AARHUS UNIVERSITET Health literacy: From populations to people Gill Rowlands Health Literacy Group UK Fellow of the Royal College of General Practitioners, UK Professor of Public Health, Aarhus University Denmark Clinical Senior Lecturer, King’s College, London, UK 1

AARHUS UNIVERSITET What is health? Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. 2 Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948

AARHUS UNIVERSITET What is health literacy? Health literacy implies the achievement of a level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions. 3 Nutbeam D. Health Promotion Glossary. Health Promotion International. 1999;13(4):349-64

AARHUS UNIVERSITET What is health literacy? Health literacy means more than being able to read pamphlets and make appointments. By improving people’s access to health information, and their capacity to use it effectively, health literacy is critical to empowerment 4 Nutbeam D. Health Promotion Glossary. Health Promotion International. 1999;13(4):349-64

AARHUS UNIVERSITET Health literacy and public health People with lower health literacy Feel less well Are more likely to be ill Have lifetsyles that increase the risk of illness If they have a long-term illness they are more likely to find the illness limiting 5

AARHUS UNIVERSITET The size of the problem In industrialized countries, about half the population do not have the ‘level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions’ 6

AARHUS UNIVERSITET Health literacy levels in England The health information gap: the mismatch between population health literacy and the complexity of health information, an observational study. Rowlands G, Protheroe J, Winkley J, Richardson M, Seed PT, Rudd RE. BJGP 2014 (accepted for publication). Funders: MSD 7

AARHUS UNIVERSITET National and regional picture: % of adults aged years for whom health information is too complex National average 43% Text (literacy) component of health materials

AARHUS UNIVERSITET National and regional picture: % of adults aged years for whom health information is too complex National average 61% Text (literacy) and Numeracy component of health materials

AARHUS UNIVERSITET Population portraits: literacy and numeracy Lower job status: supervisory, routine, unemployed 53% of population = 18 million people Health material too complex for 74% of this group Higher job status: managerial, intermediate 47% of population = 16 million people Health material too complex for 24% of this group

AARHUS UNIVERSITET Health literacy and patients How does it feel to be a patient with low health literacy? How should we respond to the challenges faced by patients with health literacy needs? 11

AARHUS UNIVERSITET How does it feel to be a patient with low health literacy? Disempowered Struggling with complex information Multiple sources High complexity Stigmatised Likely to be coping with other barriers to health and well-being, e.g. low job status, low income, membership minority ethnic group etc. 12

AARHUS UNIVERSITET Improved health information Need to ensure health information is written at an accessible level Develop systems to share high quality information at different levels of complexity – tailored to patient health literacy as well as clinical need Meeting run by health literacy group UK to take this forward: 6 March 2015 in Leeds 13

AARHUS UNIVERSITET Health literacy and people Building skills for health in individuals and communities 14

AARHUS UNIVERSITET Why? ›Health is important to people – for themselves and their families – so is attractive as a learning objective ›Health literacy skills courses (e.g. Skilled for Health) build health knowledge, health skills, and confidence in health settings ›Skills building in communities supports social engagement and social networks – builds ‘distributed health literacy skills ’ that community members can call upon if needed 15

AARHUS UNIVERSITET Why? ›The skills built through health literacy courses are transferable to other areas of life e.g. finance ›Empowers communities – supports people to take control of their own health ›Moves from an illness setting (GP surgeries, hospitals) to a health setting (everyday life!) 16

AARHUS UNIVERSITET A call for partnerships ›Low health literacy is a public health issue that has a real impact on people ›The solutions lie in simultaneous approaches ›A health service more in tune to peoples’ health literacy needs ›Community education that builds skills and empowers communities ›Health professionals have clinical skills and knowledge ›Educators know how to develop skills in individuals and communities ›New streamlined and flexible systems bring opportunities for funding and joint working 17

AARHUS UNIVERSITET Discussion and Questions 18

AARHUS UNIVERSITET Health literacy: from populations to people Gill Rowlands 19