Addressing low levels of health literacy; a determinant of poor health.

I had the pleasure of attending the launch of the 2023 State of the Nation report from the Data Poverty APPG at the House of Commons on the 12th of September 2023. 

Within my contribution to the report, I highlight the importance of recognising information poverty alongside data and digital poverty, each impeding basic capacity to participate effectively in society. Our goal must be to improve health literacy as one means to bridge the chasm between the health and wellbeing of people on either side of the digital divide. 

It was a privilege to work with Professor Bola Owolabi, Director National Healthcare Inequalities Improvement Programme and Pritesh Mistry, Fellow, Digital Technologies, The King’s Fund and colleagues within the national NHS KLS Team to shape recommendations to address these issues.

Read the report from the Data Poverty APPG and if you would like to explore how you can support the work of the cross-sectoral Health and Digital Literacy Partnership please get in touch at kfh.england@nhs.net

In our digital age, the NHS England App is the digital ‘front door’ to patient care. However, 1 in 20 households in the UK do not have access to the internet (Lloyds Bank, 2022) and a third of people who are offline struggle to interact with healthcare services (World Health Organisation, 2021). For patients, digital inclusion means “having easy and affordable access to a suitable device with sufficient data and internet connectivity, and the digital skills and health literacy to find and understand information about a health condition and treatment options” (NHS England, 2023b).

Around 10 million adults in the UK lack health literacy; this takes a heavy toll on patient outcomes and use of healthcare services, creating a fertile environment for misinformation. Health illiteracy has a stronger correlation to poor health than education level, deprivation, age or ethnicity (National Voices, 2017). It is associated with unhealthy lifestyles, lower take up of preventive services, including immunisation and screening, low compliance with medical advice and greater reliance on emergency services, thus incurring higher healthcare costs. In 2014–15, US research estimated the economic cost of poor health literacy to the NHS in England as between £2.95 bn and £4.92 bn per year (Public Health England, 2015).

Schools, healthcare systems, communities, families and employers – with sickness rates at their highest in 20 years – each have a role to play in working together to provide multiple learning opportunities at community level.

Health and social care staff use simple techniques like ‘chunk and check’ to communicate effectively and NHS England provides relevant E-Learning (Health Education England and NHS Education for Scotland 2023). There is some evidence of positive effects of using video animations as patient information tools (Moe-Byrne, T, 2022).

NHS England advises General Practice and Integrated Care Boards always to provide choice and co-design support with patients (NHS England, 2023b). Intermediaries play a crucial role, offering digital assistance as part of broader services from health services, banks, community groups and libraries (World Health Organisation, 2021).

The NHS England Knowledge and Library Services team is building a Health and Digital Literacy Partnership with libraries across England – exemplified in Norfolk,(NHS England, 2023) Taunton and Yeovil (Somerset Council, 2023) and Oldham (The Oldham Times, 2022) – working with CILIP, Arts Council England and Libraries Connected (NHS England, 2023). The NHS team is testing a number of interventions to discover which are most effective, with the aim of empowering communities to establish sustainable approaches.

The geodata tool commissioned by NHS England provides an estimate of the percentage of each local authority population with low health literacy or numeracy (University of Southampton and Health Education England, 2023). Nationally, there is a gap in longitudinal data on health literacy to complement sources on connectivity and digital skills. Its current delivery aim is for health services to be a multi-channel offer, meeting individual needs and helping to free up resources for those who need face-to-face care.

Digital capabilities in the workplace: Employers, including NHS bodies, as part of their organisational strategy, should outline specific actions that they will take to increase the digital knowledge, skills and literacy of the workforce.

Digital literacy in schools: Schools should integrate the use of the NHS App, online health services and online health information within digital skills training as examples of essential life skills to help to address health inequalities

Digital inclusion: Public services including the NHS, local authorities and other employers should work in partnership with communities – optimising the use of libraries and community centres – to improve digital literacy and connectivity.

Alternative service options: Digital-First services should ensure provision of support and non-digital access for people who cannot use digital tools (including the NHS app) effectively. This calls for joined up approaches involving digital ambassadors and community groups

Information accessibility: Through funding and support, encourage the exploration and use of technology to tackle inequality and empower people to make informed health choices and overcome barriers posed by low levels of literacy

Robust data: A cross-government initiative should be established to gather data, and produce geodata, to inform public service planning and monitor improvement in people’s ability to use health information effectively for self-care, and to include mapping of digital poverty plus longitudinal survey data on health and data literacy.

Health Education England and NHS Education for Scotland (2023), Health Literacy: You can make a difference,
https://www.e-lfh.org.uk/programmes/healthliteracy/

Lloyds Bank (2022): Consumer Digital Index, https://www.lloydsbank.com/assets/media/pdfs/banking_with_us/whats-happening/221103-lloyds-consumer-digitalindex-2022-report.pdf

Moe-Byrne, Thirimon (2022) The effectiveness of video animations as information tools for patients and the general public: A systematic review. Frontiers in Digital Health, 31 October 2022, https://www.frontiersin.org/articles/10.3389/fdgth.2022.1010779/full

National Voices (2017) A new relationship with people and communities. https://www.nationalvoices.org.uk/publications/our-publications/new-relationship-people-and-communities 

NHS England (2023) Health and Digital Literacy Partnership. https://library.hee.nhs.uk/patient-information/working-with-partners-to-increase-skills-of-the-public

NHS England (2023b) Supporting digital inclusion in general practice: 10 top tips. https://www.england.nhs.uk/long-read/supporting-digital-inclusion-in-general-practice-10-top-tips/

Public Health England (2015), Local action on health inequalities Improving health literacy to reduce health inequalities, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/460709/4a_Health_Literacy-Full.pdf

Somerset Council, (2023): Digital and Health Information Support, https://www.somerset.gov.uk/libraries/digital-and-health-information-support/

The Oldham Times (2022): Oldham library offers digital support for patients, https://www.theoldhamtimes.co.uk/news/23085785.oldham-library-offers-digitalsupport-patients/

University of Southampton and Health Education England (2023): Health Literacy geodata, http://healthliteracy.geodata.uk/

World Health Organisation, (2021), Global strategy on digital health 2020-2025  https://www.who.int/docs/default-source/documents/gs4dhdaa2a9f352b0445bafbc79ca799dce4d.pdf