Towards Equity and Health Literacy

Abstract

Health literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health5, p10 The seminal work of Nutbeam was particularly influential in both conceptualising and popularising what was meant by health literacy.6 He successfully extended the conversation beyond basic/functional health literacy and started to raise concepts about communicative/interactive health literacy and critical health literacy.6 While these expanded definitions continued to focus on the social and cognitive skills of the individual, they also reflected a transition in thinking. They hinted towards the environmental conditions that support health literacy at a population level. Zarcadoolas and others built on this work and expanded the health literacy model, emphasising the importance of science literacy, civic literacy and cultural literacy.7 Combined, this marked a notable shift in national and global health literacy scholarship. This scholarship emphasises the multi-faceted and evolving nature of health literacy; and highlights its continued contested terrain.1, 2, 19 That is, there remain many ways to conceptualise what health literacy constitutes, and why it is perceived to matter. Recent literature has reinforced that health literacy is both an individual endeavour (ie focused on improving individual health behaviours or achieving positive lifestyle changes) and population endeavour (ie focused on improving population health outcomes).4, 13, 14, 20 Within the latter discourse, there has been a focus on improving health settings and systems to better meet the health needs of the individuals, families and communities.4, 13, 15 It involves an explicit focus on the environment in which citizens think about and make health decisions. This contrasts with earlier definitions which focus more on an individual's attitudes and behaviours. Interestingly, but perhaps not surprisingly, recognition and growing understanding around the complexity of health literacy, has paralleled a separate but intertwined public health discourse about the importance of addressing the social, economic, cultural, political and commercial determinants of health.19, 22, 23 An underpinning tenet of such work relates to the importance of reducing health inequities and empowering communities to exert control over the determinants of their health.14, 19, 22-25 This is particularly important to the most vulnerable and marginalised communities across our region, including but not limited to, Indigenous communities; refugees and people from migrant backgrounds; people from Non-English Speaking Backgrounds; people living in poverty, including those living rough or from lower socio-economic status backgrounds; and people living in regional, rural and remote locations. Gender is also increasingly identified and discussed as social determinant influencing health literacy. As such, the Health Promotion Journal of Australia is preparing a special issue on Equity and Health Literacy. With anticipated publication in late 2020, we encourage those health promotion researchers, practitioners and policy-makers undertaking work in this space to submit manuscripts. Contributions that reflect intersectoral action and strong community-oriented partnerships are particularly encouraged. We also welcome submissions from community-based researchers, First Nations scholars, early career researchers and higher education students. To be considered for this unique foray into our region's development and reflection on health literacy, submissions are required by the end of March 2020.

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