Health Literacy

Health LiteracyHealth Literacy in Canada

Initial Results from the International Adult Literacy and Skills Survey (IALSS)
September 2007

Summary

Key finding
  • With health-literacy skills that are considered to be at Level 2 and below (IALSS definition), 60% of adult Canadians lack the capacity to obtain, understand and act upon health information and services and to make appropriate health decisions on their own. More findings » 
What is health literacy?

Report resources

Health literacy generally refers to the ability of individuals to access and use health information to make appropriate health decisions and maintain basic health. For health and education researchers, the concept is a broad one. It includes whether individuals can read and act upon written health information, as well as whether they possess the speaking skills to communicate their health needs to physicians and the listening skills to understand and act on the instructions they receive.

Why does health literacy matter?

Studies over the years have repeatedly demonstrated a strong link among literacy, level of education and level of health. Health and learning are closely intertwined and the interaction between them is evident at all ages, from early childhood through to the later stages in life. The equation is a simple one: the higher a person’s education status and ability to learn about health, the better that person’s health.

Researchers and policy-makers in the health and education fields consider health literacy as a critical pathway linking education to health outcomes, as a causal factor in health disparities between different population groups and as a predictor of overall population health.

How is health literacy measured?

The results used in this report are derived from health-related literacy tasks that were included in the 2003 International Adult Literacy and Life Skills Survey (IALSS). This survey contained 191 daily tasks that were judged to measure health-related activities in five domains: health promotion (60 items), health protection (65 items), disease prevention (18 items), health-care and disease management (16 items), and navigation (32 items). Individuals scoring below Level 3 can best be characterized as possessing very limited to restricted literacy proficiencies.

Categories of Health Activities with Selected Examples
Health Activities   Focus   Examples of Materials   Examples of Tasks
Health Promotion  

Enhance and maintain health

 
  • Articles in newspapers and magazines,
    booklets, brochures
  • Charts, graphs, lists
  • Food and product labels
 
  • Purchase food
  • Plan exercise regimen
Health
Protection
  Safeguard health of individuals and communities  
  • Articles in newspapers and magazines
  • Postings for health and safety warnings
  • Air and water quality reports
  • Referenda
 
  • Decide among product options
  • Use/avoid products
  • Vote
Disease
Prevention
  Take preventive measures and engage in early detection  
  • News alerts: TV, radio, newspapers
  • Postings for inoculations and
    screening
  • Letters related to test results
  • Graphs, charts
 
  • Determine risk
  • Engage in screening or diagnostic tests
  • Follow up
Health Care and
Maintenance
  Seek care and form a partnership with health-care providers  
  • Health history forms
  • Medicine labels
  • Discharge instructions
  • Education booklets and brochures,
    health information on the internet
 
  • Describe and measure
    symptoms
  • Follow directions on medicine
    labels
  • Calculate timing for medicine
  • Collect information on merits of various treatment regimes for discussion with health professionals
Systems Navigation  
  • Access needed services
  • Understand rights
 
  • Maps
  • Application forms
  • Statements of rights and responsibilities, informed consent
  • Health-benefit packages
 
  • Locate facilities
  • Apply for benefits
  • Offer informed consent
Findings: What do the initial analyses of the health-literacy scales for Canada reveal?
  • As is the case with national scores on literacy and numeracy, the overall average level of health literacy in Canada is low.
  • With health-literacy skills that are considered to be at Level 2 and below, 60% of adult Canadians lack the capacity to obtain, understand and act upon health information and services and to make appropriate health decisions on their own. In addition, the proportion of adults with low levels of health literacy is significantly higher among certain groups, a finding that raises questions of equity.
  • Canadian adults with less than a high-school education perform well below adults with higher levels of education and this gap widens with age. This suggests that the aging process amplifies initial levels of education-based inequality.
  • Average health literacy varies significantly by province and territory. Yukon Territory demonstrates the highest level of official language health literacy and Nunavut the lowest.
  • Differences in literacy and numeracy skills exert a profound influence on a range of social, educational and economic outcomes. Differences in average health-literacy skill seem to be associated with large differences in perceived general health status.
  • Large differences in average literacy exist between different population sub-groups within Canada—especially among the elderly.
  • Canadians have higher levels of health literacy than do Americans.

Full report (PDF, 722 KB)
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Mapping health literacy in Canada

The Canadian map below provides researchers and policy-makers with a snapshot of low health-literacy rates in thousands of communities and represents 95% of the country's population. This map is based on a new analysis of data reported in CCL’s first annual State of Learning in Canada report. It shows the percentage of the adult population (ages 16 and older) with health-literacy skills that are considered to be at Level 2 and below, according to the 2003 International Adult Literacy and Life Skills Survey (IALSS) and information from 2001 Census.

Clearly, health literacy varies considerably throughout the country and within each region. Such information will help health and literacy organizations, health professionals and governments to develop specific practices, programs and policies to improve health literacy—and consequently health outcomes—across Canada.

Click here, or on the image below, for a high-resolution PDF of the map (6 MB).

What are the next steps

Over the past 20 years, research has shown a strong link between literacy, education levels and relative health.  The evidence clearly shows that the higher a person’s education status and ability to learn about health, the better their health.

This report presents new data for health literacy in Canada and pinpoints where low literacy levels exist. It provides useful background on how health literacy is measured, and will support efforts in areas such as health promotion, health protection, disease prevention and navigating the health-care system.
 
Building on these initial results, CCL is planning to release a second report in 2008, examining:

  • the relationship of health literacy to prose literacy, document literacy, numeracy and problem-solving skills
  • the level and social distribution of health literacy
  • the relationship of health literacy to individual health
  • the determinants of health literacy
  • the relationship of health literacy to population health
  • how health literacy levels are likely to change over the next decade
Summary of the methodology:

The data for the local area maps is from the 2003 International Adult Literacy and Life Skills Survey (IALSS) conducted by Statistics Canada and the Organisation for Economic Co-operation and Development, and the 2001 Canadian Census. The maps were produced using a mapping technique developed by the Canadian Research Institute for Social Policy (CRISP). The CRISP mapping technique estimates a score on an outcome variable for all Canadian citizens, based on the best available information for each individual, and then displays the resulting scores on provincial or local area maps.

The approach uses the 2001 Canadian census data to create a file for each province that includes a “pseudo-record” for every individual in the province, based on the distribution of people by gender and age in each Dissemination-Area (DA). An estimate of a person’s outcome (in this case their “health literacy” score) for all people in the pseudo-record file is estimated using multilevel multiple regression techniques, based on the following data:

  1. information at the individual level from a Statistics Canada survey (in this case the IALSS) about how well other people of the same age and gender scored in the person’s DA, and in other DAs in their local area (out to three levels of contiguity), and
  2. information at the DA-level on the average outcome scores and the demographic characteristics of all DAs in the province. For each estimate we add an error term based on the regression results of the multilevel model. Results are then aggregated to the DA level and used for mapping.  

 

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