HEALTH LITERACY: A PUBLIC HEALTH PERSPECTIVE Dr Giri Rajaratnam Deputy Regional Director, Public Health England M&E Regional team

Introduction: PHE Public Health England PHE Regional Teams and Centres NHS England and the NHS Local government Other stakeholders

Public Health England Fulfil Secretary of State’s duty to protect the public’s health Secure improvements to the public’s health including reducing inequalities in health outcomes Improve population health, supporting sustainable health and care systems Ensure the public health system maintains capability and capacity to tackle public health challenges of today and of the future.

The Public Health Perspective Health and wellbeing challenges of the 21st Century Choosing healthy lifestyles Accessing medical care and taking advantage Seeking information, understanding it and making decisions that enables individuals, families and communities take advantage of the opportunities and the system is what I mean by Health Literacy. System complexity; navigation and clinical content

Impacts of low health literacy Individuals with low health literacy are more likely to: have unhealthy lifestyle behaviours such as poor diet / smoking / lack of physical activity use fewer preventative and health promotion services, e.g. screening / immunisations experience increased hospitalisation or premature death have less recall and adherence to healthcare regimes find it more challenging to access appropriate health services make more use of accident and emergency services and have longer in-patient stays have less effective interactions with health and social care practitioners Source - PHE / UCL report 2105: Local action on health inequalities Improving health literacy to reduce health inequalities Health literacy therefore contributes to health inequalities because the population groups most at risk of low health literacy are also known to have the poorest health outcomes.

How can health literacy interventions help? Increase health knowledge and build resilience Encourage positive lifestyle change Empower people to effectively manage long-term health conditions Reducing the burden on themselves, their families and communities including health and care services From the PHE / UCL report in 2015: ‘Local action on health inequalities: Improving health literacy to reduce health inequalities

Supporting improvements in Health Literacy Partly rooted in education and attitudes and partly in system complexity Development of information that is easily understood and actionable Piloting and evaluating approaches that reflect the diversity of communities in M&E and England Systematising and scaling up interventions that improve health literacy.

Impact of giving everyone the health of the educated Woolf et al; AJPH 2007;97(4):679-683 The study estimated the number of averted death attributable to medical advances and the number of deaths that would have averted if mortality rates among adults with lesser education had been the same as those among college educated adults The period of study was 1996-2002 The results were that medical advances would have averted approximately 175k deaths whereas correcting education associated mortality rates would have saved approximately 1.4m deaths.

Why Prevention Matters We know that with regard to life expectancy that healthcare contributes only 10% to the prevention of premature deaths, whilst 40% of the contribution comes from changes in behavioural patterns, yet only 4% of healthcare spend is on prevention We know that there is considerable scope for prevention, with higher levels of female smoking in the UK than the EU average, with 2 in every 3 men and 3 in every 4 women deemed to be physically inactive and adult alcohol consumption in the UK being 10% higher than the EU average We also know (and have done since the Wanless report of Feb 2004) that a ‘fully engaged scenario’ where the public are supported to manage their health and engage with prevention activities that £30bn could be saved through reduced need and demand for services.

Giri.Rajaratnam@phe.gov.uk