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Letter from the Editors--Health literacy and Health Promotion, A Compilation

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I Introduction

Canada has a serious health literacy situation. More than 55% of Canadian adults do not have the skills to understand information about their own health or make daily decisions about their health, according to a report released in early March by the Canadian Public Health Association.  Its expert panel called the low levels of health literacy in Canada "critical" and said that a countrywide strategy is needed to solve the problem, especially since our health-care system will become increasingly complex.

"We were shocked to learn that 88% of adults over the age of 65 (3.1 million) appear to be in this situation [health illiterate]" says report author Irving Rootman, director of Health and Learning Knowledge Centre at University of Victoria. Seniors are facing a higher level of health information demands as they are more likely to have chronic health problems and need medications that may be difficult to understand.

Research shows a strong link between low health literacy and poor health, and that low health literacy may contribute to higher health service costs. Addressing the issue of health literacy could lead to significant improvements in the health of Canadians. What can health promoters do about health literacy? Understand the concept and how it relates to theory, practice and policy, find resources, and build our capacity to act in changing policies, and interventions.

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II What is Health Literacy?

According to the CPHA Health Literacy Portal, Health literacy involves access to health information and the ability to understand, communicate and act on this information ((

It means people's ability to read and act upon written health information (such as the use of  medications), the skills to communicate health needs to physicians, or listening skills to understand the instructions that are given.

Health literacy is an evolving concept, and how health promotion practitioners are involved has varied from educating individuals to systems change. Over the past 15 years health literacy has focused on an individual's ability to read and understand health information.  Lately, the focus has expanded to include the ability of health systems and care providers to communicate in relevant and easy to understand ways.

The recent alarming reports on the levels of health literacy in the Canadian population should cause us not to quibble over definitions, but to look for what we can do, who we can work with, and what level of action is required.

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III Find out more about health literacy in Canada

Health Literacy in Canada: Initial Results from the International Adult Literacy and Skills Survey (IALSS)
The Canadian Council on Learning, September 2007
Maps out the distribution of the estimated 60% of adult Canadians who are believed to possess low health-literacy rates

Vision for Health Literate Canada Report of Expert Panel on Health Literacy
Canadian Public Health Association, March 2008
CPHA's Expert Panel found a majority of Canadian adults do not have the skills needed to respond to daily health information demands. Low health literacy is associated with poor health and the Panel estimates that the situation in Canada is critical.

Health literacy portal
Canadian Public Health Association (CPHA)
This site defines health literacy as an essential ingredient of health promotion; offers links to facts and statistics, strategies and solutions, tools and resources; describes CPHA's work in health literacy; and provides links to health literacy partners. 

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IV Resources on health literacy

These resources are increasing in availability, but our best web source that brings together health promotion resources from non-profit organizations--the Canadian Health Network (http://www.canadian-health-network)--is being shut down by its funder, the Public Health Agency of Canada, on March 31, 2008.

Right now you could easily search for "health literacy" resources on CHN and get a high-quality  annotated links list of more than 30 web-based free resources. Those publications and portals will still be on the Internet in April but harder to find and not in one place. There is a new portal at the Canadian Public Health Association that highlights their own project, publications, facts, and figures. Health literacy networks across the country are linking to resources on plain language, education, and health. In the United States and across the European Union, there are national reports on the issue and policy commitments, and a number of consumer health information resources and online tutorials and materials.

Here are the top helpful resources from CHN.

The CPHA Health Literacy Portal

Literacy and health: implications for active living
Defines literacy and health literacy, suggests why active living practitioners should be interested, comments on health literacy and active living communications, and provides approaches to use in practice
Source: Alberta Centre for Active Living Wellspring

Mental health literacy in Canada: phase one report: mental health literacy project
Discusses the conclusions of the first phase of the 'Mental Health Literacy' project. Provides a review of existing data, a national survey, a follow-up with focus groups, and a summary of findings; suggests the best approach to increasing the mental health literacy of Canadians.
Source: Canadian Alliance on Mental Illness and Mental Health (CAMIMH)

Health Literacy Network News
A program of the BC Coalition of People with Disabilities, providing information on health resources, services and events in BC and beyond

Health literacy
Defines what health literacy is and why it is important to people with disabilities, describes the Health Literacy Network (HLN), includes references to health information in easily understood plain language and alternative formats for people with disabilities
Source: BC Coalition of People with Disabilities (BCCPD)

Health Literacy
Describes a Nova Scotia initiative to raise awareness among primary health care providers about literacy issues and how to help patients better understand information about their health, provides links to the initiative itself as well as factsheets and related resources for health professionals.
Source: Nova Scotia Department of Health

Navigating health: the role of health literacy
Presents the conclusions of a European healthy policy forum; calls on policymakers to make health literacy a central pillar in health policy discussions, research and action at all levels; defines health literacy, the prevalence and costs of low health literacy, and what works
Source: European Men's Health Forum (EMHF)

Health literacy and Internet: recommendations to promote health literacy by the means of the Internet
Explores how the use of Internet can contribute to improve health literacy among European citizens, especially of those with low health status, as well as the use of this media among vulnerable groups
Source: EuroHealthNet 2005

Unified Health Communication 101: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency
US Department of Health and Human Services, Health Resources and Services Administration (HRSA) (2007)
This free online interactive training course designed to improve interaction between health care providers and their patients "aims to raise the quality of provider-patient interactions by teaching providers and their staff how to gauge and respond to their patients' health literacy, cultural background, and language skills."  The course's five modules take 4-5 hours to complete. Modules 1 through 4 provide an introduction to health communication, health literacy, cultural competency, and limited English proficiency. In Module 5, participants can apply information learned in previous modules ( 
[Thanks to Susan Murray's column in March 2008 Journal of Canadian Health Libraries]

The BC based Health Literacy Network
This network suggested a different American health educators online course on health literacy: "Health Literacy: New Field, New Opportunities"--an online tutorial in 4 parts:

  • Health literacy challenge
  • Meet some health literacy practitioners
  • Learn successful strategies and practices
  • Apply what you have learned

World Education  and National Network of Libraries of Medicine

"Culture, Health and Literacy: A Guide to Health Education Materials for Adults with Limited English Literacy Skills"
World Education in collaboration with the National Institute for Literacy, Washington DC (2000)
This guide is for use by health-care practitioners who need appropriate health education materials and websites. Each material listed has a description of how it can be used,  how to order it, and costs. Subject and language indices are in the back of the guide.

Expanding the Reach and Impact of Consumer E-Health Tools
The report from the US Dept. of Health and Human Services notes there is an opportunity to use these technologies to improve population health, and describes the most significant requirements as well as provides a vision to help guide the development of an inclusive environment of e-health benefits.

U.S. Surgeon General's Workshop on Improving Health Literacy
The proceedings of September2006 national workshop on state of science of health literacy from multiple perspectives and identified issues of public health consequences, meeting special populations needs and established evidence base for taking action.

Recent articles in mainstream media on health literacy

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V  Additional References

Rootman, Irving; Frankish, Jim; and Kaszap, Margot. "Health Literacy: a new frontier,  in Health Promotion in Canada (2nd edition). Toronto: Canadian Scholar's Press, 2007.

Rootman, Irving. "Health literacy: Where are the Canadian doctors?" Canadian Medical Association Journal 175 (6) 606. Available at

Rootman, I. & Ronson, B. "Literacy and Health Research in Canada: Where Have We Been and Where Should We Go?" Can. J Public Health 96 (suppl 2). Available from NALD,