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Public Health, Literacy & Ethics for Population Health Improvement

Andrea L. Lowe, MPH, CPH
Social Impact Studio Consulting, LLC

Public health professionals reflect a spectrum of backgrounds, expertise, and disciplines — ranging from communications, to policy, to community health education and everything in between. However, we are united by the belief that the health of an individual, and the entire community, is paramount to the health of our wider society. There is nothing more critical than literacy to achieving these goals.

If a person or community does not understand what or why an intervention is necessary, they are much less likely to respond and participate in the way that we intend.

We regularly discuss the impact of social and physical environments and stressors on the health of our communities. However, how often do we not only discuss, but actively address, literacy levels to improve health? Often, this conversation is considered one part of larger healthcare improvement strategies but may not be actively baked into every strategy, plan, and intervention that public health professionals and their partners create. We must change this paradigm to see tangible improvements in population health.

National Strategies to Improve Health Literacy 

The 2010 National Action Plan to Improve Health Literacy continued an ongoing discussion to address health literacy, outlining seven strategies that can still be effective today, and under a new HealthyPeople 2030 framework. Outlined strategies span both traditional and nontraditional health care and public health spheres, including:

  • Supporting the development and dissemination of accurate, developmentally appropriate health and science information across our educational systems
  • Increasing research opportunities in health literacy
  • Building partnerships with policymakers to consider health literacy levels when discussing health care and public health topics with constituents

Guidance to Public Health Professionals Faced with Ethical Challenges 

More recently, the 2019 Public Health Code of Ethics adopted by the American Public Health Association (APHA), provides guidance to public health professionals faced with ethical challenges that impact their policy and practice work. It is designed to serve as a thoughtful document that engages public health professionals prior to, during, and after they develop interventions to guide decision-making for improved community health.

I am proud, as one of my roles, to serve as the Chair of the APHA Ethics Section, whose leaders and members spearheaded the development of this document.

Several core values and obligations outlined in this document relate to and are impacted by health literacy, including:

  • Health justice and equity
  • Interdependence and solidarity
  • Inclusivity
  • Engagement

Section 3, Guidance for Ethical Analysis, poses self-reflective questions focused on respect, effectiveness, and public participation:

  • Without considering the health literacy of the individuals and communities that we are working with, are we truly treating them with respect?
  • Is the program truly effective?
  • Are people fully able to participate in our work?

In Section 4, Action Guidance Recommendations, the authors specifically note the importance of health literacy to ensure public information does not harm individuals and communities (4.1.5), encourages building public health knowledge and awareness across the lifespan (4.4.2), and supports improved access to social resources (4.7.3-4.7.6).

Addressing health literacy levels will always be an obligation of public health professionals.

Given the diversity of the communities we live in and serve and varying levels of health education and interaction with the healthcare system, we will always need to consider literacy in our work. If you have not considered it before or considered it as an afterthought — it is not too late to start. The health of our nation will depend on it.

About the Author