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Health Literacy and Gender Analysis

Chronic Disease Network Conference, Darwin

9-10 September 2010

Dr Anita Peerson

School of Health and Development

Deakin University, Geelong-Waterfront, Victoria

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Gender

= a dynamic set of socially constructedrelationships embedded in everyday

interaction (Emslie and Hunt 2008:808)

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Gender analysisgender analysis frameworks

to encourage the application of a genderlens to health policies and programs (UN 2006,Tiessen, 2007)

Australia - not common

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Men and Women Sex/biology and gender/sociocultural

differences Special needs groups: Australia

low socioeconomic status

persons with a disability

rural and remote areas

indigenous persons culturally and linguistically diverse

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Health Literacy the cognitive and social skills which

determine the motivation and ability ofindividuals to gain access to, understand

and use information in ways which promote

and maintain good health(WHO 1998:10).

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Health literacy 3 levels of health literacy (Nutbeam 2000:263-4)

functional

communicative/interactive

critical

= an asset and a risk with implications

for health outcomes of individuals and

population groups(Nutbeam 2008)

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Health literacy (NT) Having access to the information

necessary, as well as the skills andresources required, to make

decisions for ones own health(Department of Health and Families 2009:25) .

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Example sexual health Gender and age

Public:private Indigenous health

Women's business and men's business

Preference for same sex/gender

patient and health professional

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Example sexual health

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Factors impacting on health literacy

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Australia Literacy

(ALLS data - 2006) (ABS 2008:5)LiteracyDomains

Level 1 orLevel 2

Level 3 Level 4/5

Prose 46% 37% 16%

Document 47% 36% 18%

Numeracy 53% 31% 16%

Problem-solving

70% 25% 5%

Health 60% 35% 6%

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Health literacy of Australians

Approximately 60% of Australians have a

health literacy level less than theminimum required for daily functioning

(ie. Level 3) (ABS 2006, 2008).

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Problems associated with low

health literacy

poorer self-reported health,

inappropriate medication use andnoncompliance with physician orders,

poorer glycemic control [ie. blood

sugar levels] and increased prevalence

of self-reported complications thatresulted from poor control, less

health knowledge, less sharing in

decision-making about treatment, less

expression of health concerns and

worse communication with

practitioners (Rootman 2006:606).

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Implications of low health literacy (2)

Individuals and families

health promotion and illness-injuryprevention in everyday life (Peerson 1998)

Public health initiatives

specific population groups and the widercommunity

how to do this successfully?

Example: quit smoking

Quit Victoria: http://keepquitting.org.au/

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HL research

United States, Canada

limited evidence base - Australia

patients in health care settings navigating the health system

NOT

laypeoples/citizens healthpromotion/protection in everyday life

health promotion/public health approaches

(Peerson and Saunders 2009a,b)Gap in evidence base in these areas

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Indigenous health literacy(1)

School retention and educationalattainment (Year 12 or above) by indigenousindividuals is positively associated withhealth status

Difficult to locate publications using thekeyword/title: indigenous health literacy

international literature (few studies) explicitly engage, measure and validate

Indigenous-asserted health constructs,potentially overlooking significant wellspringsof health promotion within Indigenous

communities (Burgess et al 2008).

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Indigenous health literacy (2)

Difficulties in cross-cultural communication

between indigenous patients and non-

indigenous health professionals

English not 1st language

limited access to health services poor understanding of oral/written health

information (in English/health literacy level)

provided by health professionals/services delayed diagnosis/treatment

poor health outcomes (ABS 2008, Hudson 2009)

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Example diabetes. woman (50+ years) - remote community, NT. routine health check (45+ years)

. impact on self

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Health literacy and gender ALLS data

more women (48%) than men (43%) achieved anoverall score of Level 3 or above

women had higher scores for prose and healthliteracy, while men had higher scores fordocument literacy and numeracy (ABS 2006)

men and women access, interpret,respond to and act upon health informationto promote and protect health in differentways

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Example - Heart attack

www.heartattackfacts.org.au

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HL - Men and boys

less knowledgeable than women and girls

about health in general, specific diseases and

their risk factors (Courtenay 2000)

less able or likely to access, interpret and

apply information to maintain and improvehealth (Galdas et al, 2005, AIHW 2008)

exhibit low levels of health literacy even

about male-specific health issues (Singleton 2008)

evidence gap - mens health research and

health literacy research (Peerson and Saunders 2009b)

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Implications of gender analysis Health practice

Resource development Social marketing

Health promotion

Health research

Policy development

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Gender mainstreaming = integrating mens and womens

health concerns in the design,development, implementation and

evaluation of policies and programs(WHO 2002, 2008)

Australia - Office for Women (2010)

a panel of gender experts

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Mens health policy National Mens Health Policy (Ireland)

(DHC 2008) - multiple masculinities, health

literacy

National Male Health Policy (Australia)

(DHA 2010) - social determinants of health absence of gender analysis, masculinity and health

literacy (Saunders and Peerson 2009, 2010)

Mens Health and Wellbeing Strategy(Vic) (DH 2010) - includes gender analysis ,masculinity focus but refers to mens health

literacy indirectly

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A way forward gender-sensitive approaches to health

literacybenefit health promotion, social marketing

and public health

evidence-based policy and practice (Peersonand Saunders 2010)

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Acknowledgements

Colleagues

Margo Saunders, Mark Kennedy, TrishaDunning, Evelyne de Leeuw, James A Smith,

Dagmar Schmitt

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