Clinical briefing: A health literate public?
The Government wants people to take more responsibility for their own health but is the population sufficiently health literate to make the right decisions?
The much-hyped NHS Long Term Plan emphasises personal responsibility for health, stating: “Action by the NHS is a complement to – not a substitute for – the important role of individuals, communities, government, and businesses in shaping the health of the nation” [italics added].1
Similarly, the Department of Health and Social Care’s document Prevention is Better than Cure, published last November, comments that: “Everyone has a part to play, and we must work together across society. This includes recognising the responsibilities of individuals and families in reducing the chances of becoming unwell in the first place”.2
Most people seem to accept individual responsibility for health. An online survey of 1,069 members of the public from across the UK, sponsored by Sanofi, found that 85 per cent “acknowledge they have a responsibility to keep themselves as healthy as possible to reduce the NHS burden”.
But there’s a rather portly, non-adherent elephant in the room sitting on the sofa playing video games: the UK’s generally poor health literacy, even among the supposedly well-educated.
Prevention is Better than Cure envisages “giving people the knowledge, skills and confidence to take full control of their lives and their health and social care, and making healthy choices as easy as possible”.2 What is not clear is, even if you gave people the knowledge, whether they are sufficiently health literate to know what to do with it. After all, surely everyone knows we shouldn’t smoke, drink excessively or lead a sedentary life?
Some examples of poor health literacy are simply tragic. In a thought-provoking blog on the NHS England website:
- One woman believed that a ‘positive’ cancer diagnosis was good news
- Another woman actuated her inhaler on her neck because she had been told to “spray it on her throat”
- Women may not know the location of their cervix
- Some young people don’t even know where their waists are.3
Then there is a study from Queen Mary University of London investigating factors determining uptake of colorectal cancer screening. The numeracy of 964 subjects was assessed by asking: “Which of the following numbers represents the biggest risk of getting a disease: ‘1 in 100’, ‘1 in 1,000’, ‘1 in 10’.”
Almost half (45.7 per cent) got the answer wrong; 34.5 per cent of those with undergraduate or higher education got the answer wrong compared with 57.8 per cent of those with ‘minimal education’.4 Education, it seems, does not guarantee health numeracy.
Another UK study evaluated patients’ understanding of 64 health materials covering, among other topics, health promotion, disease prevention and managing illness.
All contained information as text and 50 also contained numerical data. The study enrolled a large sample, assessing literacy in 5,795 people, and literacy and numeracy in 4,767 subjects.
The authors set two competency thresholds: equivalent to GCSE grades A* to C or higher for literacy and GCSE grades D to G for numeracy. It was found that 43 per cent of people were below the text-only threshold, while 61 per cent were below the text and numeracy threshold.5
Education, it seems, does not guarantee health numeracy
Room for improvement
Nevertheless, information can be communicated in a way most people can understand, as exemplified by nutritional labels. A study published in 2010 reported that between 83 and 88 per cent of respondents (depending on the information format) identified the healthiest ready meal from a choice of three – but there is still room for improvement.
For example, 58 per cent thought that regular yoghurt is low in saturated fat, 63 per cent believed smoked salmon is low in fat, while 66 per cent said that margarine was high in saturated fat.6
A recent survey of 2,087 adults sponsored by Diabetes UK found that 61 per cent struggle to find nutritional information about food in restaurants, cafes and takeaways. That said, providing information doesn’t guarantee people will read it, let alone act. In the 2010 study, just 27 per cent of shoppers looked at the nutritional information on the label across six product categories.6
So ministers envisage a greater role for community pharmacists in this prevention agenda. Prevention is Better than Cure notes, for example, that “the Government wants to encourage more people to make the most of their local pharmacy, and for local pharmacies to play a stronger role in helping people stay well in the community”. The report points out that almost 10,000 community pharmacies are registered as Healthy Living Pharmacies in England.2
To fully realise their potential in prevention, community pharmacists will need to further educate and explain. For instance, in the Sanofi survey, 47 per cent of those who had taken a shortcourse (two to four weeks) prescription and 60 per cent who had a prescription for a long-term condition didn’t read the label.
And it is a moot point how much of the information they understood anyway. As we’ve seen, health literacy and numeracy is generally poor. When it comes to prevention, ignorance is not bliss.
1. NHS Long Term Plan
2. DHSC public health briefing: Prevention is better than cure
3. NHS England blog: Does health literacy matter?
4. Journal of Health Psychology 2014; 21:1665-1675
5. BJGP 2015; 65:e379-e386
6. Appetite 2010; 55:177-189
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