Basic health literacy: Canada is doing poorly

Creating health awareness and promotional events is a core function of public health as they support governments, communities, and individuals to cope with and address health challenges. In 1974 Dr S.K. Simonds put forward the concept of health literacy as an important aspect of health education in schools. In 2016 the World Health Organization recognized the importance of health literacy as perhaps one of the critical determinants of individual and public health.

In most general terms, having adequate literacy skills means being able to understand, evaluate, use, and engage with written texts. In 2013 Canada was ranked 11th of the 18 countries of the Organization for Economic Cooperation and Development in an International Assessment of Adult Competencies test on the percentage of adults with suitable literacy skills. In that survey, the percentage of Canadian adults with suitable literacy skills was 48%. Seventeen percent of Canadian adults functioned at a level so low that, for example, the person was not able to understand instructions in a cookbook.

The focus of adequate health literacy is more narrowly defined by Canadian centres of disease control and prevention as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. According to the Public Health Agency of Canada, 60% of Canadian adults and 88% of seniors are not health literate. Some seniors cannot follow instructions on a medicine bottle.

A recent Lancet editorial comments on a November 2022 WHO report on health literacy. The report calls for a collective practice of a community, rather than placing responsibility on the shoulders of the individual to acquire literacy in the health field. The report calls for educational programs involving schools, churches, sport groups, and workplaces. The editorial points out that the WHO approach is right but it fails to consider the negative impact from commercial determinants of health—that is, being exposed to the wrong information—like those related to tobacco, alcohol, or junk food. Also, the rise of misinformation on social media makes making sensible, healthy decisions more difficult. 

In 2017, the Health System Improvement Unit at Deakin University, Australia, published their project to Optimise Health Literacy and Access (OpHeLiA). The investigators posed 44 questions within nine health literacy domains to members of defined communities to discover what health literacy–related interventions might be required, with the potential to impact health and equity outcomes. The domains included being understood by health care providers, having sufficient information to manage health, actively managing health, having social support for health, understanding health information, engaging with health care providers, navigating the health care system, knowing how to find good health information, and understanding health information well enough to know what to do. Time is too short yet to measure if the interventions responding to the discovered health literary needs have in fact substantially improved the health literacy levels of the selected populations. But identifying the supports needed for improved population-wide health literacy is an important step forward. Understanding what makes our societies run healthy is at stake.  
—George Szasz, CM, MD

Suggested reading
ABC Life Literacy Canada. Health literacy still an issue in Canada. Accessed 4 January 2023.

Beauchamp A, Batterham RW, Dodson S, et al. Systematic development and implementation of interventions to Optimize Health Literacy and Access (Ophelia). BMC Public Health 2017;17:230.

Lancet. Why is health literacy failing so many? Lancet 2022;400(10364):1655.

Selva-Pareja L, Ramos-Pla A, Mercadé-Melé P, Espart A. Evolution of scientific production on health literacy and health education—a bibliometric analysis. Int J Environ Res Public Health 2022;19:4356.

Simonds SK. Health education as social policy. Health Education Monographs 1974;2(1_suppl):1-10.

This post has not been peer reviewed by the BCMJ Editorial Board.

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