the basics - World Health Communication Associates

4.6 POLICY-MAKING ARENASPolicies at all levels—institutional, community, national and regional—shape thefactors which determine health literacy and health. The engagement of citizensin policy-making processes is a fundamental democratic principle. Furthermore,a key trend in many health system reforms is empowerment of patients and thedevelopment of more patient-centred care. To function effectively in politics andpolicy-making, people need the ability to advocate for policy change; be activecitizens (for example, have a vote); be knowledgeable about health rights andresponsibilities; and be able to participate in health organisations.ChallengesFinancial crisisThe world is confronting a severe financial crisis at a time when it is also facing majorenergy and environmental problems and wide social inequalities. While the crisis hasglobal roots, its impact is already being felt unequally between regions and countries(WHO 2009). Many experts point to long-lasting consequences for health all over theworld. The crisis may lead to an opportunity to trigger significant changes in socialnorms, lifestyles and health-related behaviours or it could lead to a widening of socialinequalities and further health literacy disparities.Social determinants and health inequitiesThe Commission on the Social Determinants of Health (CSDH 2008) makes a strongcase for the root causes of health and health literacy inequities as being based onstructural societal factors, such as income differentials, lack of social protection oruniversal health care access. They call for society-wide action to address these factorsand to reduce differential exposures to risks, differential vulnerabilities to both acuteand chronic disease, and differential outcomes of care that poorer people in everycountry experience on a socially determined gradient. This social health gradientmeans that each successive social class is worse off with regards to their health thanthe class just above them.Numerous studies (see section 2 above) demonstrate that poor health literacyskills are associated with a wide variety of negative health outcomes. Furthermore,studies point to clear social class differences in health literacy skills (Kickbusch et al.2008). The CSDH does not deal directly with the issue of health literacy in their report.The relationship of health literacy to socially determined inequities is an importantarea for further study. This guide sees health literacy as a differential capacity that54SECTION 4: WHAT CAN WE DO TO STRENGTHEN HEALTH LITERACY?