We have a natural tendency, it seems, to seek out simple and straightforward answers when analyzing the causes of social issues. One classic example is our understanding of the literacy/health connection. To date, research in this area has followed one of two directions. It has focused either on the impact of lower levels of literacy in understanding medication instructions or on unemployment’s social cost. Education and Social Services policy makers understand the relationship between labour market access and literacy. But they have not contributed much yet to our understanding of the relationship of literacy to health. It’s as though ‘job’ is the only outcome worth measuring and, of course, health is contained within a separate policy silo where they deal mostly with treatment. Health policy makers have accepted the notion that there are at least 9 determinants of health that influence health outcomes. They can be described in short as follows. Income and Social Status - We know that the gradient in health is directly related to income. But some interesting studies showed that for people in the workplace, your health may be affected more by the status you get from your job than the income you receive from it. Education - Studies in Manitoba showed that among seniors, education was a slightly more important predictor of health than income. But education is not a complete solution, for when you look among the most educated, mental health becomes the important predictor of premature mortality. Social Support Networks - Men with few friends have twice the risk of coronary heart disease, communities with strong support networks have lower heart disease rates, and research has demonstrated reduced immune response when we feel less secure and when our society does not establish mechanisms to support us. Employment and Working Conditions - Work environments which offer little opportunity to use our skills and little authority to make decisions are damaging to our health. Making valuable contributions and being recognized for them, matter. Physical Environments - Even the strongest immune systems cannot withstand a constant assault from unsafe environments either at home or the workplace. Healthy Child Development - A strong early start is essential to reducing a life-time risk of poor health. But poverty, despair and low self-esteem affect a parent’s capacity to provide that healthy start. Personal Health Practices and Coping Skills - While we know we should, we do not always engage in optimal health practices. Under ongoing stress, we all fall into unhealthy practices. Now imagine the impact it might have on your ability to follow that diabetes diet or undertake an exercise program. Biology and Genetic Endowment - We receive more than genes from our parents. We also learn their behaviours. Health Care - Our system is effective at treating the symptoms which arise from the above, but less so at finding true cause. Most of the prevention will lie outside it. All of these determinants combine to impact the amount of control we can bring to deal with the day’s demands. We should understand ‘control’ to mean self-efficacy, hardiness, competency (the absence of powerlessness). Imagine how these factors work on the lives of those with low levels of literacy. As we look to the new millennium, we must realize the only effective solutions are holistic ones. Government because of its tendency to be stuck in silos, is not as effective as community-organized, learner centred models. As important as the ‘job’ is, I hope the future measure of program effectiveness will be the impact on health status. Let us dare to dream that we can narrow the mortality gap in Canadians. |
