1. Health Literacy, Empowerment and Culture – Critical Crossroads for Health
4th AHLA Conference
Workshop – Professional Development
Haiphong, Vietnam – November 2016
Prof. Diane Levin-Zamir, PhD, MPH, MCHES
Director, National Department of Health Education and Promotion
Clalit Health Services, Israel
Associate Professor - University of Haifa – School of Public Health, Israel
IUHPE –Global Working Group Health Literacy

2. Why Focus on Health Literacy?
To Promote Health

3. Ottawa Charter for Health Promotion - World Health Organization
Healthy Public Policy
Supportive Environments
Community Involvement
Developing Personal Skills (Health Literacy)
Reorientation of Health System

4. Health literacy affects the quality of health care.
“Good quality means providing patients with
appropriate services, in a technically competent manner, with good communication, shared decision-making, and cultural sensitivity.”
IOM. Crossing the Quality Chasm: A New Health System for the 21st Century

5. Best use of scarce and valuable resources
Why Focus on Health Literacy?
Best use of scarce and valuable resources

6. To create a shame free environment and promote dignity and self-esteem
Why Focus on Health Literacy?
To create a shame free environment and promote dignity and self-esteem

7. Partnership for Clear Health Communication, USA
Why Focus on Health Literacy?
Low Health Literacy is responsible for:
- An additional $7,500/person/year in healthcare costs
- An additional $50-73 BILLION/ year in national healthcare costs
Partnership for Clear Health Communication, USA

8. Equity and Human Rights
Why Focus on Health Literacy?
Equity and Human Rights

9. Health Literacy and Policy
Including health literacy in public policy is essential for overcoming challenges and to ensure a sustainable benefit.

11. Health Literacy Policy addresses the need for cultural competency in a globalized world

12. “The single biggest problem with communication is the illusion that it’s taken place”
George Bernard Shaw

13. Cultural Competence
“The capacity to function effectively as an individual and as an organization within the context of cultural beliefs, behaviors, and needs presented by consumers and their communities.”
HHS CLAS

14. Cultural Responsiveness
Cultural awareness - sensitivity to values’ beliefs and lifestyles that stem from person’s culture.
Cultural knowledge - sound educational foundation concerning worldviews of various cultures
Cultural skill - ability to collect
(verbal and physical) relevant cultural data
regarding client’s health histories and presenting problems
Cultural encounter - cross culture interactions with clients from culturally diverse backgrounds
Speaking of Health, IOM, 2002

15. The Israel Health Literacy Study
Cultural Appropriateness in Research
The Israel Health Literacy Study
National survey: close collaboration with HLS-Euro
Objective: To assess the level of health literacy in the Israeli population and to study the association between health literacy, social determinants, and association with measure of healthcare service use, health behavior, and reported health.
Methodology: Face-to-face home interviews among a representative sample of 600
Four languages: Hebrew, Arabic, Russian & Amaharic
Instrument validated via focus groups with key informants
Journal of Health Communication, Sept. 2016

16. “Refuah Shlemah”
1. Culturally appropriate services - Ethiopian health and inter-cultural liasons, for bridging the cultural gap between patients and healthcare staff.
2. Cultural competency training for healthcare staff - promoting awareness and sensitivity, bridging inter-cultural gaps, developing communication skills Ethiopian perception of health and dis-ease causation
3. Implementing health education and promotion activities for new immigrants, based on health literacy

17. On-Line in Hebrew, Arabic, Russian, French, Portuguese
Cultural Appropriateness in Practice -
On-Line in Hebrew, Arabic, Russian, French, Portuguese
Play >
On-line health information – 4 million entries/mo – 80% unique entries

18. Recommendations for Areas of Action and Research - New and Future Challenges
Develop standards for appropriate messages and applying them in the development of materials using formative research
Make more efficient use of culturally appropriate mass media
Develop and implement policy for promoting cultural and literacy competence among professionals in the health field.

19. Recommendations for Areas of Action and Research - New and Future Challenges
Change current procedures to promote community involvement and collaboration with key stakeholders
Redesign bureaucratic procedures to become more user –friendly , based less on sophisticated written communication
Develop text-free educational methods based on learning styles of non-readers.

20. Cultural Change is Dynamic

21. Health Literacy in All Policies
Ultimate action..
Health Literacy in All Policies

22. It is never too late….

23. Thank you!