Understanding Health: How Does Health Literacy Impact Health Inequalities?

Being able to access, understand, interpret, and apply health information to decisions about our health is a key capability that directly impacts our health outcomes. However, a 2015 study found that more than half of adults in England have difficulty understanding common health information resources (Rowlands, 2015). Low health literacy, which is seen at higher rates in more deprived communities, is also correlated with the increased use of health care services and higher mortality. Addressing these health inequalities requires an understanding of what health literacy is, the impact of low health literacy on health, and how it interacts with other social determinants of health.

What is Health Literacy?

Health literacy is described by the WHO as “the personal characteristics and social resources needed for individuals and communities to access, understand, appraise, and use information and services to make decisions about health.” This broad term can mean different things to different people and, alongside the challenge of defining health literacy, comes the challenge of measuring it (Berkman et al., 2010). Many studies, like Rowlands et al., 2015, measure literacy and numeracy as a proxy for health literacy, as these are skills that are necessary for tasks such as calculating appropriate doses of medication or completing a health questionnaire. However, with health information easily accessible over the internet and health care services increasingly delivering services by using technology, adequate health literacy also requires digital literacy. In order for people to benefit from this information, they must also have the ability to differentiate between reliable sources of health information and health information sourced from pseudoscience or fake news. The term health literacy has also been questioned by some who suggest it comes with a stigma that can prevent individuals from engaging with initiatives aiming to improve their literacy with the terms health competence or ability proposed instead (Raynor, 2012).

Terms that could be described as medical jargon are especially confusing to those with low health literacy.

How Does Poor Health Literacy Interact with Poverty?

Health literacy is a social determinant of health and impacts health inequalities. In addition to the trends mentioned above, individuals with lower health literacy have poorer adherence to medication, lower levels of mental wellbeing, and higher rates of chronic illnesses. With lower health literacy levels being associated with lower levels of education and lower socioeconomic status, disentangling these causes of health inequalities is challenging. However, studies such as Lastrucci et al, 2019, have shown that improving health literacy will most significantly improve the health of individuals from a low socioeconomic status background, demonstrating an effective approach to tackling these health disparities.

Impact of Poor Health Literacy on Health during the Pandemic

With the emergence of a new virus and constantly changing public health guidelines, even the medical community has struggled to access reliable, clear, and consistent health information regarding SARS-CoV-2. At the same time, there has been a pressing need for good health literacy to interpret complex public health guidelines. Furthermore, with the dramatic reduction in hospital services during the pandemic, particularly face-to-face appointments, many individuals have been forced to become more responsible for managing their own health care. As previously mentioned, lower health literacy is associated with lower socioeconomic statuses and in addition to this correlation, some individuals are more susceptible to contracting COVID-19 based upon their ethnicity and living arrangements. Essentially, these issues come together to highlight the need to improve health literacy.

What Needs to Change?

In a similar vein to improving access to green spaces, which was discussed in our blog post last week, improving health literacy can improve health outcomes and reduce health inequalities, particularly in more deprived communities. Although supporting individuals to improve their health literacy through building their numeracy, literacy and digital skills is important, improving the quality of organisational health literacy through ensuring health information is accessible, suitable, and relevant is another key factor. Further, as many health services shift their focus to informed patient decision making, it must be ensured that individuals are equipped with a sufficient understanding of health information to make decisions about their own health care, which is a goal that requires the collaborative efforts of schools, charities, and health services.

More about the Author: Anya Webber