Covid-19: why health literacy matters
Scientists tell us that it may take several months to develop and administer a vaccine for COVID19. During the window from outbreak to production and delivery of a safe and effective vaccine, the only practical defence against the pandemic—short of martial law—is communication about how to minimise the risk of infection. International agencies including the WHO recognise the importance of public communication campaigns as a critical element of the pandemic planning response.
Empowering citizens at the local level to deal with the reality of a global pandemic is indeed a task that calls for ingenuity. Well-planned and sustained health promotion programmes that are informed by—and respond to—the various needs and motivations of different audiences, can make a significant impact on disease prevention, management, early diagnosis and compliance with treatment.
However, the health literacy of the population in engaging with such health promotion initiatives faces a challenge from the Covid-19 pandemic: information on the virus is incomplete; subject to change; and can depend on context. Yet, at a time like this, good health literacy is essential so that citizens are able to filter information from a range of sources and to allow them to trust and act upon reliable information, recommendations, and advice. This involves people applying a range of skills to make sense of health information and services available even in rapidly changing situations and contexts1. Trusted sources must provide reliable and timely information that is easy to access, easy to understand and easy to use. The need for effective communication plans that enable coherent, credible and timely communication and community engagement during public health emergencies have become integral to emergency response and planning.
Given that a treatment and/or vaccine for Covid-19 is unlikely to be available for at least several months, the stakes of conducting emergency risk communication were particularly high at the start of the outbreak. Early emergency risk communication, such as raising awareness of the disease and promoting health prevention behaviour like hand washing and social distancing have been essential in order to help control disease transmission. The success of the campaigns depends on the health literacy of the public about the Covid-19 virus and the perceived susceptibility to infection.
“Flattening the curve”, has been a call to action which has become part of our consciousness since the outbreak began. The graphics used to demonstrate this have provided a simple-to- understand way of visualising that a slower infection rate means less stress on the NHS. Likewise, the mantra of “physical distancing” has also been a strong and effective message as a way of slowing down the rate of infection. Another graphic that has become a key element in the discourse around the virus is that which depicts the rate of transmission – the so called “R” factor and the need to keep this below 1 – the rate at which one person transmits the virus to less than one other person. At the outset, one person was transmitting the virus to 3/4 people.
Over the last two decades, information technology and social media have transformed the way we can reach people during pandemics. Indeed, social media has catapulted the ability to reach large populations, while also simultaneously targeting vulnerable and at-risk populations, to deliver health messages, such as those associated with hand-washing. Over the past few weeks, there has been a steady flow of memes urging people to wash their hands, often with thoughtful use of graphics alongside. However, social media can also have its pitfalls. Misinformation and fake news have been rampant. This has the potential to stifle health promotion efforts during the current pandemic. Therefore, it is important to know who is saying what, why, and with what level of authority.
At this point, it is useful to reflect on who is most vulnerable in a pandemic like Covid-19. While the virus has the potential to impact on everyone in communities, the effects will be felt differently by different sectors of the population. Therefore, the steps taken to prepare, protect, treat, reduce transmission and innovate, need to take into account the issue of health equity. It is crucial to recognise that pandemics and the respective Government and corporate decisions that accompany it can both influence and are influenced by the social, economic and political determinants of health. The authorities face the difficult proposition of finding a balance between protecting health, preventing economic and social disruption, and respect for human rights2. Reflecting on what is known can be helpful.
While what we understand about Covid-19 is constantly being updated, it is well understood that such a pandemic can have potentially serious repercussions for vulnerable populations. It is important to study the association between social and individual factors and communication inequalities—differences among people from different socioeconomic positions (SEPs), racial, ethnic and geographical backgrounds, to understand how individuals access, interpret and act on messages they have received and to identify the best ways to quickly and effectively reach diverse populations with important preventive information. For example, individuals from lower socio-economic backgrounds have been found to have lower levels of health literacy and knowledge regarding pandemics, leading to poorer behavioural responses when dealing with a viral outbreak3.
Research shows that during a pandemic there will be a disproportionate impact on vulnerable populations, such as the elderly, those with disabilities and people with chronic conditions, particularly in the absence of assertive health promotion initiatives4: that those from low socio-economic backgrounds, those who work in casual employment, and many racial and ethnic minorities, are unlikely to have the necessary financial resources to make self-distancing and self-isolation a viable option within the context of their daily livelihoods5; that the elderly and people with disabilities rely on public transport to access essential services, including food shopping and health services that are required during pandemics6; and vulnerable populations may not have the necessary language and literacy skills to understand and appropriately respond to pandemic messaging7. While these things may be generally well understood, there is less certainty about what should be done about them.
It is imperative that in developing health promotion responses, the UK government and our locally devolved Assembly ensure that the principles of health equity and social justice inform the responses developed to tackle COVID198. However, this may be difficult to accomplish if the crisis comes to be seen in terms of population health versus national economic stability. While the campaign encouraging hand-washing is an essential health promotion intervention, we must guard against it being portrayed as an action that helps to promote equitable social and economic outcomes for those most vulnerable during the pandemic. It is crucial that public health promotion campaigns and the measures which are introduced to tackle Covid-19 help to support those most in need to get accurate and timely information to assist them to reduce the risk to themselves, their families and their community.
In terms of the general public’s knowledge of the Covid-19 pandemic against the background of the Department’s public health campaign, the ongoing success of social distancing would appear to demonstrate that the general public has the capacity to respond effectively to the outbreak of Covid-19. Communities have shown a high level of health literacy in terms of having a good understanding of the clinical features of the pandemic and subsequently amending their behaviour by taking the precautions required to minimise its spread in the community.
What the Covid-19 outbreak has shown is that the concept of health literacy is a highly crucial element in the armoury used to protect and sustain the health and wellbeing of the population. The pandemic is also a strong reminder to us that investing in education for health literacy across the life course is a vital resource and community asset.
- Sørensen, K.; van den Broucke, S.; Fullam, J.; Doyle, G.; Pelikan, J.M.; Slonska, Z.; Brand, H. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health 2012, 12, 80. [CrossRef] [PubMed]
- World Health Organisation. WHO Director General's opening remarks at the Mission briefing on COVID-19 - 12 March 2020. Geneva: WHO; 2020.
- Media Use and Communication Inequalities in a Public Health Emergency: A Case Study of 2009–2010 Pandemic Influenza A Virus Subtype H1N1, Leesa Lin, Minsoo Jung, Rachel F. McCloud, Kasisomayajula Viswanath. Public Health Rep. 2014; 129(Suppl 4): 49–60.
- Heymann D, Shindo N. COVID-19: what is next for public health? Lancet. 2020;395(10224):542-5; Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19? Lancet Respir Med. 2020:S2213-2600(20)30116-8. https://doi-org.hsclib-ezp.qub.ac.uk/10.1016/ S2213-2600(20)30116-8; Plough A, Bristow B, Fielding J, Caldwell S, Khan S. Pandemics and health equity: lessons learned from the H1N1 response in Los Angeles County. J Public Health Management Practice. 2011;17(1):20-7; Kayman H, Ablorh-Odjidja A. Revisiting public health preparedness: Incorporating social justice principles into pandemic preparedness planning for influenza. J Public Health Manag Pract. 2006;12(4):373-80; Hutchins S, Fiscella K, Levine R, Ompad D, McDonald M. Protection of racial/ethnic minority populations during an influenza pandemic. Am J P
- Kamate SK, Agrawal A, Chaudhary H, Singh K, Mishra P, Asawa K: Public knowledge, attitude and behavioural changes in an Indian population during the Influenza A (H1N1) outbreak. J Infect Dev Ctries 2009, 4(1):7–14; Rubin GJ, Amlot R, Page L, Wessely S: Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: cross sectional telephone survey. Br Med J 2009, 339:2651; Hilton S, Smith E: Public views of the UK media and government reaction to the 2009 swine flu pandemic. BMC Publ Health 2010, 10:697.
- Currie G, Delbosc A. Exploring public transport usage trends in an ageing population. Transportation. 2010;37:151-64; Bezyak J, Sabella S, Gattis R. Public transportation: an investigation of barriers for people with disabilities. J Disabil Policy Stud. 2017;28(1):52-60.
- Vaughan E, Tinker T. Effective health risk communication about pandemic influenza for vulnerable populations. Am J Public Health. 2009;99(S2):S324-S332.
- Kayman H, Ablorh-Odjidja A. Revisiting public health preparedness: Incorporating social justice principles into pandemic preparedness planning for influenza. J Public Health Manag Pract. 2006;12(4):373-80; Blumenshine P, Reingold A, Egerter S, Mockenhaupt R, Braveman P, Marks J. Pandemic influenza planning in the United States from as health disparities perspective. Emerg Infect Dis. 2008;14(5):709-15.
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