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Health Literacy in Australia

Introduction

Health literacy is defined by the World Health Organisation as “the cognitive and social skills

which determine the motivation and ability of individuals to gain access to, understand and use

information in ways which promote and maintain good health” (World Health Organization,

1998, p. 10). In terms of practical examples, health literacy can refer to a person’s ability to

understand instructions on prescription medication (Parker et al., 1999), their capacity to find,

interpret and understand health information (Adams, Stocks, Wilson, & Hill, 2009a), and how

well they are able to engage in preventative health behaviours (Canadian Council on Learning,

2007, as cited in Australian Bureau of Statistics [ABS], 2006). It has been reported that up to

59% of Australians aged 15 to 74 years have an inadequate level of health literacy (ABS, 2006);

inadequate being a level which is below the “minimum required for individuals to meet the

complex demands of everyday life and work in the emerging knowledge-based economy”

(Statistics Canada, 2005, as cited in ABS, 2006, p. 7–8). This percentage is alarming because

lower levels of health literacy have been found to be associated with a lack of health knowledge

(Moore, Smith, & Reilly, 2013; Smith, Sullivan, Bauman, Powell-Davies, & Mitchell, 1999;

Williams, Baker, Parker, & Nurss, 1998), poor preventative health behaviours (Adams et al.,

2009b; Lim et al., 2017; Scott, Gazmararian, Williams, & Baker, 2002; van Eijsden, van der

Wal, & Bonsel, 2006), increased risk of chronic disease (Adams et al., 2009b), and higher rates

of hospitalisation (Adams et al., 2009b; Baker, Parker, Williams, & Clark, 1998; Baker et al.,

2002). In terms of Australia, chronic disease is a major cause of premature mortality

(Australian Institute of Health and Welfare [AIHW], 2016), as well as a major contributor to

healthcare expenditure (AIHW, 2014). This report aims to explore each of these associations

and justify why health literacy is a significant social determinant of Health in Australia.
Preventative health knowledge

One aspect of health literacy involves knowledge about preventative health. In order to prevent

disease, it is important for people firstly to understand whether a disease is preventable. A study

by Moore et al. (2013) in rural Victoria found that many people underestimated the

preventability of a number of health conditions. Skin cancer was nominated as the most

preventable condition, with 50.3% of respondents considering it to be an ‘all or mostly’

preventable condition (Moore et al., 2013). Further, lung cancer was considered ‘all or mostly

preventable’ by 35.5% of respondents, hypertension by 34%, cervical cancer by 27.4%,

diabetes by 25.4%, and heart attacks by a 14.7% (Moore et al., 2013). This is in contrast to the

fact that all these conditions are highly preventable through behavioural and screening

measures (AIHW, 2011; Gyárfás, Keltai, & Salim, 2006; Krousel-Wood, Muntner, He, &

Whelton, 2004; Makin, 2011; Rerucha, Caro, & Wheeler, 2018; Schulze & Hu, 2005). Fourteen

years prior to the study conducted by Moore et al. (2013), a similarly low level of knowledge

regarding disease preventability was found by Smith et al. (1999) in the south west Sydney

population. In this study, 61.7% of respondents believed that skin cancer was ‘all or mostly

preventable’; 39.8% for lung cancer, 32.1% for hypertension, 27.8% for cervical cancer, 23.4%

for heart attacks, and 16.7% for diabetes (Smith et al., 1999). Worryingly, many of these

diseases are (or contribute to) the leading causes of premature mortality in Australia (AIHW,

2016). Respectively, heart attacks, lung cancer and stroke were the first, second, and seventh

leading causes of premature mortality (AIHW, 2016). Moreover, hypertension and diabetes are

both established risk factors for heart attacks (Anand et al., 2008) as well as stroke (Goldstein

et al., 2001). It follows; if people are unaware that many of the leading causes of death are

preventable, they are probably less likely to engage in behaviours to prevent them. Moreover,

by analysing the data from Smith et al. (1999) and Moore et al. (2013), it is evident that

Australian’s have poor preventative health knowledge and that it has not improved over time.
Health literacy and preventative health behaviour

Preventative health behaviour involves any activity by a person, undertaken with the intention

to prevent disease or detect asymptomatic disease (Kasl SV & Cobb S, 1966). As an example

of preventative health behaviour, dietary habits are important in the prevention of many health

conditions. Studies have shown that there is an inverse relationship between eating fruit and/or

vegetables and the development of coronary heart disease (He, Nowson, Lucas, & MacGregor,

2007), type 2 diabetes (Carter, Gray, Troughton, Khunti, & Davies, 2010; Liu et al., 2016),

hypertension (Kim & Kim, 2017), some cancers (Aune et al., 2011; Aune et al., 2012; Lunet,

Lacerda-Vieira, & Barros, 2005), and dementia (Loef & Walach, 2012). Worryingly, in 2014–

15, only 49.8% of Australian adults met the recommended daily fruit intake, and only 7.0%

met the recommended daily vegetable intake (ABS, 2015). Linking dietary habits with health

literacy, an Australian study by Lim et al. (2017) found that greater health literacy was

associated with higher intake of fruit and vegetables. In particular, intake was higher in

participants who proactively managed their health and those who had a greater ability to

appraise health information (Lim et al., 2017). These findings in Lim et al. (2017) are echoed

in a study by Reisi et al. (2014) who found that inadequate levels of health literacy were

associated with lower consumption of fruit and vegetables.

Many other studies have found an association between inadequate levels of health literacy and

lower levels of preventative health behaviour (Adams et al., 2009b; Parker & Jamieson, 2010;

Scott, Gazmararian, Williams, & Baker, 2002; van Eijsden, van der Wal, & Bonsel, 2006).

Scott et al. (2002) found that those with low levels of health literacy were more likely to have

never had an influenza or pneumococcal vaccine compared to those with higher levels of health

literacy. Further, those with lower levels of health literacy were also less likely to have had a

mammogram in the past 2 years, and more likely to have never had a Pap smear test (Scott et
al., 2002). Another study by van Eijsden et al. (2006) found that a lower level of health literacy

(in this case mainly due to language barrier) was associated with poor knowledge and use of

folic acid supplementations during the periconceptional phase. Research by Adams et al.

(2009b) showed that people with lower health literacy were less likely to engage with

healthcare providers, including general practitioners, specialists, dentists, and allied health

professionals. And finally, a study by Parker and Jamieson (2010) found that Indigenous

Australians with lower levels of oral health literacy were less likely to own a toothbrush; and

for those that owned a toothbrush, less likely to have brushed their teeth in the past day.

Through these examples, and the findings by Lim et al. (2017) and Reisi et al. (2014), a clear

link can be seen between lower health literacy and poor preventative health behaviour.

Health literacy, chronic disease and hospitalisation

In addition to low health literacy being associated with less health knowledge and poor health

prevention behaviours, an Australian study by Adams et al. (2009b) found that low health

literacy is associated with an increased risk of chronic disease. In particular, they found that

people with low health literacy were significantly more likely to have diabetes, cardiovascular

disease, or to have suffered from a stroke (Adams et al., 2009b).

Adams et al. (2009b) also found that those with low health literacy were more likely to be

admitted to hospital, particularly those who were older than 65 years. These findings are similar

to research conducted by Baker et al. (1998) and Baker et al. (2002) which found an association

between low health literacy and higher risk of hospital admission.


Chronic disease and health expenditure

In Australia, management of chronic disease accounts for a large amount of health expenditure

(AIHW, 2014). For example, in 2008-09, out a total health expenditure of $112.8 billion

(AIHW, 2010), an estimated $7.74 billion dollars was spent on cardiovascular disease and

$1.52 billion on diabetes mellitus (AIHW, 2014).

Discussion

Much of the research presented in this report has found an association between health literacy

and a singular outcome (preventative health behaviours, chronic disease and hospitalisation).

In addition to the association between health literacy and each outcome, it is likely that a causal

relationship exists between the outcomes themselves. For example, in the Australian context,

a number of people appear to be unaware about the preventability of many diseases (Moore et

al., 2013; Smith et al., 1999), including cardiovascular disease, lung cancer, and stroke. Many

are also unaware that diabetes and hypertension (both are risk factors for cardiovascular disease

and stroke (Anand et al., 2008; Goldstein et al., 2001)) are preventable diseases (Moore et al.,

2013; Smith et al., 1999). It is highly probable that a lack of this preventative health knowledge

translates into poor preventative health behaviours, for example, less intake of fruits and

vegetables (Lim et al., 2017); which translates further into an increased risk of chronic disease

and hospitalisation (Adams et al., 2009b). In reverse, it follows that improved health literacy

may lead to increased preventative health behaviours such as smoking cessation, engagement

in regular physical activity, and increased consumption of fruits and vegetables; which may

lead to a decreased risk of chronic disease and hospitalisation.

The evidence in this report has demonstrated the important role that health literacy has in

preventing chronic disease, and this is significant because chronic disease is the largest
contributor to premature mortality in Australia (AIHW, 2016) and is also responsible for a

large proportion of Australian health expenditure (AIHW, 2010; AIHW 2014).

Conclusion

In summary, improving health literacy in Australia is likely to result in a reduction in chronic

disease, thereby reducing premature mortality and decreasing health expenditure. Thus, health

literacy is a significant social determinant of health in Australia.

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Academic Honesty

For this assignment:

- All work presented here is my own original work – I have not engaged an online

service, acquaintance, friend, parent, another student, etc. to complete or edit any part

of the assignment

- I have not colluded with, nor copied any part from another student – I have only had

discussions with other students regarding general ideas and the format of the essay

o Further, none of this work has been recycled from a previous assignment
- I have ensured that all the presented information has been attributed to the respective

authors and properly referenced – this includes all data, ideas, phrases, and quotes

o All quotes have been written in quotation marks and have a page number

included – for example – “the cognitive and social skills which determine the

motivation and ability of individuals to gain access to, understand and use

information in ways which promote and maintain good health” (World Health

Organization, 1998, p. 10)

o All secondary sources also have the primary sourced referenced – For example

(Canadian Council on Learning, 2007, as cited in Australian Bureau of

Statistics, 2006) and (Statistics Canada, 2005, as cited in ABS, 2006, p. 7–8)

- None of the presented statistics and research findings have been fabricated – for

example:

o All percentages from this excerpt are verbatim from the source – ‘In this

study, 61.7% of respondents believed that skin cancer was ‘all or mostly

preventable’; 39.8% for lung cancer, 32.1% for hypertension, 27.8% for

cervical cancer, 23.4% for heart attacks, and 16.7% for diabetes’ (Smith et al.,

1999)

o Similarly, all values are verbatim from their respective sources – ‘For

example, in 2008-09, out a total health expenditure of $112.8 billion (AIHW,

2010), an estimated $7.74 billion dollars was spent on cardiovascular disease

and $1.52 billion on diabetes mellitus (AIHW, 2014).

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