PREPARED BY Self, Service, System the heath literacy span Teresa Wall Deputy Director-General Māori Health, Te Kete Hauora

The health care realm Need a balance between: making services responsive to individuals having a system that ensures people can manage their own conditions as much as possible System Service Self whānau

Effective health care communication helps make us health literate Need to know SystemService Self whānau communication What is the individual’s role? What is the service provider’s role? What is the practitioner’s role? What is the system’s role? What is the Ministry’s role? Effective communication and health literacy

How important is health literacy? People with poor health literacy levels are: more likely to be hospitalised less likely to use preventive action – eg. screening likely to have less knowledge of their illness, treatment, and medicines less likely to manage long term-conditions effectively more likely to use emergency services more likely to die younger

Improving health literacy – does it help? Health literacy improvement has potential for: better use of health services improved consumer experience reduction in health-related costs empowering individuals/whānau to make appropriate choices for their health and wellbeing. In a constrained resource environment, it makes sense to improve health literacy levels

What is our situation? Our present health care climate asks us to: manage our own health care as much as possible manage our long-term conditions choose and purchase our support care integrate our health services more improve the effectiveness of our health services reduce disparities. All these need fairly good levels of health literacy acquired through effective communication.

Health literacy and our population Figures from Tatau Kahukura: Māori Health Chartbook 2010 Health literacy distribution for males, 16–65 years, 2006Health literacy distribution for females, 16–65 years, 2006 Note: Prioritised Māori ethnic group (both figures) – see Ngā Tapuae me ngā Raraunga: Methods and Data Sources Source: 2006 Adult Literacy and Life Skills Survey ‘Level 3 is described as the “minimum required for individuals to meet complex demands of everyday life and work in the emerging knowledge based economy”.’ - Tatau Kahukura

Kōrero Mārama Kōrero Mārama showed that: over half the New Zealand population has poor health literacy some groups have even poorer health literacy – older people Māori those on lower incomes unemployed people those with lower education levels people in the 18–24 year age group. Others groups likely to have lower health literacy: Pacific peoples other ethnic minorities people with disabilities. How do we improve? What do we face?

Self We need to know: about our condition what to do about it where to go for help who to ask how to ask where to find information how to interpret information how to act on information What are the literacy demands on us? We need to understand and use: documents; forms; labels; instructions

Service The providers Need to offer a service that is: high quality relevant to user population easily accessible What are the demands? The practitioners Need to engage with individuals and whānau: at an appropriate level with cultural competence using appropriate resources and resources appropriately

System Provide national and local populations with services that are: appropriate user-friendly accessible culturally relevant widely known health promoting disease preventing The role of the system hospitalpharmacy clinic laboratory district health board

Integration of care Communication through the health care continuum talking, listening, watching, reading, explaining, writing patient primary care specialist clinic whānau hospital physiotherapist pharmacist practice nurse GP navigate services and facilities nurse doctor therapist booking clerk consultant administrator

What is the Ministry’s role The Ministry can: Guide through good policy based on research Support through helping fund health literacy work where appropriate Encourage through continuing to acknowledge the importance of health literacy Improving health literacy

“From discussion to action” MOH Statement of Intent 2009–12 Action point: “developing and implementing a work programme to look at the improvement of health literacy for Māori whānau” Initial work programme focussed on Māori as the population group shown to have the poorest health literacy levels. MOH Statement of Intent 2011–14 Action point: to provide “advice on the health literacy aspects of communicating and accessing health information through a variety of media” Health literacy is now involved in a number of work streams across the Ministry.

Ministry work involving health literacy Research “build understanding of and research on health literacy as well as interventions and approaches that strengthen health literacy” Resources and programmes “ensure that existing (and future) health programmes work for people with lower levels of health literacy” Responsiveness “raise the awareness of health literacy and strengthen its practice within our health workforce ” Objectives in three broad categories

Research Objective one Health literacy research projects: palliative care (3) affecting older Māori, and rural and urban Māori prevention and early diagnosis of gout gestational diabetes skin infections carers of young Māori with disabilities “build understanding of and research on health literacy as well as interventions and approaches that strengthen health literacy”

Resources and Programmes Projects involving health literacy: review of publicly available information on gout treatment with medication CVD/diabetes pilots in several DHBs – care pathways for Māori rheumatic fever resource development review of immunisation resources development of online child health information service Objective two “ensure that existing (and future) health programmes work for people with lower levels of health literacy”

Responsiveness Work involving health literacy: cultural competence training tool review of health education resource development guidelines implementation of clinical guidance tools for health practitioners development of rapid-e guidelines for self-management of chronic or long-term conditions such as diabetes Objective three “raise the awareness of health literacy and strengthen its practice within our health workforce”

Health Literacy and Us Dr Rudd shows, and I agree, that we all have a role and a responsibility to improve health literacy levels - through effective communication in: a variety of media a variety of settings Empowerment for choice My thoughts Improving health literacy is about empowering individuals and whānau to: make decisions about their health care manage their own care