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Health literacy has been criticised for focusing on the role of the individual in healthcare and health improvement. This critique emphasises that too little account is taken of the impact of adverse social and economic conditions that are beyond the immediate control of individuals and the limitations these place on individuals in their options to respond to health communication. This includes the impact of our physical environment, access to education, employment, and adequate housing and income. These conditions can significantly limit individuals’ abilities and options to respond to health communications intended to protect or improve health. For example, communications that tell people to change the food they eat when “healthier” food is not available at a price they can afford, or provide healthcare advice that is complex and resource intensive. When our communications require responses from people that are beyond their skills and resources, we run a serious risk of “blaming the victim” and perpetuating already existing inequalities in health. Put simply, those who are better educated and have greater access to resources are often best able to respond to health communications and benefit from them. Those with limited resources get left further behind.
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Many of our communications are of necessity directed at individuals, are intended to improve personal knowledge and skills, and are directed to facilitate predetermined changes in behaviour. There is nothing inherently wrong with this “functional” approach to health communication. That said, throughout the book we have consistently emphasised that people have different capacities to respond to standardised communication, and that these capacities are significantly influenced by the demands and complexities of the environment in which communication takes place. The concept of universal health literacy precautions referred to in Chapter 2 has emerged from this understanding of health literacy. Adopting universal precautions in health communication together with organisational action to reduce the demands and complexities of our health services can help reduce the risk that our health communications are only effective with a minority of consumers.
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So far, so good; universal health literacy precautions can help mitigate “risk”, but do little to develop health literacy as a personal and societal “asset”. Neither do they engage people in understanding and acting on the determinants of health that constrain their choices and opportunities. These social, economic and environmental conditions have a profound impact on access to the resources (and power) that enable people to exert greater control over their health.
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In Chapter 1, we introduced the concept of critical health literacy to describe the most advanced health literacy skills that can be applied to critically analyse, understand and apply information from a wide range of sources. We have examined in subsequent chapters how more advanced health literacy skills can be developed through the use of interactive communication methods and more diverse content. In this chapter, we consider more deeply the relationship between health literacy, the social determinants of health ...