1 distribution of health literacy in canada irving rootman, ph.d. executive director, hlkc cpha...
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Distribution of Health Literacy in CanadaIrving Rootman, Ph.D.
Executive Director, HLKCCPHA Conference Workshop
June 2, 2008Halifax, Nova Scotia
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Outline
• Why health literacy matters in Canada
• Distribution of health literacy skills
• Vulnerable groups
• National progress
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Health Literacy is…
• the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course (Rootman and Gordon-El-Bihbety, CPHA, 2008).
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Why Health Literacy matters in Canada
1. Large numbers of people appear to have low levels of health literacy
2. Lower levels of health literacy appear to be related to poorer health outcomes
3. Increasing rates of chronic disease will increase the need for health literacy skills
4. Lower health literacy appears to be related to higher health care costs
5. Increasing complexity of the healthcare system and the deluge of health information now available put high demands on people for health literacy skills
6. Low health literacy may reflect inequities in health
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Many people in Canada have low levels of HL
• Based on the 2003 IALSS, 11.7 million working age residents of Canada (55%) are estimated to lack the minimum level of health literacy needed to effectively manage their health information needs (CCL, 2007a).
• When seniors are added, an estimated 14.8 million may be without adequate health literacy skills. An estimated 88% of respondents 65+ fell below Level 3 on the Health Literacy Scale in the 2003 IALSS survey (CCL, 2007a).
Level 3 is considered the minimum level of proficiency required to meet the demands of modern day life including those posed by health information
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Health Literacy Scores by Self-perceived General Health Status, Canada, 2003
Poor
Fair
Excellent and Very good
190 200 210 220 230 240 250 260 270 280 290
interval95% Confidence
Interval
Estimated average score
Good
scoresSource: CCL, 2007b, CCL, based on IALSS 2003
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Incidence of diabetes by health literacy mean scores of each health disctrict in Canada
0
2
4
6
8
10
220 230 240 250 260 270 280 290
health literacy mean score
Incid
en
ce (
in %
) o
f d
iab
ete
s i
n t
he p
op
ula
tio
n (
12
an
d o
ver)
Source: IALLS 2003 and
Source: CCL, 2008, based on IALSS 2003
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Increasing chronic disease and health literacy
• The number of people with diabetes in Canada is projected to increase from approximately 1.4 million patients in 2000 2.4 million in 2016 (Ohinmaa, et al., 2004)
• One of the ways to address chronic disease which is being increasingly used is patient self-management (McGowan, 2005)
• Low health literacy is a barrier to effective self-management. A review of randomized control trial studies found that 62% of patients with lower reading skill levels were unable or unwilling to engage in self-management (Johnston et al., 2006)
• Improving literacy and health literacy should lead to improved
self-management of chronic diseases
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Health Literacy (Reading Proficiency) and Cost:
• An analysis of expenditure data from a study of public hospital patients found that predicted in-patient spending for a patient with inadequate HL (Reading Proficiency) was $993 higher than a patient with adequate reading skills. A difference of $450 remained after controlling for health status (IOM, 2004).
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Estimated Economic Drain of Low Health Literacy on U.S. Economy:
• “initial approximation places an order of magnitude of the cost of low health literacy to the U.S. Economy in the range of $106 billion to $238 billion annually” (Vernon et al., 2007)
• “When one accounts for the future costs of low health literacy that result from current actions (or lack of action), the real present day cost of low health literacy is closer in range to $1.6 trillion to $3.6 trillion” (Vernon et al., 2007)
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The relationship between GDP and average health literacy scores by province
240.0
245.0
250.0
255.0
260.0
265.0
270.0
18000 20000 22000 24000 26000 28000 30000 32000
GDP per capita
Hea
lth
Lit
erac
y A
vera
ge
Sco
re
Source: CCL, 2008, based on IALSS 2003
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Demands of health information materials:
• Over 800 studies have found that health- related material for patient education far exceeds the reading levels of the average adult (Rudd, 2007). A Canadian study found that the mean reading level of patient education materials in a primary care clinic in Montreal was grade 11.5 (Smith and Haggerty, 2003)
• A study of health information websites in Canada, the U.K. and Australia found that the content of all sites was written at a higher level than recommended by literacy organizations. The lowest level was grade 11 (Petch, 2004)
1313Source: CCL, 2007b, based on IALSS 2003
200 210 220 230 240 250 260 270 280 290
Nunavut
New foundland and Labrador
Prince Edw ard Island
Ontario
Manitoba
New Brunsw ick
Quebec
Canada
Nova Scotia
Northw est Territories
British Columbia
Alberta
Saskatchew an
Yukon Territiory
Health literacy score
95% Confidence interval
Estimated average score
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Distribution of Health Literacy Scores, adult population (16 and over), 2003
0 100 200 300 400 500
Quebec
Yukon Territory
New Brunswick
Saskatchewan
Alberta
Canada
Manitoba
Nova Scotia
British Columbia
Prince Edward Island
Ontario
Newfoundland and Labrador
Northwest Territories
Nunavut
Health Literacy Scale
Mean± s.e.25%
Perc.75%Perc.
5%Perc.
95%Perc.
Source: CCL, 2008, based on IALSS 2003
1515
1616The analysis and mapping of the health-literacy results were conducted by J. Douglas Willms, Canada Research Chair in Human Development at the University of New Brunswick (UNB), with the assistance of Teresa Tang, GIS Programmer at the Canadian Research Institute for Social Policy at UNB
1717
Health Literacy Scores and Confidence Intervals by Age Group, Canada, 2003
66+
56-65
46-55
36-45
26-35
16-25
190 200 210 220 230 240 250 260 270 280 290
95% Confidence interval
Estimated average score
Source: CCL, 2008, based on IALSS 2003
1818
Health Literacy Mean Scores for key adult sub-population (16 and over) subgroups and sub-population size, 2003
26-35 Yrs
36-45 Yrs46-55 Yrs
56-65 Yrs
Over 65 Yrs
Male
ImmigrantNot Employed
Aboriginal (Off reserve)
16-25 Yrs
Female
Not Immigrant
Non Official Language
Official Language
French Minority Language
Employed
Canada Total
190
215
240
265
290
0 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000
Sco
res
wit
h 9
5% C
on
fid
ence
In
terv
als
Population Size
Level 1Level 2
Level 3
Source: State of Learning in Canada 2007, Canadian Council on Learning, based on IALSS 2003
1919
-0.25 -0.15 -0.05 0.05 0.15 0.25 0.35
Engagement in community or volunteer activities
Age
Gender
English speaking
Literacy practices at w ork
Foreign-born
Community size
Mother tongue different than test language
Occupational status
Informal learning by exposure to varied contexts
Aboriginal status
Labour force participation
Household income
Adult education and training
Informal learning by self study
Parents' education
Educational attainment
Literacy practices at home
Standardized regression w eight
Factors Predicting Health Literacy for Adults aged 16-65
Source: CCL, 2008, based on IALSS 2003
2020
National Progress in Health Literacy in Canada in Last Decade
• 2000: Workshop at First Canadian Conference on Literacy and Health
• 2004: Workshop at Second Canadian Conference on Literacy and Health
• 2005: Establishment of CCL Health and Learning Knowledge Centre with Health Literacy as cross-cutting theme
• 2006: Establishment of Expert Panel on Health Literacy
• 2007: Publication of national data on Health Literacy
• 2008: Release of Expert Panel on Health Literacy Report; National Symposium on Health Literacy; Workshops at CPHA Conference
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References
• Canadian Council on Learning. (2008) A Healthy Understanding: What have we learned about health literacy in Canada? Ottawa: CCL
• Canadian Council on Learning. (2007a). State of Learning in Canada: No Time for Complacency. Ottawa, ON: Author.
• Canadian Council on Learning. (2007 b). Health Literacy in Canada: Initial Results
From the International Adult Literacy and Skills Survey. Ottawa: CCL.
• Institute of Medicine. (2004). Health Literacy: A Prescription to End Confusion. Washington, D.C.: National Academies Press.
• Johnston L, Ammary N., Epstein, L, Johnson, R, Rhee, K. (2006). A Transdisciplinary Approach to Improve Health Literacy and Reduce Disparities. Health Promotion Practice, 3.
• McGowan P. (2005). Self-Management: A Background Paper. Paper presented at New Perspectives: International Conference on Patient Self-Management.
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References (Cont.)
• Ohinmaa A, Jacobs P, Simpson S, Johnson J. (2004). The projection of prevalence and cost of diabetes in Canada: 2000 to 2016. Canadian Journal of Diabetes, 28(2).
• Petch, T. (2004). Final Report: Analysis of Health Information Web Sites, Vancouver, B.C.: ACT4Health project, Simon Fraser University.
• Rootman, I. & El-Bihbety, D., A Vision for a Health Literate Canada, Ottawa: CPHA, 2008.
• Rudd, R.E. (2007). Health Literacy Skills of U.S. Adults, American Journal of Health Behavior, 31, supp.1, S8-S18.
• Smith, J.L. and Haggerty, J. (2003). Literacy in Primary Care Populations: Is it a Problem? Canadian Journal of Public Health, 94(6), 408-412.
• Vernon, J.A., Trujillo, A., Rosenbaum, S., and DeBuono, B. (2007). Low Health Literacy: Implications for National Health Policy, New York: Pfizer. Can be accessed at www.clearcommuncation.org/
• Weiss B. & Palmer R. (2004). Relationship between health care costs and very low literacy skills in a medically needy and indigent Medicaid population. Journal of American Board of Family Practitioners, 2004, 17:44-47.