SUMMARY Health literacy is a relatively new concept in health promotion. It is a composite term to describe a range of outcomes to health education and communication activities. From this perspective, health education is directed towards improving health literacy. This paper identifies the failings of past educational programs to address social and economic determinants of health, and traces the subsequent reduction in the role of health education in contemporary health promotion. These perceived failings may have led to significant underestimation of the potential role of health education in addressing the social determinants of health. A ‘health outcome model’ is presented. This model highlights health literacy as a key outcome from health education. Examination of the concept of health literacy identifies distinctions between functional health literacy, interactive health literacy and critical health literacy. Through this analysis, improving health literacy meant more than transmitting information, and developing skills to be able to read pamphlets and successfully make appointments. By improving people’s access to health information and their capacity to use it effectively, it is argued that improved health literacy is critical to empowerment. The implications for the content and method of contemporary health education and communication are then considered. Emphasis is given to more personal forms of communication, and community-based educational outreach, as well as the political content of health education, focussed on better equipping people to overcome structural barriers to health.

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Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century

Health inequalities among British civil servants: the Whitehall II study

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673605710485.pdf

4 million neonatal deaths: When? Where? Why?

Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016

Increasing social inequalities in health in the United States and elsewhere, coupled with growing inequalities in income and wealth, have refocused attention on social class as a key determinant of population health. Routine analysis using conceptually coherent and consistent measures of socioeconomic position in US public health research and surveillance, however, remains rare. This review discusses concepts and methodologies concerning, and guidelines for measuring, social class and other aspects of socioeconomic position (e.g. income, poverty, deprivation, wealth, education). These data should be collected at the individual, household, and neighborhood level, to characterize both childhood and adult socioeconomic position; fluctuations in economic resources during these time periods also merit consideration. Guidelines for linking census-based socioeconomic measures and health data are presented, as are recommendations for analyses involving social class, race/ethnicity, and gender. Suggestions for research on socioeconomic measures are provided, to aid monitoring steps toward social equity in health.

Measuring Social Class in US Public Health Research: Concepts, Methodologies, and Guidelines

The inverse care law

https://pmj.bmj.com/content/postgradmedj/59/688/131.1.full.pdf

Inequalities in Health, The Black Report

https://journals.sagepub.com/doi/pdf/10.1177/014107688107401204

A New Kind of Doctor

Inequalities set to rise as criteria for funding change in the UK 

Multimorbidity, usually defined as the coexistence of two or more long term conditions within an individual, is rapidly becoming the norm among people with chronic disease. Although often seen as a problem of elderly people, it affects large numbers of younger people too. Multimorbidity is not simply a problem of chronological ageing, but neither is it randomly distributed.1 In a recent Scottish study of almost 1.8 million people, more people with multimorbidity were aged below 65 years than above,2 and similar findings have been reported outside the United Kingdom.3 The level of deprivation influences not just the amount but also the type of multimorbidity that people experience. Multimorbidity is more common and occurs 10-15 years earlier in the most deprived areas than in the most affluent ones.2 4 A greater mix of mental and physical problems …

Multimorbidity and the inverse care law in primary care.

Eighteen patients with stable mild hypertension (mean blood pressure 144/93 mm Hg) restricted their sodium intake for eight weeks while taking part in a double blind randomised crossover trial of slow sodium and placebo tablets. Mean 24 hour urinary sodium excretion was 143 mmol(mEq) during the period on slow sodium and 87 mmol during the period on placebo. Five patients were unable to reduce their sodium intake below 120 mmol, but the others had a mean 24 hour urinary sodium excretion of 59 mmol during the period on placebo. There was no significant difference in blood pressure between the slow sodium and placebo treatment periods, although the study had a power of 99% to detect a difference of 5 mm Hg in mean arterial pressure between the two periods. Moderate dietary sodium restriction does not lower blood pressure in patients with this degree of hypertension.

https://www.bmj.com/content/bmj/286/6363/432.full.pdf

Julian Tudor Hart

Papers

The inverse care law

Inequalities in Health, The Black Report

A New Kind of Doctor

Multimorbidity and the inverse care law in primary care.

Dietary sodium restriction for mild hypertension in general practice.