July 8, 2020
COVID-19 has been a painful and sad reminder of the link between health inequities and health literacy. It’s also been a reminder that communicating health messages to culturally diverse communities isn’t just a question of providing translations of information. Organisations are well placed to reduce health inequities by responding to health literacy needs. Doing so requires an ongoing commitment to building partnerships with communities and working with them to design and deliver messages. Now is a good time for us to reflect on how we can work towards doing better.
Health literacy – who is responsible?
Health literacy is often defined as a person’s ability to find, understand and use information to make effective decisions about their health and take appropriate action (ACSQHC, 2014). This definition places the onus of responsibility on individuals, and consequently improvement efforts have focused on improving the skills and capacity of individuals (Rudd, 2017).
More recently we’ve acknowledged that the health literacy skills a person needs change depending on how complicated the services they are trying to access are (Trezona et al., 2020).
At HealthWest (2019) we define organisational health literacy as:
‘An organisation that makes it easy for anyone to find, understand, and use information and services.’
This definition recognises that services and systems can be complicated. It’s our responsibility to reduce confusion for everyone by being health literate organisations.
Health literacy – it’s more than just translating pamphlets
Most people think of organisational health literacy as being limited to providing interpreters and translated materials. In fact, addressing health literacy needs is far more complex. At its core, addressing health literacy needs requires tailoring information and services that are appropriate to the communities accessing them. The only way to do this is to create strong partnerships with communities and to work with them to understand the issues.
Engaging and working with communities provides insights into barriers and enablers and allows for solutions to be tailored thoughtfully (Brach, 2017). Every community is different. Communities can be disadvantaged if organisations fail to work with them to address their specific needs and preferences. It’s important that both organisations and consumers are recognised as having an equal measure of expertise in improving health literacy.
Not addressing organisational health literacy – exacerbating health inequities
When the health literacy needs of a community are not addressed, they are at risk of experiencing health inequities. Health inequities can be defined as differences in health between groups that are avoidable and considered unfair or unjust (Whitehead, 1992).
The link between health inequities and low health literacy are well established – individuals with low health literacy levels experience poorer health outcomes (Berkman et al., 2011). Those most at risk of low health literacy are the elderly, minority groups, people from non-English speaking backgrounds and those with low socio-economic status and education levels (Berkman et al., 2011).
Organisations are well placed to reduce health inequities by responding to the health literacy needs of different communities appropriately. They can also reduce the complexities of their services and information. The only way to do this effectively is to work with communities.
The COVID-19 context
COVID-19 has been a painful and sad reminder of the link between health inequities and health literacy. It’s also been a reminder that communicating health messages to culturally diverse communities isn’t just a question of providing translations of information. Many community members do not get their information from traditional media sources. How we access information depends on our skills (literacy, language), assets (technology) and culture. Skills and assets that our most vulnerable and marginalised do not always possess. We also have different understandings about health and disease, which are influenced by our cultural backgrounds. Messaging about COVID-19 and the ever-changing restrictions must reflect these differences. Doing so requires an ongoing commitment to building partnerships with communities and working with them to design and deliver these messages.
- How do we ensure that all communities understand the messaging around COVID-19 and lockdown restrictions?
- Beyond the pandemic, how do we reduce health inequities by ensuring that anyone can find, understand and use our information and services?
By Estelle Donse, Systems Integration Manager
Australian Commission on Safety and Quality in Health Care. Health Literacy: Taking action to improve safety and quality. Sydney: ACSQHC, 2014.
Berkman N, Sheridan S, Donahue K, Halpern D, Crotty K. Low Health Literacy and Health Outcomes: An Updated Systematic Review. Annals of Internal Medicine. 2011 July. 155(2): 97-107. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21768583
Brach C. The Journey to Become a Health Literate Organization: A Snapshop of Health System Improvement. Stud Health Technol Inform. 2017 Nov. 240: 203-237. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28972519
HealthWest and INWPCP. Make it Easy: A handbook for becoming a health literate organisation. 2019. Available at: http://healthwest.org.au/wp-content/uploads/2019/08/HealthWest_Make-it-Easy_web.pdf
Rudd E. Health Literacy: Insights and Issues. Stud Health Technol Inform. 2017. 240: 60-78. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28972509
Trezona A, Dodson S, Fitzsimon E, LaMontagne A, Osborne R. Field Testing and Refinement of the Organisational Health Literacy Responsiveness Self-Assessment (Org-HLR) Tool and Process. Int J Environ Res Public Health. 2020 Feb. 17(3). Available at: https://www.ncbi.nlm.nih.gov/pubmed/32033385
Whitehead M. The Concepts and Principles of Equity and Health. Int J Health Serv. 1992. 22: 429-445. Available at: https://www.ncbi.nlm.nih.gov/pubmed/1644507