Literacy As a Social Determinant of Health

Health is a multi-factorial concept composed of intertwined and independent Social Determinants of Health (SDH) which include, but are not limited to, socioeconomic status, biological factors, and cultural influence (WHO, 2019). The most important structural stratifiers for health include income, education, occupation, social class, gender, and race/ethnicity (WHO, 2010). Disparities created by SDH directly impact individual, community and population health, reflected in both life expectancy and quality of life and result in inequity of health among individuals and communities (Leonardi, F., 2018). Understanding the impact of SDH determines health outcomes, sense of security, and policy development and implementation. Health literacy is an independent influencer in health outcomes, whereby those with lower literacy rates tend to need more medical care and have difficulty navigating the healthcare system, resulting in institutional financial burden and decreased health outcome (Palumbo, R. 216). Understanding literacy as a social determinant of health is vital for improving population literacy and creating a healthcare system which is accessible and approachable for all patients.

Social Determinants of Health. Retrieved from https://www.kidney.org/atoz/content/social-determinants-health-and-chronic-kidney-disease

The World Health Organization (WHO) defines health as the “complete absence” of illness or disease but this is ill-suited to meet the complex, dynamic, and inclusive needs for health (Huber, M. 2011). This once revolutionary definition fails to place proper importance on intentional language, negating literacy as a social determinant of health. The language must be more intentional when defining health so as to be more reflective of the dynamic state of health (Leonardi, F., 2018).

Why Language Matters

The simple truth is that “language matters: it reflects underlying beliefs either directly or indirectly” (Nutbeam & Lloyd, 2012). Neutral terminology such as “disparities” and “inequities'' removes any blame associated with the circumstances and enables indifferent evaluation of those criteria and the expansion of evidence-based policies (ODPHP, 2022). The consequence is lack of accountability and action on those factors if they are deemed inevitable or outside of one’s control. More striking vocabulary such as “equity” spur action and emotions, raising cultural awareness of socio-economic discrepancies (Nutbeam & Lloyd, 2012). This can be a call to arms while simultaneously raising distraction from solving the upstream factors.

The Organization for Economic Co-operation and Development (OECD) defines literacy as, “the ability to understand, evaluate, use, and engage with written texts to participate in society, achieve one’s goals, and develop one’s knowledge and potential” (OECD, 2012). Literacy skills empower people to reach their potential, fulfill their goals, and participate more actively in society and the economy. Poor literacy rates tend to result in less engagement with public health initiatives, lower rates of preventative services, and struggle more with the management of chronic illness or disease (Cameron & Cameron, 2006). Similarly individuals and communities with higher functional and critical literacy skills were better able to obtain quality health information, analyse its impacts, make autonomous informed decisions, and have improved health outcomes (Nutbeam & Lloyd, 2018).

Improving Health Literacy and Empowering Canadians

To improve population literacy, a multi-systemic approach is needed. Literacy skills are the responsibility of the government to empower its populations and promote wellness and autonomy (WHO, 2019). To this end, simplifying access to care is vital to empower individuals of all literacy rates to navigate the healthcare system and obtain goods and services necessary for acute and chronic disease diagnosis and management. Similarly, community based educational campaigns are vital

to improve functional, interactive, and critical skills in multiple disciplines beyond health, and from multiple sources, being cognisant of cultural preferences, norms, and traditions (Frawley, et. al. 2022).

Improved health literacy can potentially improve individual and population socio-economic status and overall health and is its own independent variable which must be addressed at the micro-, and macro-level to improve life expectancy, disease management, and reduce health disparities.

The pursuit of health is rooted in contradiction and inconclusive expectations. Different cultures have different expectations of what it means to be healthy which dictates how they perceive, treat, and plan for healthcare needs and mitigation strategies (Palumbo, R, 2016). “Health” the word is as fluid as the objective; where Greek-Latin cultures have roots in “harmony”, and Anglo-Saxon cultures have roots in “wholeness” implying different viewpoints and outcomes for the same concept. If the word itself cannot be singularly defined, neither can the outcome be singular (Leonardi, F. 2018). In this ever-elusive objective, it is no longer reasonable for the current definition by the World Health Organization to remain transfixed on a singular objective, the “complete absence” of illness or disease (Huber, M.,2011). Health is not just theoretical - it has real impact on practice, policy, health services, health promotion, and overall well-being (Leonardi, F., 2018). Current arguments to expand the definition of health beyond the singular and towards a pleural dynamic, measurable, and individualistic criteria are better representative of the social determinants of health, specifically health literacy, and the subjective well-being of individuals surrounding post-colonialistic impacts (Leonardi, F. 2018).

References

Cameron, J. & Cameron, S. (2006). The Economic Benefit of Increased Literacy. UNESCO. https://unesco.org/ark:/48223/pf0000145957

Frawley, J., Russell, G., Sherwood, J. (2022). Cultural Competence and the Higher Education Sector: Australian Perspectives, Policies, and Practices. Springer Nature Singapore Press Ltd. Singapore. P. 164-173.https://doi.org/10.1007/978-981-15-5362-2_9

Huber, M. (2011). Health: How Should We Define It? BMJ: British Medical Journal, 343(7817), 235–237. http://www.jstor.org/stable/23051314

Leonardi, F. (2018). The Definition of Health: Towards New Perspectives. International Journal of Health Services, 48(4), 735–748. https://www.jstor.org/stable/48513032

Nutbeam, D. & Lloyd, J.E. (2021). Understanding and Responding to Health Literacy as a Social Determinant of Health. Annual Review of Public Health: 42: 159-173. https://doi.org/10.1146/annurev-publhealth-090419-102529

OECD. (2012). Literacy, Numeracy and Problem Solving in Technology-Rich Environments: Framework for the OECD Survey of Adult Skills. Paris: OECD Publ.

Office of Disease Prevention and Health Promotion.(2022). Health Equity and Health Disparities: Environmental Scan. Healthy People. http://health.gov/sites/default/files/2022-04/HP2030-HealthyEquityEnvironmentalScan.pdf

Palumbo R. 2016. Designing Health-Literate Health Care Organization: A Literature Review. Health Services Management Research. 29(3):79–87. https://doi.org/10.1177/0951484816639741

World Health Organization. (2010). A Conceptual Framework for Action on the Social Determinants of Health. Commission on Social Determinants of Health, Switzerland. iris.who.int/bitstream/handle/10665/44489/?sequence=1

World Health Organization. (2019). WHO Strategic Meeting on Social Determinants of Health: Final Meeting Summary. Switzerland. https://cdn.who.int/media/docs/default-source/documents/social-determinants-of-health/14138_legislation_manual_summary_dec17_final.pdf?sfvrsn=d5a289b6_5&download=true