What do we know about health literacy? Although there is little research into levels of health literacy skills in the UK, a recent study (unpublished) carried out by London South Bank University, identified that 43% of adults in England aged between 18 and 64 routinely do not understand health information. This figure rises to 61% when an element of numeracy is involved. We also know, from a WHO report (Kickbusch, I. 2013) that limited health literacy is prevalent.
Like general literacy, health literacy can be measured at the individual, organisational, community and population levels. The European Health Literacy Survey (2012) revealed that 12% of all respondents have inadequate general health literacy and 35% have problematic health literacy. Limited health literacy in Europe is thus not just a problem of a minority of the population. The WHO report also noted that specific vulnerable groups have much higher proportions of limited health literacy than the general population in Europe. These groups include people of lower social status (low self-assessed social status, low level of education, low income and people with problems in paying bills), people of worse health status (measured by self-perceived health, long-term illness and limitations in activities because of health problems) or people of relative old age.
Why does it matter? From a health perspective it matters significantly. In a recent WHO report (2013:7), Kickbusch et al note that 'limited health literacy is associated with less participation in health-promoting and disease detection activities, riskier health choices (such as higher smoking rates), more work accidents, diminished management of chronic diseases (such as diabetes, HIV infection and asthma), poor adherence to medication, increased hospitalisation and rehospitalisation, increased morbidity (illness) and premature death.' Examples of the above have been provided by Williams et al (1998), who report that asthma sufferers with low health literacy were more likely on the one hand to have poorer knowledge of the correct use of inhalers and on the other hand make more use of emergency services. Garbers and Chiasson (2004), report that women with low levels of health literacy were less likely to have undergone cervical screening.
Health literacy is also important because it has a major impact on health inequalities, the term used in a number of countries to refer to those instances whereby the health of two demographic groups (not necessarily ethnic or racial groups) differs despite comparable access to health care services. Examples include higher rates of illness and premature mortality for those in lower occupational socio-economic groups. These differences were highlighted in the 2010 University College London Fair Society, Healthy Lives report (Marmot, 2010) on the relationship between health and poverty. They showed that the life expectancy of the poorest is seven years shorter than for the wealthiest, and that the poor are more likely to have a disability. It is also acknowledged that those people with the lowest levels of health literacy also experience significant health inequalities.
How can literacy practitioners improve health literacy? Every time literacy tutors use the theme of health in a literacy class, they are increasing the health skills and knowledge of their learners. This in turn means those learners may make informed decisions about a whole range of choices regarding their health, such as deciding to increase physical activity, to drink more fluids, to eat more fruit, to drink less alcohol or to contemplate quitting smoking. However, it is likely that many literacy practitioners would never describe their work in these terms; rather they see it as part of their primary remit - improving literacy. On one level, of course, that doesn't particularly matter, after all, unintended beneficial consequences are a by-product of many activities, not just those of literacy practitioners.
There is a growing body of practitioners, in health as well as in learning, who think that literacy practitioners might be missing out on an opportunity to expose the full value of what they do. This is because it is becoming
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