What does it mean for substance use and why does it matter?
Reprinted from "Health Literacy" issue of Visions Journal, 2013, 8 (2), pp.11-12
The impact of substance use on the health and well-being of British Columbians is substantial. Substance use contributes to heart disease and cancer. It is a major factor in injuries and accidental deaths. And it adds to numerous social and relational problems for individuals, families and communities.
The growing (many would say, unsustainable) cost of maintaining our health care and social service industries is leading to increasing attention to modifiable risk factors such as food choices, physical activity and substance use. This, in turn, has led to debates about the relative roles of individual responsibility, social determinants of health, and healthy public policy. More and more, we are becoming aware that we need to ensure more people achieve and maintain a standard of health that minimizes their need for expensive healthcare services. It is in this context that we should consider the role of mental health literacy.
Two perspectives on health literacy
The term “health literacy” has been around for a long time and used to apply concepts about literacy to the world of healthcare. But the apparent simplicity of the term masks the complexity of its components: health and literacy. This complexity involves scope, setting and purpose. In a narrow definition, literacy is the ability to read and write. This ability is developed and certified in schools in order to help people communicate. Most educators, however, prefer a broader definition that includes abilities to compute and solve problems required to function in society, achieve one’s goals and develop one’s potential. The difference in scope, setting and purpose reflected in these definitions of literacy is echoed in the discussions of health literacy.
Much of the interest in health literacy has focused on knowledge and skills related to communication within healthcare settings, such as a doctor’s office. This usually means the ability of patients to apply literacy skills to material such as prescriptions, medicine labels and informational brochures. The goal is increased compliance with treatment, help-seeking behaviour, or self-management of the disease or symptoms. This can be called clinical health literacy1 or medical literacy.2 Low medical literacy is directly related to low literacy (in the narrower sense) and is a risk factor associated with a range of poor health outcomes.3 Medical literacy is, therefore, important.
A different understanding of health literacy arises from a public health or health promotion perspective. Health literacy, in this case, is the, “ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course.”4 This suggests that health literacy is a resource or asset—“a means to enabling individuals to exert greater control over their health and the range of personal, social and environmental determinants of health.”3 Health literacy involves awareness of the interconnections between individual, social and environmental factors and the ways in which these connections influence the health and well-being of individuals and communities.5
Mental health literacy and drug education
“Mental health literacy” has almost exclusively been used in the narrow sense of medical literacy.6 This risk-factor understanding of health literacy has also dominated in drug education efforts. The goal has usually been to get young people to not use drugs. In other words, the goal has been to increase compliance with a pre-determined pattern of behaviour. Various approaches have been used in order to achieve this goal, but none have been very successful.
A new possibility is suggested by the asset definition of health literacy. In this model, drug education would be directed toward health capacities, which enable individuals to exert greater control over their health. This involves understanding and managing the factors that impact drug use and its consequences, among other things. Some of these factors relate to individual behaviour choices, but many are social or environmental factors that are only minimally modifiable at the individual level. Health literacy is not, however, restricted to capacity for making individual lifestyle choices. It should, “incorporate the empowerment of individuals and communities to take action on social, economic and political determinants.”7 In fact, health literacy is a precondition for taking community action for health or developing healthy public policy.
Just Health Action is a Seattle-based non-profit organization that has been working to develop and teach a health literacy curriculum that encourages critical analysis and reflection. Their curriculum involves exploring knowledge about “what is health,” “health inequities” and “causes-of-the-causes.” It also focuses on building specific skills and using tools and strategies to take action on achieving health and health equity. Finally, it involves helping students find their own way of engaging in health action, including advocating for healthy public policy.7
The potential of mental health literacy
Building health capacities though health literacy and influencing health opportunities through other health promotion actions, such as restricting access to psychoactive substances or increasing equity through access to resources and support services, will not guarantee individuals choose healthy actions. In fact, it may be important for society to give individuals the freedom not to choose a particular healthy action.8 Nonetheless, individuals and communities that understand the various factors and mechanisms that influence health and have the skills to take action on them are more likely to choose healthy personal behaviours and also more likely to advocate at the community and policy levels for actions that build healthier environments.9
Containing the costs and harms related to substance use will require increasing the mental health literacy of the population. This means a greater understanding of the human experience with psychoactive substances. The traditional emphasis on the health impacts of drugs is part of that story. But understanding how social inequities impact the harms related to substance use is also a critical part. Drug education should graduate students empowered to take greater control of their own health and well-being and to be active in promoting action on the social and environmental determinants of health. The success of drug education efforts might be measured as much by the types of policies citizens support as by the personal choices they make around substance use.
About the author
Dan leads a team at the Centre for Addictions Research of BC, University of Victoria that is involved in developing learning resources for BC schools designed to increase mental health literacy to help young people develop the knowledge and skills they need to survive and thrive in a drug using world. See www.carbc.ca/HelpingSchools.aspx
- Pleasant, A. & Kuruvilla, S. (2008). A tale of two health literacies: public health and clinical approaches to health literacy. Health Promotion International, 23(2), 152-59.
- Peerson, A. & Saunders, M. (2009). Health literacy revisited: what do we mean and why does it matter? Health Promotion International, 24(3), 285-96.
- Nutbeam, D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67(12), 2072-78.
- Rootman, I. & Gordon-El-Bihbety, D. (2008). A vision for a health literate Canada: report of the expert panel on health literacy. Ottawa: Canadian Public Health Association. www.cpha.ca/en/portals/h-l/panel.aspx.
- Freedman, D., Bess, K., Tucker, H. et al. (2009). Public health literacy defined. American Journal of Preventive Medicine, 36(5), 446-51.
- Bourget Management Consulting. (2007). Mental health literacy: a review of the literature. Canadian Alliance on Mental Illness and Mental Health. www.camimh.ca/key-reports/mental-health-literacy.
- Mogford, E., Gould, L. & Devoght, A. (2010). Teaching critical health literacy in the US as a means to action on the social determinants of health. Health Promotion International, 26(1), 4-13.
- Kickbusch, I. (2002). Health literacy: a search for new categories. Health Promotion International, 17(1), 1-2.
- Sparks, M. (2009). Acting on the social determinants of health: health promotion needs to get more political. Health Promotion International, 24(3), 199-202.