What is the difference between health literacy and health promotion? Well, it kind of depends on your understanding of what health literacy is. If you believe, as I do, that it is about identifying an individual's resources and skills and developing further skills towards health gain and empowerment, then I would say the two concepts are hard to separate. But here's why health literacy is useful and why it should be further developed alongside the health promotion.
It has resonated with the medical profession – provided them with tools, instruments and measures to support them to be better communicators. There's often an assumption that doctors purposefully and arrongantly communicate badly. Not true, (well, I'm sure it is sometimes). Communication is a skill that comes easily for some and not for others. Health literacy tools, particularly those that have come out of the States, fit neatly inside the medical or clinical framework. They are tools that can be written into a clinical practice guideline, they are a set of instructions, steps towards supporting the patient and can be measured and tested and trialed. No, they won't necessarily support patients to be anything more than "compliant" in their current episode of care and the patient won't necessarily feel any more empowered but communications between doctors and their patients will have improved, and by any measure that is a good thing.
Of course, there is a long way to go on this - but it's a start
Health literacy is bringing together the fields of healthcare and education; particularly adult education and ESL and encourging health care providers look outside their worlds to consider what other fields of expertise are offering. Again, not enough but it is happening.
Health literacy has provided a focus on information and has helped us to acknowledge the demands of health information in a increasingly knowledge-based society. I think maybe, that in the context of health promotion campaigns, health information has tended to take a second place to activities, events and social marketing. Brochures and booklets are only a small part of the overall campaign. Health promoters have always considered plain langauge and pictures and accesiblity but not, I don't think, to the same extent as they are considered in the context of health literacy interventions. And consideration for the role of health literacy also makes us think about the ways in which information is accessed, the impact of delivery, the role of functional literacy and numeracy in ways that maybe the health promotion movement hasn't.
So, it has its place and its importance and needs to develop its own theory and framework (something which is still absent). And then it can merge with the developing theories around health promotion - salutogenesis for example! (It's ok, new to me too).
Finally another question and I would love my colleagues to answer it with me . . . If literacy, in its broadest sense, is a skill for health, is health also an opportunity to develop literacy? In other words, should we be using the health encounter; a time when people are open to ideas and information, as an opportunity to promote learning and literacy? A good example of this is the Baby Basics program in New York. It exploits pregnancy, a time when most women want to do the best by their babies, by offering information in a tantilising format. It subtly introduces women to the idea of information use, reading and finding information - in theory, increasing their generative health literacy. They suggest that childbirth education classes be held in libraries so that women, for perhaps the first time in their adult lives, are able to get a library card. In, London the LLU+ - an adult education organisation - work with women who have small babies to "make" books to encourage literacy in their babies but inadvertantly the women themselves are developing their own skills.
Research that was done by the America's national medical research institute, the National Institutes of Health, has found that a mother's reading skill is the greatest determinant of her children's academic success, outweighing other factors such as as neighbourhood and family income. Go read it at http://www.nih.gov/news/health/oct2010/nichd-25.htm
So any concerted efforts to promote literacy in mothers is a plus for the community's health. And if pregnany is an ideal opportunity what should our role be?