Long time no post

I have been quiet on the blogging front. Caught up in doing and forgetting about the need to record.  Health literacy as a concept continues to keep its head above water in the Australian context. The National Commission for Quality and Safety is working hard to entrench health literacy in the national standards that all hospitals must strive to achieve. The Health Knowledge Network at Latrobe University is doing great work towards collaborating with hospitals to develop national guidelines for health information. The Centre for Culture Ethnicity and Health have developed a course for health professionals to build skills and conduct projects within their health services. My own workplace strives to improve access to pregnancy and parenting information focussing always on equity and access.
But the debate continues.
What is health literacy? I know right. We are still asking the question. Which of the 17 or so definitions suits out need? The IOM definition doesn't quite capture it, still too much emphasis on individual skills and not enough of the barriers put up by the health care system. Health literacy is often, quite rightly, bundled up with the other social determinants (education, income, culture - all the things that make it less easy to be healthy). Health literacy it is a social determinant say some, it is socially determined say others (its both says Dr Rima Rudd!).  And yet, all things being equal (i.e the social determinants have been cured) health literacy can be completely undermined the moment people are confronted with the health system.
I spoke to a group of medicare local folk a week or so ago. They want to promote after hours locum services to a public that has no idea the services exist, who think after hours doctors can't possible be as good as emergency services, that they would cost a fortune, that a doctor in your house in the middle of the night is kind of creepy. They have an image problem. So people take their sick and ailing bodies out into the chilly night and clog up emergency services instead.  It's a health system in constant flux and the change is hard to keep up with. A colleague broke her shoulder, was sent by a GP to a hospital fracture clinic who told her the GP would need to make an appointment - and she wouldn't get in for some time. It was a week before she was able to see someone who was able to make a proper diagnosis and she had to pay for it.
My point, though slightly rambling, is that if health literacy is a social determinant, its the one social determinant that we, in the health sector, can impact. We can make our system more accessible. We can make it easier for people to know where to go, how to use our services, how to make appointments, when we might have to pay, when its free. I recall a report on women from African communities and health information, which concluded that women have quite reasonable health literacy but struggled with understanding the Australian health system. I know how they feel.