Heading home

Flying home last week, via an unexpected and unwelcome detour to Sydney, I started to wonder how I might go about communicating the massive amount of information I have gathered. Health literacy is a poorly conceived notion in many ways. There are many definitions - all involving abilities and capacities to access, understand, communicate, use and evaluate health information. But the jury is very much out on what it is about health that is so tricky to access, understand, communicate, use and evaluate. Why is it that some people are able to manage relatively well? Is it cognitive ability, education levels, socio-economic status - empowerment, confidence? Or is it an increasingly complex health care system, together with an increase in chronic disease and the necessity for people to manage their own health. Is it a bit of all of those things? At the Health Literacy UK conference that I attended in Manchester, Don Nutbeam (health literacy guru in the UK) pointed out that the broader notion of literacy has struggled for a theory and measurement for many decades. So we needn't panic. The debate will continue and theories and measurements will come and go but in the meantime we need to apply what we do know and in doing so we need to feed the development of those theories and measurements.

So how do we act? What do we put in place to cover all possible reasons for why health literacy might be an issue. Actually, there are some very good starting points - the Calgary Charter, the American National Action Plan, the plain language movement (yes, I know, It's a start but not enough). Rima Rudd's work on health literate environments and the many, many interventions that encourage better communication from health professionals and better access for people who, for whatever reason, have been disconnected from health. As health professionals we do have a role to encourage what Christina Zarcadoolis refers to as generative health literacy - applying information to new or novel situations. And that requires a new understanding of how we all work as patients. How, as patients, we access, understand, use, communicate and evaluate information. And that's hard, because we all do it differently. It's hard but necessary.

Leeds - Wakefield - Yorkshire

Some great work going on at the University of Leeds. Particularly interested in some research with a critical health literacy bent. One study looking at the links between health literacy and women's decision making about pain relief during childbirth and another study about women, diet and exercise. Researchers here are also looking into diabetes, self management and some really interesting work on the information that comes with the various medical devices that people need to self manage. The findings, rather unsurprisingly found that the misuse of such devices can lead to incorrect readings. Really? (Said with irony!) And what are the consequences of having incorrect readings of your blood sugars and insulin? The European Union requires that information provided to patients passes a usability test but this kind of information slips through some kind of loop hole and is consequently excluded. Crazy.

In Wakefield I met with Sam who has led a health literacy program in the local Primary Care Partnership over the last three or so years. Wakefield and its five towns - are nestled between between Leeds and Sheffield and the population is almost as stable as the beautiful old cathedral that sits in the the town's centre (above). But towns like these bear the brunt of economic crisis and consequently there is a lot of disadvantage. Indeed the town has probably been beset by social issues long before us city dwellers ever used the words economic and crisis side by side in a sentence. Sam comes at health literacy through adult education and, in her pre-Trust life, her job was to develop info and resources for adults to develop skills using their interest in, say, football. Again it is this approach to adult learning which manages to move away from the "threat" of learning - and learning is a threat if you have been disempowered by the experience of education - and instead finds common ground that the adult learner can engage with. Sam's passion has lead to the establishment of the "Barge project". The idea dawned on her one day when she realised that the canals ran through the backyards of some of the most disadvantaged communities. The project has developed its own legs over time and successfully takes out groups of locals; distracts them with the driving of the boat and the sheer novelty of being out and about - a holiday at home for people who just don't holiday - and whether they know it or not these people are developing their health literacy. How? Through cooking on the boat, using a knife, cutting a vegetable, talking about stuff, sharing information. Rules around smoking and using electronic gadgets have the affect of making people realise the benefits of being busy and distracted. Strong community development work - not necessarily stuff that can be taken to my workplace, well not beyond what I have been already gathering on the best ways to engage and to pass on information to people and to create environments that encourage generative health literacy. But certainly this illustrates the obvious benefits of such an approach.

Turku - Finland

In the old Finnish capital of Turku, remnants of its former glory are tucked amongst many less elegant structures from the latter half of the last century. There are big cobblestone squares and buildings that have stood for so long they slouch. But there are also big soulless concrete blocks lining the city’s centre; functional, living spaces, businesses etc. But I saw very little of it really, beyond the well worn path from my hotel to the conference centre and the never-dark view from my window. And Turku needs time I think.

I was there for the International Health Promoting Hospitals Conference where a surprising number of doctors and senior hospital administrators, as well as a handful of academics and health promotion practitioners have gathered to nut out the role of the hospitals in promoting health as well as treating illness. The theme of the conference was salutogenesis – which, as I understand it, is a shift of focus from the risks of ill health to the resources for health. So rather than research what makes people take up smoking, consider what it is about the people who never take it up, or drives people to give it up. That’s it in a nutshell. Indeed it is rather similar to the way that Christina Zarcadoolis talks about health literacy. Let’s not focus on what is wrong with people – let’s find what is right about them and build our efforts to communicate around that.

At this conference, I was struck by how many of the health professionals, particularly the clinicians, had developed their interest in health promotion. It really was like a bolt from the blue, like they had suddenly started listening to their patients and realised that there was something wrong with the way that healthcare was being delivered. The classic “aha” moment, where the pieces all fall into place .

Some quotes . . .

“what is the point of treating these people over and over again without addressing the issues that are making them sick in the first place.”

“Health is no longer a thing of its own. It is connected and takes a part in shaping society”.

“The health care system has made massive gains in keeping people alive but not increasing healthy life years”.

It all makes sense – now for the mechanisms.