Can health literacy help us address health inequities, or is that asking too much of the overworked concept?
Health literacy is increasingly seen as a way to reduce health inequities. But are we relying too heavily on a concept that is becoming too broad to wield? Dr Jane Lloyd discusses if and how we can improve health literacy to address disadvantage.
At its core, health literacy refers to the skills that enable individuals to obtain, understand, appraise, and use information to make decisions and take actions that will have an impact on their health. Health literacy places an emphasis on the skills of individuals. These skills can be applied in a medical environment during a medical appointment or in the social environment when making decisions about one’s health and wellbeing.
Over the last two decades, there has been growing academic, policy and practitioner attention on health literacy as a mechanism for improving health outcomes, leading to:
an increasing evidence base which includes tools for measuring health literacy, frameworks for improving individual, organisation and system health literacy
the development of health literacy policies, including a national statement on health literacy in Australia
the inclusion of health literacy in the National Safety and Quality Health Services Standards
the development of a health literacy workforce in primary health care and in local health districts.
While this growth has been promising, it is wide-ranging. Health literacy is at risk of becoming a catch all phase. There are multiple definitions of health literacy and health literacy has been seen as a mechanism for helping to address a range of complex problems including patient engagement, patient safety, quality of care, integrated care, access to health care, self-management and shared decision making. But while the broad application of health literacy to laudable concepts such patient centre care is a strength, it is also a limitation. It can be seen as everything to all people.
So it is with some trepidation that I discuss how addressing health literacy can reduce health inequities. These concepts are different, but they are interrelated. Low health literacy disproportionately impacts marginalised groups, including those from low socioeconomic areas and culturally and linguistically diverse populations. In other words, people who are disadvantaged by the conditions in which they live and work are more likely to have low health literacy. If we were to address the health literacy barriers, these populations would still suffer from the health inequities generated from the conditions in which they live and work.
Addressing health literacy is within the remit of the health sector. Improving the health literacy of the health care system may be more malleable than addressing other determinants of health such as housing and poverty, which are the responsibility of all, but the remit of other sectors. Yet health systems and services are often designed in a way that assumes a high level of health literacy among the population. The inadvertent, high health literacy requirement of health services and systems systematically and unfairly disadvantages those with low health literacy from accessing health care.
The delivery of effective health literacy interventions may provide a tangible way for the health care system to address one of the determinants of health inequity. To attend to our health equity commitment, future health literacy interventions should focus on improving health communication to reach a diversity of populations, especially by improving frontline professional skills and resourcing; supporting citizens to develop transferable skills in accessing, understanding, analysing, and applying health information; and ensuring that priorities are arranged that are proportionate to need by engaging population groups who are disproportionately affected by health literacy. These interventions need to be evaluated to determine if they are having the desired social impact. There is also a need for future health literacy interventions to focus on the design and organisation of health services and systems. Health services need to be designed to assume that patients will have limited health literacy and in ways that will meet the needs of the diverse population that it services. Evaluations need to be informed by routine feedback from diverse populations on their experiences of accessing health services, communicating with providers and managing their conditions.
The delivery of effective health literacy interventions will improve access to health care, communication between patients and providers, and support self-management for patients who are disadvantaged. This is a promising investment, but not a panacea to address the broader determinants of health inequities.
Bio: Dr Jane Lloyd is a Research Fellow at the Centre for Social Impact and Adjunct Associate Professor at UNSW Centre for Primary Health Care & Equity. Her research explores the theory and practice of improving health and social justice among marginalised populations. You can follow her on Twitter: @JaneLloyd17
Moderator: Dr Rhiannon Parker