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The plague of low health literacy

Bottles of medication with instructions
Canadians are having difficulty understanding health information, including instructions that appear on medications.
OTTAWA  |  Instructions from the doctor used to be as simple as, "take two pills and call me in the morning." But today more than half of the Canadian population cannot understand or evaluate basic health information.

Fifty-five per cent of adults and 88 per cent of seniors do not have adequate literacy skills to make informed decisions about their own health, according to a new report on literacy in Canada from the Canadian Council on Learning.

"You are exposed to health information in many different contexts," says Irving Rootman, a professor of health research at the University of Victoria.

"When you go to see your doctor or pharmacist, when you watch television and see medical ads, when you're buying food and reading nutrition labels, health literacy has to do with people's ability to make sense of that information."

Rootman thinks the statistics are an indicator of the complexity often found in health instructions and reflect the fact literacy levels decline with age. He thinks health providers should write materials such as brochures, safety instructions, and medical pamphlets in clear language that everyone can understand.

Literacy in Canada faces an uphill battle

Working with the not-for-profit Canadian Public Health Association (CPHA), and the federally funded National Literacy Secretariat (NLS), Rootman is co-chairing an expert panel on health literacy. The committee brings together health practitioners, researchers and educators to communicate the issue to the medical community and raise it on the political agenda.

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But the panel is facing an uphill battle as the NLS lost a quarter of its operating budget in September when the Conservative government cut $17.7 million in funding from adult learning and literacy groups.

"The federal government has cut back and has failed to fund a number of the coalitions to improve general literacy, let alone health literacy. I'm not too impressed with what they have been doing in this area," Rootman says.

The Public Health Agency of Canada notes that people with low literacy have higher rates of hospitalization and experience more difficulties using the health care system. Currently PHAC supports a project to examine determinants of health and spokesperson Jean Riverin says the "first priority issue" is to develop goals towards health literacy but no timeline has been specified.

Investing in literacy

Nonetheless, CPHA employee, Helen Simson, who is working with Rootman on the health literacy expert panel, is optimistic.

'Educated people have a better quality of life ... and are able to make informed decisions about their health.'

"If we can demonstrate that investing dollars in literacy will certainly save dollars in health care, we think that is what will grab the attention of the policy makers."

She says the committee will be looking at ways to make health information more understandable to groups like seniors or immigrants. In the near future, this will include creating informative DVDs that will play in the pharmacy or doctor's office, so people can see and hear the medical information in addition to consulting provided reading material.

Simpson also says that improving health literacy among Canadians must involve not only government but educators, and medical practitioners.

No one is immune

Canadian Council on Learning research analyst Erin Mills, who worked on the adult learning section of the report, agrees.

Erin Mills, research analyst at the Canadian Council on Learning, reads a book.
Erin Mills says improving literacy is everyone's responsibility.

She thinks that the responsibility falls on everyone because literacy is an issue that cuts across all socio-economic levels, ethnicities and ages.

"People can say, 'oh, I don't have the time, I don't have the money, governments aren't investing enough, the education system isn't doing enough, my family's not doing enough,' but really I think it comes down to fact that everyone has a role to play," she says.

This may include health providers working towards better communication with patients and plainer language being used in reading material. The CCL report also suggests that to improve health literacy, clear national targets and timelines must be established for literacy in general. And because reading skills decrease with age, continued learning is key to improving health literacy among seniors.

Mills points to countries like Sweden and Ireland, which boast higher health literacy rates than Canada because they have launched national programs to improve adult literacy and address life-long learning.

"Educated people have a better quality of life and use the health care system less frequently," Mills says. "They are able to make informed decisions about their own health and that's really important. It's critical so there's less reliance on the healthcare system and that's a really good thing."

Related Links


Opens in a new window Human Resources and Social Development Canada:
National Literacy Secretariat


Opens in a new window Canadian Council on Learning

Opens in a new windowNational Literacy and Health Program
State of learning in Canada

The Canadian Council on Learning is a not-for-profit organization to research and promote life-long learning. Its report, published in 2007, examines the learning status of Canadians in several areas. In addition to health literacy, here are some of the key findings:

Adult learning

• About 42 per cent of the adult population lack the literacy skills to succeed in today's economy.

• The proportion of Canadian workers enrolled in formal work-related training rose from 29 per cent in 1997 to 35 per cent in 2002.

Early childhood

• One in four children enters Grade 1 with learning or behavioural problems that could affect future success in academics and life in general.

• Twenty-one per cent of four- and five-year-olds from low-income families showed delayed development on a test involving copying and understanding symbols such as letters and words.

• A growing proportion of pre-schoolers are being read to daily by their parents or other adults (67 per cent in 2002-2003, compared to 56 per cent in 1994-1995).

• In 2004, Canada spent 0.25 per cent of Gross Domestic Product on early childhood services, including child care, for children up to the age of six — the lowest of 14 OECD countries with comparable information. Scandinavian countries, by contrast, spent up to eight times as much in relation to their GDPs.

Learning in school

• In reading, math, science and problem-solving skills, 15- year-old Canadians scored above the OECD average in 2003. Canadians were stronger in reading and weaker in science. Girls outperformed boys in reading, while boys scored slightly higher in mathematics.

• Nine per cent of students dropped out of high school in 2005-2006, down from 17 per cent in 1990-1991. Canada's dropout rate remains higher than many other OECD countries; and more than double that of Norway.

• The proportion of Canadians aged 20 to 24 attending post-secondary institutions increased from 25 per cent in 1990 to 37 per cent in 2005. Between 1993 and 2003, there was also a 38 per cent increase in the number of master's degrees awarded to Canadian students, and a 50 per cent rise in doctoral degrees.

Aboriginal learning

• While 21 per cent of Aboriginal people spoke an ancestral language as their mother tongue in 2001, that proportion had declined from 26 per cent over just five years. Among children, only 16 per cent spoke an Aboriginal language in 2001, down seven percentage points from 1996.

• Inuit people in Nunavut are most likely to maintain their language, with 99 per cent of older people and 81 per cent of youth speaking Inuktitut fluently or relatively well.

• In 2001, 57 per cent of Aboriginal people between the ages of 20 and 24 had at least completed high school, a steady increase from 38 per cent in 1981. Still, the proportion of young Aboriginal adults who had not completed high school was more than 2.5 times higher than among the non-Aboriginal population.

Source: State of Learning in Canada report 2007, Canadian Council on Learning


U.S. health literacy

In the U.S., government, educators and non-governmental organizations have developed a set of health objectives to be met by the year 2010. One objective that figures prominently is improving national health literacy.

The two main surveys used to measure health literacy in North America are the Rapid Estimate of Adult Literacy in Medicine (REALM), and the Test of Functional Health Literacy in Adults (TOFHLA). Both test reading ability in a health context, but do not measure oral and aural literacy.

When the TOFHLA was administered to 2,659 predominantly indigent, minority emergency room patients at two public hospitals in the U.S., 41.6 per cent were unable to comprehend directions for taking medication on an empty stomach.

Twenty-six per cent were unable to understand information regarding when to come for a next appointment.

Fifty-nine per cent could not understand a standard informed consent document.

Sources: Literacy and Health Research in Canada report 2003 and Healthy people 2010