Why do you cover health literacy in a class on social marketing? An innocent question on one hand, but also one that demonstrates the 'curse of knowledge' that haunts so many people in public health and social change who are oblivious to the insidious nature of health illiteracy. Learning how to promote health behavior and social engagement by communicating the right words at the right times to the right people, re-arranging the physical and social environments to provide more access and opportunities for more personally and socially beneficial behaviors, and removing barriers and increasing incentives to do the right things are all fine. But what if our audiences don't even understand what we are talking about - or can't hum the tune, let alone read the words on the sheet?
That's what should make health literacy an important upstream issue for social marketers. I've talked about the dismal statistics in the US, and now Canadian public health professionals are having their eyes opened to a problem that not only undermines health promotion efforts, but the quality of health care, for decades to come. From The State of Learning in Canada report.
More than half (55%) of Canadians aged 16 to 65 do not have levels of health literacy adequate to read nutrition labels, follow medication directions, understand safety instructions, or make informed and adequate choices for their own healthy living.
Health literacy is particularly low among seniors, who require health services most and are prescribed the greatest number of medications. Of all Canadians older than 65, 88% lack the literacy skills needed to deal with health information.
Low educational attainment and health illiteracy are not going to simply disappear as social determinants of health status and health care. Upstream social marketers and consumer advocates need to understand these issues from the people's POV and communicate these effectively to health policymakers who blithely seem to believe that the consumer can and should be in charge of making their own health care decisions - regardless of what they have to say! In fact, there is little evidence for how health literacy may impact the ability of patients to understand and use the basic building blocks of health care reform initiatives such as electronic and personal health records.
Where are the audience-driven research studies with these population groups around these life-or-death and quality-of-life issues? Health care reform is too important to leave just to the experts.