Literacy and Health Research in Canada

Literacy and health research and prac­ tice in Canada date back to the late 1980s when the Ontario Public Health Association (OPHA) collaborated with Frontier College, the country’s oldest literacy network, on a literacy and health project. Their first report, Making the World Healthier and Safer for People Who Can’t Read, was published in 1989.1 Their second report, Partners in Practice, docu­ mented the increasing collaboration that their work had fostered between literacy workers, health service providers and learn­ ers.2 In 1994, the Canadian Public Health Association (CPHA) established the National Literacy and Health Program (NLHP) with funding from the Secretary of State’s new National Literacy Secretariat. Through the NLHP, CPHA has collaborated with 27 national partners to improve health services for consumers with literacy difficulties. They have carried out several projects, organized conferences and generated the publication and dissemi­ nation of countless plain language materi­ als. The NLHP is considered to be a model for raising awareness, exploring issues, developing resource materials and building partnerships in this field. Its work helped Canada to become an international leader in literacy and health. Today, the field is at a critical juncture where further program and policy development requires greater evidence and evaluation of existing initiatives, more cost/benefit analyses, more culturally specific studies and greater attention to current social trends and needs. This article reviews current literature and research on literacy and health and identifies priorities for research on this topic in Canada. Information sources included documents found through an environmental scan, the Alpha Plus collection and a computer search of recent documents. The information was analyzed using a conceptual framework. The review found that low literacy has direct and indirect impacts on health. Families are at risk due to difficulty reading medication prescriptions, baby formula instructions and health and safety education materials. People with lower levels of literacy tend to live and work in less healthy environments. They have more difficulties obtaining employment and income security. Determinants of literacy include: education, early childhood development, aging, living and working conditions, personal capacity/genetics, gender and culture. Action is needed to improve literacy and health through a combination of health communication, education and training, community development, organizational development, and policy development. There is some evidence that such interventions can have a positive effect on health, particularly when combined with one another. Further program and policy development requires greater evidence and evaluation of existing initiatives, more cost/benefit analyses, more culturally specific studies, and greater attention to current social trends and needs. MeSH terms: Literacy; health; health literacy; research; evaluation; health promotion La traduction du résumé se trouve à la fin de l’article. 1. Professor and Michael Smith Foundation for Health Research Distinguished Scholar, University of Victoria 2. Consultant and Fellow, Centre for Health Promotion, University of Toronto Correspondence: Dr. Irving Rootman, Faculty of Human and Social Development, University of Victoria, PO Box 3060, Stn CSC, Victoria, BC V8W 3R4, Tel: 250-472-4102, Fax: 250-472-4836, E-mail: [email protected] Acknowledgements and Sources of Support: This article is based on a paper prepared for an International Think-Tank on Reducing Health Disparities and Promoting Equity for Vulnerable Populations sponsored by the Canadian Institutes of Health Research (CIHR) held September 21-23, 2003. The authors acknowledge the Reducing Health Disparities Initiative of CIHR and the Canadian Population Health Initiative of the Canadian Institute for Health Information for sponsoring the pro­ duction of this article. They also thank the Social Sciences and Humanities Research Council’s “Valuing Canadian Literacy” Program for their support of the project to develop a program of research on literacy and health, and the CIHR Population and Public Health, Aboriginal and Gender and Health Institutes for supporting the workshop on literacy and health research. Thanks to participants at the think-tank for their input; to the investigators on the SSHRC grant (Jim Frankish, Deborah Gordon El-Bihbety, Heather Hemming and Margot Kaszap); and to participants in the focus groups for their input into the conceptual framework for literacy and health research presented here. Particular thanks go to Jim Frankish for his constructive comments on this paper, and to the reviewer of this paper for constructive suggestions. The content remains solely the responsibility of the authors. Some of the trends we are facing that make this kind of work so timely are that our ethnic and linguistic make-up is changing rapidly; the use of computers and new technologies is proliferating; there are greater literacy requirements for func­ tioning in our knowledge economy; there are unprecedented stresses on our healthcare and education systems; we have an aging population at the same time as there is a growing reliance on home and com­ munity care in place of institutional care; and Canadians are finding increasing opportunities and responsibility to provide health-care information, support and edu­ cation internationally as well as locally. Finally, we urgently need multi-sectoral collaboration to solve many kinds of prob­ lems. The field of health promotion has a S62 REVUE CANADIENNE DE SANTÉ PUBLIQUE VOLUME 96, SUPPLÉMENT 2