By Kristine Sørensen, Global Health Literacy Academy, Risskov, Denmark
According to the World Health Organization (WHO), today’s health services are not fit for the 21st-century challenges. Globally, more than 400 million people lack access to essential health care. Where health care is accessible, it is often fragmented and of poor quality. However, WHO’s newly launched framework on integrated people-centred health services is a call for a fundamental shift in the way we fund, manage, and deliver health services. It sustains countries’ progress towards universal health coverage by shifting away from health systems designed around diseases and health institutions towards health systems designed for people.
Integrated people-centred health services put people and communities, not diseases, at the center of health systems, and empower people to take charge of their health rather than being passive recipients of services. Evidence shows that health systems oriented around the needs of people and communities are more effective, cost less, improve health literacy and patient engagement, and are better prepared to respond to health crises.
Hence, health literacy is a critical 21st-century capacity of people and professionals. Health literacy is defined as the knowledge, motivation and competency to access, understand, appraise and apply information to form a judgement and make decisions concerning health care, disease prevention, and health promotion in everyday life to maintain and improve quality of life during the life course. Improving health literacy is not only a concern of the individual. It also involves the interaction of the individuals with health care services and societal institutions, which in turn creates a demand for organizations to improve their health literacy responsiveness to become health literate organizations.
Systems designed around diseases have informed the health literacy field for decades by focusing on how to fix people’s low health literacy by educating them to match the demands of the health system’s complexity. However, this approach did not adequately address the health literacy gap; the health literacy disparity is still a neglected public health challenge in many countries.
Instead, to truly enhance people-centered health services in the 21st century, health professionals need to change their health literacy mindset from focusing on people’s skills to meet the complex demands of systems to focusing on the system’s skills to meet the complex demands of people.
Figure 1: Shifting the health literacy mindset to enhance people-centred health services
By changing the mindset from fixing people to fixing the health care system, health professionals can be held more accountable for implementing the values of putting people and communities at the core of their professional mission by applying the health literacy definition to guide their work in practice. Essentially, health professionals will need to find out about people’s needs, be sure to fully understand their problems, help enable them to appraise what they want, and support them in the application of solutions according to their abilities, complexities, and prospects. Health professionals will have to move away from one-size-fits-all solutions to tailor-made, personalized solutions that match each individual’s demands. All health professionals need to recognize and respect that, with any contact, they hold a small piece of the other person in their hands as described by the Danish philosopher K.E. Løgstrup in 1956:
“A person never has something to do with another person without also having some degree of control over him or her. It may be a very small matter, involving only a passing mood, a dampening or quickening of spirit, a deepening or removal of some dislike. But it may also be a matter of tremendous scope, such as can determine if the life of the other flourishes or not.”
Shifting the health literacy mindset does not mean to ask people to conform and find their way through the health services themselves. Instead, health professionals need to learn the real art of helping as outlined by the Danish philosopher Kierkegaard in 1856:
“If one is truly to succeed in leading a person to a specific place, one must first and foremost take care to find him where he is and begin there. This is the secret art of helping.”
Simply speaking, health professionals need to meet people where they are and provide them the services they need right from the start. The transformative power of health literacy may be one of the most influential forces to create people-centred services designed for people, rather than diseases.
Kristine Sørensen presented these ideas to the HHS Health Literacy Workgroup on Tuesday, April 24, 2018. You can get in touch with the Global Health Literacy Academy by sending an email to: contact@globalhealthliteracyacademy.org