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Health literacy Movements in Asia

Professor Dr. Peter CHANG, MD, MPH, ScD, FRCP Secretary General, Asian Health Literacy Association AHLA. Vice president, International Health Literacy Association, IHLA Visiting Professor, Asfendiyarov Kazakh National Medical University, Almaty, KZ Visiting Professor, Dian Nouswantoro University, Semarang, Indonesia Guest lecturer, University of Southern California & Tufts University, USA Academic advisor, École des hautes études en santé publique (EHESP), Rennes, France; Thu Duc Hospital, HCMC, Vietnam

Health literacy • Health power • Health credits • For individual, family • For community, society • National agenda

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Health literacy investment • Not expensive, even save money • Essential. Without health literacy, without good health • Learning throughout life. The earlier, the better • Learning from one’s environment • Relative to one’s health system

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Health literacy researches in Asia

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PubMed Health literacy 11954 2015/ 1370

Health education 498272 2015/ 32684

PubMed HL %

Australia 1003 33.5

India 562 18.8

China 287 9.6

Japan 157 5.3

Iran 156 5.2

Pakistan 132 4.4

Taiwan 118 3.9

New Zealand 109 3.6

Bangladesh 108 3.6

Korea 102 3.4

Hong Kong 82 2.7

Thailand 53 1.8

Malaysia 48 1.6

Vietnam 33 1.1

Indonesia 24 0.8

Russia 15 0.5

Kazakhstand 4 0.1

Total 2993 ~ 25%

Health literacy google scholar 2,170,000

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Google scholar HL %

Australia 329000 15.7

India 296000 14.1

China 255000 12.1

Japan 188000 9.0

New Zealand 121000 5.8

Bangladesh 110000 5.2

Pakistan 97700 4.7

Korea 96500 4.6

Russia 89000 4.2

Hong Kong 82600 3.9

Vietnam 80500 3.8

Indonesia 79000 3.8

Thailand 78300 3.7

Malaysia 66800 3.2

Taiwan 62100 3.0

Iran 57600 2.7

Kazakhstan 12600 0.6

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2017/8/4 Thailand 4.0

2007 1st Japan mental health literacy

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• 80% websites by Google U.S. acceptable, 45.5 % for Yahoo Japan and 37 % for Google Japan. • Nonprofit organizations or public institutions ran 45.7 percent of the medical sites generated by Google U.S.,

only 15.9 % and 7.4 % Japanese-language sites on Yahoo Japan and Google Japan

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2017/8/4 Thailand 4.0

2008 1st health literacy in Taiwan mental health literacy

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Mental health literacy

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2017/8/4 Thailand 4.0

In each health contact, assist the public, through life course improve and owe adequate health

knowledge and skills ~ health literacy

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2017/7/6

17

18

20+ countries, 60+ institutions, 80+ global partners 19

3rd International Conference on Health Literacy & Healthcare Efficiency

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4rd International Conference on Health Literacy & Healthcare Efficiency

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2017/7/6

Nov 2016 AHLA KKU Office Dr. Somsak

2017/7/6

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2017/8/4 Thailand 4.0

Why health literacy matters • To know health is the right of an individual • The more health they know, can manage, the healthy they are • Health literacy is part of literacy, education, culture, society, solidarity • Health literacy by the health system of the individuals • Health literacy developed by an individual? parents, families, lectures,

media, contacts with healthcare services, media, friends, et al.

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2017/8/4 Thailand 4.0

• Literacy is a human right • A tool of personal empowerment • A means for social and human development • Educational (health) opportunities depend on

literacy (health literacy) • 2003-2012 the United Nations Literacy Decade • UNESCO partnering with UN agencies and other

organizations to promote literacy, teach basic health literacy, through formal and informal educational programs in many countries.

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• Incorporating health literacy into educational programmes for youth and adult learners is vital.

• An example of a groundbreaking health literacy project is the collaboration between UNESCO, the Joint United Nations Programme on hiv/aids (UNAIDS) and other stakeholders resulting in the launching of

EDUCAIDS in 2004 –

the Global Initiative on Education and HIV&AIDS

Primary goals 1. To prevent the spread of HIV through education; and 2. To protect the core functions of the education system from the worst effects of the epidemic.

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Recommendations to improve health literacy

1. Health professionals aware of education and health literacy 2. Health information user-friendly, verbal, written information

simple. Charts and pictures text-free educational methods. 3. Neutral and friendly atmosphere between the providers and the 4. Training and educating health care professionals, teachers, social

workers and community volunteers. 5. Local cultural beliefs and customs. 6. Programmes redesigned or adapted. 7. Supporting the adult education sector. 8. Policies at the national, state and local levels. 9. Empowering women and communities.

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2017/8/4 Thailand 4.0

2017/8/4 Thailand 4.0

Health literacy, a paradigm shift Private and individuals, families, communities, work in UHC

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Health literacy matters in UHC

• Universal coverage, what will be covered?

• Quality of health services essential for effective health services

• Empower patients and families, communities

• Enrich all health services, the contact points, the follow-up, outcomes, and values,

• A field work of PPP, private and individuals better health care services

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2017/8/4 Thailand 4.0

2017/8/4 Thailand 4.0

2017/8/4 Thailand 4.0

The HLS-EU Conceptual Model of Health Literacy (Sorensen et al. 2012) 38

Health Literacy Survey - EU

Domains and competences of HLS-EU-Q47

8/3/2017 39

Domains Competences

1.Finding

information on health(FHI)

2.Understanding

information on health(UHI)

3.Appraising/Judging

information on health(JHI)

4.Applying

information on health(AHI)

1.Health care

(HC)

Ability to access information on medical or clinical issues

Ability to understand medical information and derive meaning

Ability to interpret and evaluate medical information

Ability to make informed decisions on medical issues

2.Disease

prevention(DP)

Ability to access information on risk factors for health

Ability to understand information on risk factors and derive meaning

Ability to interpret and evaluate information on risk factors for health

Ability to make informed decisions on risk factors for health

3.Health

promotion(HP)

Ability to update oneself on determinants of health in the social and physical environment

Ability to understand information on determinants of health in the social and physical environment and derive meaning

Ability to interpret and evaluate information on health determinants in the social and physical environment

Ability to make informed decisions on health determinants in the social and Physical environment

(Sorensen et al., 2012)

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Global comparison in public health literacy

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health literacy lower in Asia

Lower health literacy in Asia Less participation in social community program Less interacting with social media, television, education program Male <<<< Female Lower in aging populations General HL significantly associated education, perceived social status Universal coverage, less impact from ability to pay for medication

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6.5

8.6

7.8

12.5

40.6

35.5

33.2

33.9

41.1

43.5

40.9

39.3

11.8

12.4

18.1

14.3

0% 20% 40% 60% 80% 100%

GHL

HC_HL

DP_HL

HP_HL

Inadequate Problematic Sufficient Excellent0-25 points

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> 25-33 points >33-42 points >42-50 points

• Women aged with lower HL

• Negative effect of ageing significantly

• Modified by watching health related TV programs

receiving health related training/ courses

8/3/2017 46 the APACPH 2015 Conference in Bandung, Indonesia

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2017/8/4 Thailand 4.0

HL-SF12, validated, shorter, effective quick-test Keep HC, DP, HP domains

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Domains Competences 1.Finding

information on

health(FHI)

2.Understanding

information on

health(UHI)

3.Appraising/Judg

ing information

on health(JHI)

4.Applying

information

on

health(AHI)

1.Health care

(HC)

2.Disease

prevention

(DP)

3.Health

Promotion

(HP)

Low health literacy • Overuse/ underuse of health services • Frequent ER visiting • Frequent ambulance • Multi-medication • Can not follow medical compliance • Repeat same questions, • Can not explain the health status • Difficult to choose health services • Barrier to access health information • Can not conduct self health management

•5 steps of better HL

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Hospitals or refugee camp?

Who made such hospitals?

Hospitals in transition

Hospitals in transition

Hospitals in transition

Waiting room, not wasting Healthy rooms, classrooms

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https://www.cpha.ca/sites/default/files/uploads/resources/healthlit/report_e.pdf

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2017/8/4 Thailand 4.0

2017/8/4 Thailand 4.0

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2017/8/4 Thailand 4.0

1. Health literacy, global issue, local solution

2. Identify low HL and intervene

3. HL in all health aspects

Vulnerable groups -

+

High HL

Low HL 2017/8/4 Thailand 4.0