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1.1 Introduction

So much of what we do in healthcare and public health relies upon people being engaged in decisions about their health. Health education and public communication campaigns have always been an essential element of public health. In the clinic, patient education has evolved over past decades as people have become partners in decisions about their healthcare. We know from practical experience that not everyone responds in the same way and with equal success to our health communications. There are many reasons why this is the case—our communication methods may not be as good as we would wish; individuals vary considerably in their skills, capacity and motivation to respond to them; and the social and economic conditions that people experience may not support the response we are hoping for.

This book is intended to help you understand how to be a better communicator and how to work more effectively with individuals and communities in helping them to find, understand, appraise and apply health information. It will do so by exploring the concept of health literacy from multiple perspectives.

1.2 Literacy, language and health literacy

Literacy has been defined as “the ability to understand, evaluate, use, and engage with written texts to participate in society, achieve one’s goals, and develop one’s knowledge and potential” (OECD, 2013). This definition makes clear why societies around the world place great value on achieving high levels of literacy in their populations. It focuses attention on what literacy helps us to achieve—enabling people to better develop their knowledge and improve their potential to achieve personal goals. Higher levels of literacy also enable individuals to participate more fully in society and the economy.

Literacy is also associated both directly and indirectly with a range of health outcomes. Low literacy is often associated with established social determinants of health, including, for example, employment status and lifetime income. We also know that people with poor literacy also tend to be less responsive to traditional health education messages, are less likely to use disease prevention services and are less able to successfully manage illness.

Fortunately, literacy is not a fixed asset. It can be improved, especially through formal education and through structured communication. People can develop their literacy skills from basic, word level skills (such as recognising words) through to higher level skills (such as understanding and analysing meaning from continuous text). Individuals vary in their ability to learn and will respond in diverse ways to the stimulus provided by different forms of communication and media. Each of these issues is examined critically throughout this book.

Literacy should not be confused with language spoken. This is especially important in multicultural populations where many people in communities speak a language other than English. In populations where English may be a second or third language, it is important not to ...

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