Making health easier: Reducing inequalities in child health through addressing low health literacy

Abstract

Keeping their children healthy and safe is one of the most important responsibilities parents and caregivers have. It requires knowledge and skills that are acquired in a number of ways: from families and friends, through cultural heritage, at school, from health professionals, through reading, and through audio-visual media, such as television, radio and the internet. The knowledge and skills people need to meet the complex demands of health and healthcare systems in a modern society have been conceptualised as health literacy.1 Being health literate means having the knowledge, skills, motivation and confidence to accurately assess the health of yourself, your family and your community, to understand the factors that influence health at each of these levels, to take responsibility for health, and to act appropriately.1 It means being able to make well-informed decisions on personal health matters like nutrition, choice of healthcare providers, preventive interventions such as immunisation and screening, and treatment options for health problems.1 It also means being able to form informed opinions on public health issues, such as air pollution, the safety of the water supply, workplace health and safety, the quality of food offered in school canteens, the location of liquor outlets, and the social and economic determinants of health, and being able to use political processes to affect government policy relating to such matters.1-3 When faced with a personal health problem, a health literate person can recognise symptoms that warrant medical attention, seek and obtain help from the health system, make an informed choice if they are offered treatment options, and understand and follow the advice and treatment plan they are given. They can, for example, use the information on the label to determine the correct dose of liquid medicine to give their child4, or understand informed consent documents.5 They can carry out health-related tasks requiring numeracy skills, such as understanding food labels6, measuring blood sugar7, and comparing the risks of different treatment options8. They can make a phone call to make an appointment with a healthcare provider, arrange time off work to attend the appointment, get themselves to the health service, and interact confidently with health professionals by answering questions, providing a history, and asking questions about things they do not understand.9 According to the World Health Organisation, health literacy is one of the three key elements of health promotion, together with healthy cities and good governance.10 As will be explained further, many people have poor health literacy and this is a major contributor to poor health outcomes and to health inequities between different population groups. In their 2015 discussion paper Health literacy: A necessary element for achieving health equity11, Logan et al. made the following three key points about health literacy and health disparities: Health literacy is intrinsically linked to both an individual’s and a community’s socioeconomic context, and is a powerful mediator of the social determinants of health Health literacy interventions are viable options among other evidence-based strategies to address social adversity and environmental health determinants and should be considered when assessing meaningful actions to address health disparities Health literacy interventions and practices contribute to reducing health disparities, which fosters health equity and social justice. This article discusses the research on health literacy and its relation to health outcomes, the research on interventions to improve health outcomes for people with low health literacy, and how the health system can reduce the health literacy demands it places on patients and better serve patients with low health literacy.