Canadian Health Network

Send this to a friend Print-friendly version Medication matters: how you can help seniors use medication safely Past Articles Subscribe to our Healthlink newsletter

ave you ever left your doctor's office confused by the advice you were just given?

At some time or other, most of us have felt limited in our knowledge and understanding of information related to our health.

Health literacy is a new concept that links our level of literacy with our ability to act upon health information and, ultimately, take control of our health. It builds upon the idea that both health and literacy are critical resources for everyday living.

Addressing health literacy means breaking down the barriers to health that low literacy creates and finding ways to enable all people to:

• Access the services and supports they need
• Understand and use information to promote their health and prevent disease
• Make informed health decisions about self-care and treatment of illness
• Advocate for their own health, as well as that of their family and community
• Gain greater control over their health and well-being.

			Literacy challenges are everyday health challenges
			People with limited literacy skills face difficulties in their daily lives, such as: Following instructions for a diabetic diet Giving the correct amount of medication to a feverish child Determining the amount of sodium or fat from the label of a packaged food Preparing infant formula safely and in the proper strength Safely operating a kitchen appliance Completing a medical form Finding a dentist or other health care provider Understanding an informed consent form for medical treatment Asking for and getting a referral to a specialist

You may be surprised to learn that many Canadians lack the basic literacy skills required to deal with the increasingly complex demands of everyday living.

• Almost 50% of Canadian adults can't work well with words and numbers.
• 22% of Canadians have serious difficulties with any type of printed material.
• Another 26% have problems with all but the simplest tasks requiring reading and writing.

Moreover, fewer than 10% of Canadians with low literacy skills have ever enrolled in an upgrading program and of those who do, dropout rates are high.

When it comes to health, limited literacy can cause practical health challenges in everyday life.

Literacy is more than the ability to read or write. Some definitions of literacy focus on the basic reading and writing skills that enable people to function in everyday situations - i.e. the ability to read and follow a recipe or the instructions for an appliance.

To participate effectively in daily life, however, people also require communication skills. In this context, literacy involves the combination of thinking skills and social skills. The term critical literacy has been used to describe the more advanced set of cognitive skills, which, together with social skills, are needed to critically analyze and use information to exert greater control over life events and situations.

Health means more than simply not being sick. Health is a state of physical, mental and social well-being. If individuals are to reach such a state of well-being, they must be able to identify and realize their goals, satisfy their needs, and change or cope effectively within their environment.

This view of health as a resource for everyday life, rather than the objective of living, was put forth in the Ottawa Charter for Health Promotion (1986). The Ottawa Charter recognized health promotion as the process of enabling people to increase control over, and to improve their health. Many factors determine our health.

Not only is literacy a major determinant of health; it is also closely associated with other socio-economic conditions that influence health, such as income, social status, employment opportunities, social support, early childhood development, culture and gender.

Canadians who have low literacy are more likely to have poorer health, higher rates of chronic disease, and an earlier death than those with a higher level of literacy.

Regional trends in tracking health outcomes support this finding. Atlantic Canada has a higher percentage of adults with limited literacy skills than in the rest of Canada. Atlantic Canadians also have higher rates of chronic disease.

Literacy influences health both directly and indirectly. Most obvious are the direct effects. Less obvious, but even more profound are the indirect effects of reduced literacy on health.

Most people are highly skilled in compensating for their lack of literacy. They are likely to hide the fact that they are having difficulty finding and understanding information or advice. It's not always easy to know if someone has limited literacy skills.

			Low literacy may be a health barrier if someone...
			Frequently returns for health-related services Routinely misses scheduled appointments Arrives for appointments without completed forms Never refers to written information they have received Avoids filling out forms and questionnaires Relies on others to read material for them Brings family members to appointments as a surrogate reader Claims to have vision or other problems to avoid reading Asks a lot of questions … or does not ask any questions at all Ignores or misunderstands advice/instructions (e.g. medications) Reads slowly with obvious effort Reads something faster than expected with no comprehension Never jots down instructions Exhibits facial signs of frustration or anxiety while reading Attempts to read material upside down Has problems understanding how to access appropriate services

Some factors associated with limited literacy include:

• Having difficulties speaking English
• Speaking English as a second language
• Being an older adult (many seniors did not have the advantage of completing their education)
• Not completing high school
• Living in conditions of poverty and lacking adequate resources such as income and social support

Some behaviours can serve as signs to service providers that they should be especially sensitive to the literacy level of their clients when communicating health-related advice. (See sidebar on signs that low literacy may be a health barrier)

So if you have ever felt confused after a health-related appointment, know that you are not alone. We all encounter situations where we must depend on our health literacy skills to find, understand and act upon health information and advice.

Health literacy is an opportunity for practitioners from the fields of health and literacy to work together to address the health concerns of people limited in literacy, and the literacy concerns of people experiencing poor health. Health and literacy practitioners are recognizing that much can be done to reduce the barriers that limited literacy imposes on one's health and well-being.

A conference held October 17-19, 2004 demonstrates action on health and literacy. Sponsored by the Canadian Public Health Association, the Second Canadian Conference on Literacy and Health was a national forum to discuss what is being done to improve the health of Canadians with low literacy skills.

Improving practices, programs and policies requires building new partnerships and strengthening existing ones between the health and literacy sectors and between policy makers and practitioners. Working together to address health literacy can promote both literacy and health as resources for everyday living for all Canadians.

Movement for Canadian Literacy

ABC Canada

Ottawa Charter for Health Promotion (1986)

How does literacy affect the health of Canadians? Health Canada.

The National Literacy and Health Program. Canadian Public Health Association.

Health Literacy in Rural Nova Scotia Research Project.