By Jill Roberts, author of 'Improving Health Literacy to Reduce Health Inequalities'.
Following years of assessing evidence, there’s general agreement that the biggest contributor to health is the wider determinants of health - so, where and how we live, and the social and economic conditions around us, starting from the womb. Inequalities in these social determinants give rise to unfair differences in health, so to have the greatest impact on health inequalities we need to address these social determinants.
How we find, understand and use information about all aspects of health – healthcare, health behaviours, genetics, and crucially, the social determinants of health - underpins our ability to both prevent and treat ill health. This is often referred to as ‘health literacy’. Health literacy is therefore one of the pathways to good health, but it is influenced by the social determinants of health.
This week IHE have published a paper, commissioned by PHE, which sets out why we all need to have the appropriate skills, knowledge, understanding and confidence to be able to find, understand and use health information – be that making GP appointments online, to understanding dosage instructions on medicines, leading a healthy lifestyle or even lobbying for safer, greener environments.
But ‘health literate individuals’ alone are not enough: we also need ‘health literate organisations’. This means that employers and all services with the potential to influence people’s health – such as GP services, hospitals, children’s centres and local councils, to housing and adult education services - need to provide clear, accessible information for all, and make a particular effort to reach, engage and serve those people and population groups with the worst health. They also need to advocate for healthy social, economic and environmental conditions.
A well-educated person can have limited health literacy when required to understand and use unfamiliar language and concepts in unfamiliar healthcare settings, and when navigating health information online, especially when illness makes them more vulnerable. Research has found that in England, 42% of working-age adults are unable to understand and make use of health information, rising to 61% when numeracy skills are also required for comprehension. Basic literacy and numeracy skills are therefore essential necessities for adequate health literacy, but they are not sufficient.
It is, however, the people and population groups with limited financial and social resources – those people with no work or unstable work, no or low income, poor quality housing, limited social support networks, for instance - who are more likely to have limited health literacy, and, at the same time, who are less likely to be adequately served by those services that influence health. These vulnerable groups, including more disadvantaged socio-economic groups, migrants and people from some ethnic minorities, older people, people with long-term health conditions and disabled people, are, in turn, more likely to have a poor diet, to smoke and not exercise, and to have an increased risk of morbidity and premature death.
Improving health literacy can have a range of benefits, including building resilience, encouraging positive lifestyle changes and empowering people to effectively manage long-term health conditions; all of which can help to reduce the burden on over-stretched health and social care services, improve everyone’s general health and wellbeing, and reduce unfair differences in health.
We’ve therefore set out simple, effective and cost-effective examples of health literacy strategies that are known to improve health outcomes. These include: the ‘teach-back’ method, which involves professionals asking service-users to repeat the information they have just received to check for understanding; local areas adopting an early-intervention approach to health literacy promotion, and; community-based, peer-support approaches to help distribute health literacy among social networks.
Even small changes to the way we communicate health information can make a big difference.
Whether you’re a professional who works to improve the conditions in which people are born, grow, live, work and age (across all tiers of an organisation), or a community-member, we all have a role to play in making sure that the information people need for a healthy life touches, and is understood and used by everyone, but especially those who have the most to gain.