As someone who has done some work on the measurement of health literacy, I agree with Jenny that there is a problem with the literature/research on health literacy related to how health literacy is operationalised in much of this literature/research. There is no doubt that most of the research and literature does focus at the individual level and that the existing measures (including our own) do not fully capture the essence of what health literacy is or might be. However, there is a growing realization by people working in the field that health literacy is more than an individual phenomenon. As the Institute of Medicine Committee pointed out in their 2004 report, health literacy has to do with the interaction between the individual and the various health contexts that they encounter in their lives. Unfortunately, this is a very difficult conceptualization to operationalize and although there is some work taking place to try to do so, it is still in its infancy. In the meantime, we are still relying on individual level measures, and inadequate ones at that. Thus, statements such as the one noted by Stasha have to be taken with a grain of salt. What I think would be fair to say, based on existing research is that literacy is one outcome of education that appears to have a strong direct and indirect impact on health; and health literacy which is in part, an outcome of general literacy and other kinds of literacies (e.g. scientific literacy) as well as life-long learning, has a mainly a direct effect on health. In other words, as suggested by Stacha both literacy and health literacy are "downstream" factors that appear to affect health, or perhaps "mechanisms" though which education and other "upstream" factors such as those noted by Stacha affect health. This doesn't mean that they are unimportant, but they probably don't qualify as "determinants of health" in sense of "causes of the causes" as defined by the Commission on the Social Determinants of Health. I hope this is helpful. Irv Rootman Adjunct Professor, Human and Social Development University of Victoria, British Columbia From: "Popay, Jennie" <[log in to unmask]> To: [log in to unmask] Date: 2011-02-04 05:41 AM Subject: Re: [SDOH] Heath Literacy as a Key Determiant of Health Sent by: Social Determinants of Health <[log in to unmask]> _____ Agree entirely with Dennis's recently reply re Wright Mills on psychologism but there is an additional dimension to/problem with the literature/research on health literacy whcih relates to how health literacy is operationalised in much of this research. I am not totally up to date with research in this area (it has a tendency to depress me and given where our ConDem coalition are taking us just now in the UK in terms of the wider determinants of health I have more than enough triggers for depression without voluntarily adding any more), however there is a tendency to collective evidence via structured questionnaires with all the problems associated with the construction of appropriate questions and to define health 'illiteracy' in terms of a lack of more 'scientific' knowledge about causes e.g. do people know what 'healthy food' is, do they realise how important it is to take exercise, etc. As research has shown (see our own now dated modest contribution referenced below) there are key difference between the perspective obtained on 'lay' knowledge about health inequalities/causality depending on the research methods used to obtain it. Always seemed to me that health professionals illiteracy about health inequalities and causal pathways is a much more serious problem for SDOH policies/action that any lack of quasi-scientific knowledge amongst lay people. But these are just my prejudices. Jennie Popay, J Bennett, S. Thomas, C. Williams, G. Gatrell, A. Bostock, L. (2003) Beyond Beer, Fags Egg and Chips? Exploring lay understandings of social inequalities in health, Sociology of Health and Illness. 25(1)1 - 23 Professor of Sociology and Public health School of Health and Medicine Lancaster University Lancaster UK From: Social Determinants of Health [ <mailto:[log in to unmask]> mailto:[log in to unmask]] On Behalf Of Stasha Donahue Sent: 04 February 2011 06:19 To: [log in to unmask] Subject: [SDOH] Heath Literacy as a Key Determiant of Health Hi all SDOH list participants I recently read this statement from an in house not yet released document which was essentially a literature review on health literacy done by an external consultant in Calgary. I wanted to gain perspective from others via this posting. "Health literacy is highly correlated with health outcomes and is considered a better predictor of health status than education, socioeconomic status, employment, race/ethnicity, or gender". I have yet to read the full document as I am too busy conducting focus groups with AHS staff with regards to Reducing Health Disparities across the province. I am just wondering how the rest of the SDOH list thinks about that statement regarding health literacy... particularly those in Population and Public Health realms? From what I have read and reviewed health literacy is a function of determinants such as eduction, employment, income levels etc? This (health literacy) seems kind of downstream to me as a previous ground level evidence based population health practitioner focussed on poverty reduction and SDOH for health equity. Of course, far be it for me to criticize AHS... Any thoughts? And feel free to challenge me if you think I am incorrect in my thinking... Stasha Donahue Health Promotion Specialist -Reducing Disparities Health Promotion, Disease & Injury Prevention Population and Public Health Fort Macleod Health Care Centre Box 520 Fort Macleod, AB T0L 0Z0 Tel: 403-553-5352 Fax: 403-553-2333 From a population health perspective, I strongly disagree with this statement. _____ This message and any attached documents are only for the use of the intended recipient(s), are confidential and may contain privileged information. Any unauthorized review, use, retransmission, or other disclosure is strictly prohibited. If you have received this message in error, please notify the sender immediately, and then delete the original message. Thank you. 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