The following post was written by Kelsey Franklin, our Summer Student working in the Communications Department as a Fundraising Assistant.
I went to El Salvador a couple years ago without knowing a word of Spanish. I was terrified that the language barrier would hinder my trip, so I quickly made friends with the locals. However, I soon realized that language was the least pressing border I would face. It was the unfamiliar culture, jargon and norms that were the most difficult to grasp. Though I had an amazing experience, I can only imagine what my trip would have been without my El Salvadorian friends. From translating the menu, to attempting to explain the various cultural events we attended, I realized literacy extends much further than language. Though these were all fun events, I can only imagine a more serious outcome of if I had needed to use a healthcare service. A simple Spanish to English translation would not have sufficed. Unfortunately, many newcomers to Canada find themselves in this situation. With only interpreters to help bridge the gap between two very different cultures, important health information slips through the cracks.
Health literacy is defined by the World Health Organization (WHO) as, “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health[i].” It expands by acknowledging the importance of improving people’s access to health information and fostering their capacity to use said information effectively. Health literacy is an important part of individual empowerment. Health promotion is a term often incorrectly used interchangeably with health literacy. Health promotion is an umbrella term that includes health literacy; it is broad and a call to action for improving resources that aid people in living a healthy life. Health literacy is one of the most valuable resources anyone can have.
Health literacy is important on many levels. At the societal level, there is a direct correlation between low health literacy levels and poor health outcomes in a country. Being able to process and follow health instructions is extremely important to one’s health and can be the difference between life and death. In the 1990s, India had an average of 148,000 maternal deaths/year attributed to poor health literacy. Today, with a better health education system in place, maternal deaths in India are down to 50,000 deaths/year[ii]. On an individual level, health literacy plays a role in disease and general illness self-management. For example, some antibiotic medications have strict instructions to take the medication for a specific amount of time. If a person stops taking the medication when they feel well, there may still be a bacteria population lying dormant in the body. The bacteria, having then survived the antibiotics, will be stronger and cause a more serious illness. For chronic diseases, health literacy is important in self-management and activities of daily living. Someone can have an interpreter translate what the doctor is saying into their language, but if they are not health literate and have the capacity to understand the importance of the instructions, how to take the medication, and how to adjust their lifestyle, the results could be disastrous.
It is clear now that health literacy is multi-faceted and requires more than our health care system is currently offering to the general public. However, resources do exist, and they were created to target the many different aspects of health literacy and the skillset required for a person to be health literate. Programs like: The UHN Patient & Family Education Program[iii] and Access Alliance’s Health with Dignity program[iv] were created to help newcomers and vulnerable populations better navigate the health care system. They understand that access to health care services is an important and understated part of health literacy. If a person cannot access health care services and cannot make their appointments, they will not be able to gain valuable health information. These programs help by providing resources and support staff who are flexible and work with the patient’s schedule to ensure that they access this information. Risk and benefit analysis is another part of health literacy that requires a more hands-on approach than our current, fast-paced health care system offers. It is important that people not only possess health information and instructions, but that they have the capacity to make their own decisions at the end of the day. Analyzing the risks of treatment or medications vs. the benefits is a crucial skill, and having staff to explain these options is an invaluable resource. Other aspects like calculating dosages, interpreting test results, locating health information, and developing the capacity to communicate with health care providers in a two-way fashion are all skillsets that health literacy programs help individuals to develop.
So I think back to El Salvador and imagine myself going there again, fluent in Spanish, having absorbed the culture and imagine the difference between my last trip and this one. Having the capacity to navigate the country on my own would be empowering. The same can be said for those who develop the capacity to interpret health information, communicate in a health care setting, and make decisions on the basis of their own health. My hope is that our health care system will consider the broad aspects of health literacy, and more programs will be developed to provide people with the resources they need to be health literate.