Health Literacy – Proportionate Universalism?

What is Health literacy?

“Health literacy skills are those needed to gain access to, understand, and use information to promote and maintain health. At its most basic, health literacy involves functional literacy, numeracy, and ICT skills for understanding health information, but also includes skills to evaluate and apply health information in changing contexts. In addition, patients with these skills can use information to take control over environmental and social factors affecting health (critical health literacy).”

Marmot report

It has been nearly five years since Professor Sir Michael Marmot published his report on how to reduce health inequalities in the United Kingdom. The Marmot report was titled “Fair Society, Healthy Living” and was published in February of 2010 after Marmot was asked by the then Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England. The report concluded that reducing health inequalities would require action on six policy objectives:

  1. Give every child the best start in life
  2. Enable all children, young people, and adults to maximize their capabilities and have control over their lives
  3. Create fair employment and good work for all
  4. Ensure a healthy standard of living for all
  5. Create and develop healthy and sustainable places and communities
  6. Strengthen the role and impact of ill-health prevention

These six policy objectives would decrease health inequalities in England and would give all citizens equal opportunities to be as healthy and safe as possible. This is crucial today because health information in current circulation is written at too complex a level for 43% of working age adults aged 16 to 65. In England, older people with low health literacy have higher mortality. Research from the US and Europe shows people with low health literacy are more likely to have a long-term health condition and this is more likely to limit their activities. People with a low health literacy rate their health as lower than people with higher health literacy levels; people with low health literacy and lower educational levels are more likely to have unhealthy lifestyles.

Statistics are even worse among harder to reach groups, like people living in areas struck by poverty or even people currently incarcerated in prison.

  • In 2004, less than a third of prisoners had access to prison education at any one time.
  • 48% of prisoners have literacy skills at or below Level 1 and 65% have numeracy skills at or below Level 1.
  • More than one in three people in prison have a reading level below Level 1 and 75% for writing.
  • Level 1 is what is expected of an eleven year old child. This low literacy level in places where health is most needed is a huge issue that needs to be addressed.

Prison literacy

Since the Marmot report was published, there has been widespread uptake and endorsement of the review’s approach and recommendations. Over 75% of local governments are now working to embed Marmot principles in their approaches to improving health and reducing inequalities. It is important to keep all citizens in mind when planning for improvements. Focusing solely on the most disadvantaged will not reduce inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. This strategy is known as proportionate universalism and it is crucial that as many Britons as possible are well educated on their health.

The term ‘Proportionate universalism’ is ripe for defining in Word-Bank.