A systems approach_to_strengthening_health_lit


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Slides from a presentation delivered to the Statistics Canada socioeconomic conference April 27, 2010.

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  • EAL = English as an Additional Language   Re #3     to raise awareness of health literacy; enhance recent immigrants’ settlement, integration and wellbeing; and improve overall population health
  • This framework is consistent with population health approaches that recognize “health is a capacity or resource rather than a state” (Frankish, et al, 1996).
  • People draw upon health literacy skills
  • Individual issues include reading and writing ability Other barriers include:  declines associated with aging; low levels of formal education; lack of health knowledge and skills;  having a mother tongue other than English or French;  living with disabilities; social stigma;  and experiences in early childhood. (from Expert Panel, 2008)
  • Others are listed, but I suggest these are particularly relevant to today's presentation.
  • All definitions on slides 14 - 16 come from Statistics Canada's
  • [Geographic name] The total population count includes the non-immigrant population, the immigrant population and the non-permanent resident population. The non-permanent resident population is not shown separately in this table.   [Total population] Non-immigrants are persons who are Canadian citizens by birth. Although most Canadian citizens by birth were born in Canada, a small number were born outside Canada to Canadian parents.   [Non-immigrant population] Immigrants are persons who are, or have ever been, landed immigrants in Canada. A landed immigrant is a person who has been granted the right to live in Canada permanently by immigration authorities. Some immigrants have resided in Canada for a number of years, while others are more recent arrivals. Most immigrants are born outside Canada, but a small number were born in Canada. Includes immigrants who landed in Canada prior to Census Day, May 16, 2006.   [Immigrated between 2001 & 2006] Includes immigrants who landed in Canada prior to Census Day, May 16, 2006.
  • CMA     A census metropolitan area must have a total population of at least 100,000 of which 50,000 or more live in the urban core   CA    A census agglomeration must have an urban core population of at least 10,000. CD    Group of neighbouring municipalities joined together for the purposes of regional planning and managing common services (such as police or ambulance services). These groupings are established under laws in effect in certain provinces of Canada. For example, a census division might correspond to a county, to a municipalité régionale de comté or a regional district.
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  • A systems approach_to_strengthening_health_lit

    1. 1. A Systems Approach to Strengthening Health Literacy: Recent Immigrants Living in Rural Nova Scotia
    2. 2. <ul><li>Philip Girvan   pgirvan@stfx.ca </li></ul> 
    3. 3. <ul><li>Presentation Objectives: </li></ul><ul><ul><li>Define Health Literacy </li></ul></ul><ul><ul><li>Define Systems Approach </li></ul></ul><ul><ul><li>Discuss significant health literacy issues for recent immigrants living in a rural setting, e.g. having a first language other than English or French </li></ul></ul><ul><ul><li>Explore collaborative opportunities to improve health literacy suggested by English as a Second Language teachers </li></ul></ul>
    4. 4. Teacher's health definitions <ul><li>Good health or bad health...in a physical disease.  Don't automatically think  of emotional health or psychological health.  Physical health...first thing that comes to mind. </li></ul><ul><li>Health involves the whole person so I guess it’s your physical, your psychological, your emotional, and your spiritual and your social and your cultural … being pain-free  ... Health is what allows you to do the things you want to do freely </li></ul>
    5. 5. Teachers' health literacy definitions <ul><li>Is it speaking knowledgeably to your physician?   People have to be in a large part responsible for their own health and they have to be literate to be able to have a discussion with the doctor about symptoms and about maybe anything else that comes with that what your options might be for your health.  … I think that the more you know about the subject the better you are and the more literate you are. </li></ul><ul><li>literacy is our ability to interpret and understand our environment so if you put it to health literacy then it's the ability to understand  health what health means and also what one needs to do to stay healthy and that's health again in that broader definition </li></ul><ul><li>  </li></ul><ul><li>professionals who do know have to take into account that people will have different literacy levels so they have to make very specific and very clear information related to [?] and if that happens if professionals can do that then definitely people can become healthier. </li></ul>
    6. 6. Conceptual model of health literacy as a clinical risk (Nutbeam, 2008). <ul><li>  </li></ul>
    7. 7.   Conceptual model of health literacy as a personal asset (Nutbeam, 2008). <ul><li>  </li></ul>
    8. 8. Expert panel on health literacy's definition (2008) <ul><li>The ability to access, understand, evaluate, and communicate information as a way to promote, maintain and improve health in a number of settings across the life-course. </li></ul>
    9. 9. Systems Approach <ul><li>There are individual and systems barriers affecting health literacy. </li></ul><ul><li>  </li></ul><ul><li>  </li></ul><ul><li>Health literacy is an issue that transcends the individual. </li></ul><ul><li>Health literacy also transcends the clinical encounter. </li></ul>
    10. 10. The Expert Panel on Health Literacy notes system barriers such as: <ul><ul><li>lack of affordable English/French as a Second Language programs and community-based literacy upgrading programs;  </li></ul></ul><ul><ul><li>inadequate workplace training and education;  </li></ul></ul><ul><ul><li>confusing or conflicting health information from the media and the Internet;  </li></ul></ul><ul><ul><li>complex health systems; and,  </li></ul></ul><ul><ul><li>lack of awareness and knowledge about health literacy among health and literacy professionals. </li></ul></ul>
    11. 11. Health literacy issues for ESL communities may include, but are not limited to: <ul><ul><li>the role of socio-economic determinants of health, </li></ul></ul><ul><ul><li>linguistic and cultural competence of ESL populations and health service providers and institutions, </li></ul></ul><ul><ul><li>the legibility of the health care system and ability of both to overcome barriers to health care and conditions and effects of health inequities </li></ul></ul>
    12. 13. Setting is important <ul><li>Physical and social environments are non-medical determinants of health. </li></ul><ul><li>The majority of new immigrants to Canada move to large urban areas (Census Metropolitan Areas) for a number of reasons including greater opportunities for employment, members of the same ethno-linguistic community. </li></ul><ul><li>  </li></ul><ul><li>  </li></ul><ul><li>… I just feel that it’s a really hard place to come to when you don’t know… people are lonely.   </li></ul><ul><li>  </li></ul><ul><li>Teacher discussing Antigonish as a place for newcomers </li></ul>
    13. 14. Definitions of rural versus urban <ul><li>Urban area:  Area with a population of at least 1,000 and no fewer than 400 persons per square kilometre.   </li></ul><ul><li>  </li></ul><ul><li>Rural area includes:  </li></ul><ul><li>  </li></ul><ul><ul><li>small towns, villages and other populated places with less than 1,000 population according to the current census </li></ul></ul><ul><ul><li>rural fringes of census metropolitan areas and census agglomerations that may contain estate lots, as well as agricultural, undeveloped and non-developable lands </li></ul></ul><ul><ul><li>agricultural lands </li></ul></ul><ul><ul><li>remote and wilderness areas. </li></ul></ul><ul><li>  </li></ul>
    14. 15. Geographic name Total Population Non-immigrant population Immigrant population Immigrated before 1991 Immigrated between 1991 & 1995 Immigrated between 1996 & 2000 Immigrated between 2001 & 2006 Canada 31 241 030 24 788 720 6 186 950 3 408 420 823 925 844 625 1109980 Nova Scotia 903 090 854 495 45 190 30 305 3 540 4 445 6900 Halifax, CMA 369 455 339 840 27 410 16 590 2 460 3 295 5055 Cape Breton, CA 104 655 102 800 1 730 1 370 80 125 150 Truro, CA 44 580 42 720 1 810 1 370 140 115 190 New Glasgow, CA 35 755 34 805 885 750 15 20 95 Kentville, CA 25 800 24 780 1 010 815 45 50 100 Antigonish, CD 18 715 17 835 810 640 40 40 85
    15. 16. Geographic name Total Population Non- immigrant population Immigrant population Immigrated before 1991 Immigrated between 1991 & 1995 Immigrated between 1996 & 2000 Immigrated between 2001 & 2006 Canada 100% 79.3% 19.8% 10.9% 2.6% 2.7% 3.6% Nova Scotia 100% 94.6% 5.0% 3.4% 0.4% 0.5% 0.8% Halifax, CMA 100% 92.0% 7.4% 4.5% 0.7% 0.9% 1.4% Cape Breton, CA 100% 98.2% 1.7% 1.3% 0.1% 0.1% 0.1% Truro, CA 100% 95.8% 4.1% 3.1% 0.3% 0.3% 0.4% New Glasgow, CA 100% 97.3% 2.5% 2.1% 0.0% 0.1% 0.3% Kentville, CA 100% 96.0% 3.9% 3.2% 0.2% 0.1% 0.3% Antigonish, CD 100% 95.3% 4.3% 3.4% 0.5% 0.3% 0.9%
    16. 17. Antigonish:  Hitting above its weight <ul><li>What's the attraction? </li></ul><ul><li>  </li></ul><ul><li>Untested Hypothesis:   </li></ul><ul><li>  </li></ul><ul><li>St. Francis Xavier University and the Coady International Institute attract individuals unlikely to move to larger urban centres in Nova Scotia such as Kentville, New Glasgow, Truro, etc. </li></ul>
    17. 18. she’s from Argentina and quite often the doctor doesn’t listen to her maybe because the doctor doesn’t have time to listen very carefully to the way she’s saying things and the doctor doesn’t have the time to get her accent to make sure what she’s saying is clear so I think that maybe that some doctors don’t have the time or the inclination to listen to a non-English speaker Teacher recounts a student's experience at a doctor's office
    18. 19. Health Literacy Issues for Immigrants <ul><li>Communication issues, e.g., </li></ul><ul><ul><li>Language barriers </li></ul></ul><ul><ul><li>Timidity  </li></ul></ul><ul><li>  </li></ul><ul><li>Acclimatizing to Western model(s) of health </li></ul><ul><ul><li>Social construction of health, e.g., mental illness is not necessarily recognized as illness by all cultures </li></ul></ul><ul><li>  </li></ul><ul><li>Social networks (may or not not be support networks) </li></ul>
    19. 20. Collaborative opportunities <ul><li>Note the different conceptions of health & health literacy (Slides 6 & 7).   </li></ul><ul><li>  </li></ul><ul><li>Developing the model of health literacy as a personal asset involves actors outside traditional health fields, e.g. ESL teachers, promoting health literacy </li></ul><ul><li>Difference between clinical & preventative health.  Teachers may not necessarily be comfortable discussing clinical but can show where to buy healthy food and go hiking...  Teacher’s suggestion about what she can do to promote health literacy </li></ul>
    20. 21. References <ul><li>Nutbeam, D.  “The Evolving Concept of Health Literacy”.  Social Science & Medicine 67.  2008.  2072-2078. </li></ul><ul><li>  </li></ul><ul><li>Rootman, I. & Gordon-El-Bihbety, D. A Vision for a Health Literate Canada: Report of the Expert Panel on Health Literacy .  Canadian Public Health Association. 2008. </li></ul><ul><li>Statistics Canada. 2006 Census. 2007. </li></ul>
    21. 22.   <ul><li>Thank you </li></ul>