A Systems Approach to Strengthening Health

Literacy:Recent Immigrants Livingin Rural Nova Scotia

Philip Girvan 

pgirvan@stfx.ca

 

Presentation Objectives:

1.Define Health Literacy2.Define Systems Approach 3.Discuss significant health literacy

issues for recent immigrants living in a rural setting, e.g. having a first language other than English or French

4.Explore collaborative opportunities to improve health literacy suggested by English as a Second Language teachers

Teacher's health definitions

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.

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

Teachers' health literacy definitions

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.

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 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.

Conceptual model of health literacy as a clinical risk (Nutbeam, 2008).

 

 Conceptual model of health literacy as a personal asset (Nutbeam, 2008).

 

Expert panel on health literacy's definition (2008)

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.

Systems Approach

There are individual and systems barriers affecting health literacy.  Health literacy is an issue that transcends the individual.

Health literacy also transcends the clinical encounter.

The Expert Panel on Health Literacy notes system barriers such as:1.lack of affordable English/French as a Second

Language programs and community-based literacy upgrading programs; 

2.inadequate workplace training and education; 3.confusing or conflicting health information from the

media and the Internet; 4.complex health systems; and, 5.lack of awareness and knowledge about health

literacy among health and literacy professionals.

Health literacy issues for ESL communities may include, but are not limited to:

• the role of socio-economic determinants of health, • linguistic and cultural competence of ESL

populations and health service providers and institutions,

• the legibility of the health care system and ability of both to overcome barriers to health care and conditions and effects of health inequities

Setting is important

Physical and social environments are non-medical determinants of health.

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.  … I just feel that it’s a really hard place to come to when you don’t know… people are lonely.   Teacher discussing Antigonish as a place for newcomers

Definitions of rural versus urban

Urban area:  Area with a population of at least 1,000 and no fewer than 400 persons per square kilometre.   Rural area includes:  • small towns, villages and other populated places with

less than 1,000 population according to the current census

• rural fringes of census metropolitan areas and census agglomerations that may contain estate lots, as well as agricultural, undeveloped and non-developable lands

• agricultural lands• remote and wilderness areas.

 

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, CMA369 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

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, CMA100% 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%

Antigonish:  Hitting above its weightWhat's the attraction? Untested Hypothesis:   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.

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

Health Literacy Issues for ImmigrantsCommunication issues, e.g.,• Language barriers• Timidity 

 Acclimatizing to Western model(s) of health• Social construction of health, e.g., mental illness is

not necessarily recognized as illness by all cultures Social networks (may or not not be support networks)

Collaborative opportunities

Note the different conceptions of health & health literacy (Slides 6 & 7).   Developing the model of health literacy as a personal asset involves actors outside traditional health fields, e.g. ESL teachers, promoting health literacy

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

References

Nutbeam, D.  “The Evolving Concept of Health Literacy”.  Social Science & Medicine 67.  2008.  2072-2078. 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.

Statistics Canada. 2006 Census. 2007.

 

Thank you