brochures
Charts, graphs,
lists
Examples of Tasks
Purchase food
Plan exercise
regimen
Food and product
labels
Health Protection
Safeguard
health of
individuals &
communities
Articles in
newspapers and
magazines
Decide among
product options
Postings for
Use products
health and safety
warnings
Air and water
Vote
quality reports
Referendums
Disease Prevention
Take preventive
measures &
engage in early
detection
News alerts [TV,
radio, papers]
Determine risk
Postings for
inoculations &
screening
Engage in
screening or
diagnostic tests
Letters re: test
results
Graphs, charts
Follow up
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Health Care &
Maintenance
Seek care & form a
partnership with
health providers
Health history forms
Medicine labels
Discharge
instructions
Systems Navigation
Access needed
services
Calculate timing for
medicine
Education booklets & Collect information on
brochures, health
merits of various
information on the
treatment regimes for
Internet
discussion with health
professionals
Maps
Locate facilities
Application forms
Understand rights
Describe & measure
symptoms
Follow directions on
medicine labels
Apply for benefits
Statements of rights Offer informed consent
and responsibilities,
Informed consent
Health benefit
packages
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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
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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:
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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 literacy…a composite of all basic literacies
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 healthliteracy tasks.
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Health literacy …. matters
Comparison of social and health outcomes,
by health-literacy level
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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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.
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Health Literacy…varies significantly
Distribution of health-literacy scores
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 literacy…affects some groups more than others
Level 3
Health Literacy Mean Scores for key groups
26-35 Yrs
16-25 Yrs
265
46-55 Yrs
Employed
Not Immigrant
36-45 Yrs
Male
Official Language
Female
Canada
Total
French Minority Language
Aboriginal
(Off reserve)
240
56-65 Yrs
Non Official
Language
Not Employed
Level 2
Immigrant
215
Level 1
Scores with 95% Confidence Intervals
290
Over 65 Yrs
190
0
5,000,000
10,000,000
15,000,000
Population Size
20,000,000
25,000,000
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Health literacy…varies within key groups
Comparative distributions for key groups
While the mean healthliteracy 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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Health Literacy….influenced greatly by literacy practices at home
Factors predicting health literacy
ages 16 to 65
ages 66 and over
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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.
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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)
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
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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
Report of the Expert Panel on
Health Literacy
available at:
www.cpha.ca
Report & Interactive Maps
Available at:
www.ccl-cca.ca
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