Literacy – more than just reading and writing
The English word ‘literacy’ has a simple definition – the ability to read and write – and yet its precise meaning is subject to endless debate. Such debates are common in European projects, as ‘literacy’ does not have a direct translation in many languages. This is also the case for other forms of the word such as 'literate' and 'literacy learning'.
A further complication for translators is that 'literacy' has another meaning in English. As well as being used to talk about the ability to read and write, it is common for literacy to be preceded by a term referring to a specialised field. Thus we have computer literacy, financial literacy, quantitative literacy, emotional literacy, and many others; I’ve just found 33 of them (including ocean literacy). While for each of these specialised areas the use of information mediated by text, often specialised text, plays an important role, the meaning of literacy here is not reading and writing, but competency – being able to engage competently in that area. And that is the case with health literacy.
What is health literacy?
Health literacy is usually defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. At its simplest, it means being competent in looking after your own health. It covers general health care, disease prevention and health promotion and focuses on ways in which adults access or obtain information relevant to their health from professionals, medical institutions, medical products and other sources; and how they understand, evaluate and use such information.
However, health literacy is not just about individuals. Improving societal levels of health literacy is also about understanding and lowering barriers created by healthcare personnel and systems. Societal levels of health literacy can be improved when documents and processes used within health encounters are designed with an understanding of the knowledge and understanding of all of those who will take part in them. Professionals within the health care system should be good communicators, aware of the need to support patients and carers in navigating the array of information that our health produces.
The importance of adult educators in increasing awareness of the concept of health literacy and in improving the ways in which the healthcare system communicated with its users was a central message of the Canadian Calgary Charter on Health Literacy:
The health literacy skills and abilities of individuals contribute to the health literacy of a health service system or organisation. For instance, one individual with a high level of health literacy can enhance a system's performance. However, a system or organisation that has low health literacy can overwhelm a health-literate individual or diminish the effect of a well-written document.
There is little individual or system-level data about the health literacy of European societies. The European Health Literacy Survey (HLS-EU) was an output of the European Health Literacy Project, lead by Maastricht University from 2009 to 2012. The survey measured health literacy in eight countries and found that poor health literacy was widespread in Europe, but that it differed substantially across countries. There were also "subgroups within each country with socioeconomic factors such as economic status, employment and education associated with poor health literacy, suggesting the presence of the type of social gradient that is familiar from surveys of other related issues, such as literacy itself".
Adult education and health literacy
Adult education can play a central role in improving societal levels of health literacy and thus of the long-term health of European populations. Health literacy, on an individual level (being competent in the management of your own health), and on a societal level (having a population able to competently manage its own health), is a useful concept and one that is rightly gaining policy makers' attention. As well as working with adults to support them in successfully managing their own health, public policy should encourage adult educators to engage with health professionals, and the systems they work in, about the way that healthcare information is communicated.
David Mallows has over 25 years experience in adult education as a teacher, teacher trainer, manager and researcher. He is currently Director of Research at the National Research and Development Centre for adult literacy and numeracy (NRDC) at the UCL Institute of Education, London and leads the adult education strand of European Commission’s literacy policy network, ELINET.