Wednesday, May 11, 2005

Health literacy - an introduction

"Achieving healthy ageing of the population presents a series of challenges for government, business, care professionals, communities and individuals… while our biology and genetics are important, social and economic factors are also important determinants of health."

Public Relations has been described as the analysis of trends and the prediction of their consequences. One of the key trends to concern researches, social scientists and policy makers in Australia in the past five years has been the ageing population. Advances in medical science and changes in the demography of families have meant that people are remaining alive and active longer. As these "baby boomers" mature the burden on the provision of health services and welfare spending on the aged is expected to increase dramatically.

Simultaneously, the growth of new technologies at affordable prices have given the average Australian access to health information that is greater than ever before. The mass media and the Internet have made available to the health consumer vast amounts of medical and health-related information.

Policy shifts have increased consumers' access to medical records. Consumers are taking the initiative in seeking out information for themselves.

"Consumers are becoming more informed about their health and health care options and take a more active role in their relationships with their doctors and other health care providers."

The volume of information available dwarfs any amount that has ever been available before. This welter of information, however, can overwhelm consumers, they feel overloaded, confused, and uncertain which information and information sources to trust. Moreover, the technical complexity of the information can compound these problems.
In many ways, consumers often lack the health literacy to make effective use of the available information.

In an effort to overcome some of these difficulties the Australian government has sought to standardise medical information that consumers have access to through the introduction of Consumer Medical Information or CMI.

Health literacy is a complex phenomenon that plays around a delicate interplay between at least three factors:

The ability to read, understand and interpret medical information. This is frequently referred to as coding.

Of equal importance is the capacity to use medical information for one's own health and make good decisions on the basis of it. Unless the knowledge gained is put into practical use very little is gained.

Perhaps the single greatest influence is people's general attitudes toward life. Here cultural norms and attitudes play a significant role.

These components are reflected Pfizer’s publication on health literacy where it states:

" Health literacy refers to the ability to to read and understand health information and use it effectively. Because health information can be complex and scientific, people often have trouble reading and understanding written materials such as prescriptions, medical instructions, informational brochures about disease and treatments, insurance applications and consent forms."

The damaging consequences of low health literacy have been widely documented. Low health literacy is associated at the individual level with lower self-esteem and less successful interaction with healthcare providers, and at a community level with increasing health care costs and hospitalisation. Conversely, increasing health literacy can lead to crucial gains in compliance, recall, and satisfaction. As such, the concept of health literacy has become a central concern in the field of health communication.

Many view health literacy in general as a problem relegated to the third world, but research has shown different. The New England Journal of Medicine highlighted the scope of this problem when it quoted the Department of Education.

"In 1992, the Department of Education tested 26,000 adults in the National Adult Literacy Survey to assess the literacy of the U.S. population in the English language. On the basis of the survey results, it was estimated that 40 million to 44 million people, or about one quarter of the adult population in the United States, cannot understand written materials that require only very basic proficiency in reading. These people would generally be unable to read and understand instructions on medication bottles or household cleaning solutions, notes from a child's teacher, or directions on a map."

Communication is key to the efficacy of health literacy, a recent Australian government report highlighted poor communication as a factor causing medicines to be ineffectually used.

"Consumers frequently said that poor communication between consumers and doctors during prescribing consultations and consumers and pharmacists during dispensing consultations can impede the quality use of medicines."

In one respect the City of Wagga Wagga makes an ideal subject for study. A dominant influence in the town is the Charles Sturt University, which has contributed to an understanding of the importance of social research in the community. The university has also assisted the city in the provision of research services to assist in its administration.

Equally important is the availability of information in Wagga, with two comprehensive libraries equipped with the latest technology. In preparation for this project I consulted the Universities medical faculty collection, for information on trends in rural health care.
Wagga Wagga has a high proportion of Aboriginal Australians. According to the Institute of Aboriginal and Torres Strait Islander Studies;

"Health is one of the most telling markers of the recent history of Aboriginal people and their position in society. Aborigines generally have higher rates of illness and death, live in more impoverished circumstances than most non-aboriginal people. The health of many is compromised by poor diet and by the heavy use of tobacco, alcohol and other substances. A rising reported incidence of suicide injury and violence is of deep concern to many Aborigines and to the wider community."

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