Critical health literacy for the marginalised: Empirical findings

Abstract

Definitions of health literacy have differentiated between functional, interactive and critical health literacy (CHL). The latter describes advanced literacy skills that may be used to critically analyse information but also, crucially, to use this information to exert greater control over life events and situations that have an impact on health. CHL includes the development of 'skills and abilities that enable citizens to become aware of public issues to participate in critical dialogue about them, and to become involved in decision-making processes' (Zarcadoolas et al, 2006, p 61). CHL connects closely with the concept of health promotion, and is a key outcome of empowerment strategies that seek to develop personal skills, build healthy public policy and create supportive environments (see Chapters 1 and 14, this volume). Individual lifestyle factors, social and community networks, living and working conditions and general socioeconomic, cultural and environmental conditions have all been presented as important in determining health (Dahlgren and Whitehead, 1991; see also Chapter 9, this volume). The body of work evidencing the impact of these social determinants of health has grown considerably over the last 10 years and links are now well established and more fully understood (Marmot et al, 2012). Literacy is a social determinant influencing health both directly and indirectly: directly, through the difficulty of gathering and comprehending health information and the organisation and functioning of the healthcare system; and indirectly, through the personal and socioeconomic challenges that often go with limited literacy, for example, self-confidence, employment, income, housing, healthy eating and the stress that comes from constant worry about meeting these basic human needs for ourselves and for our families.