A Systems Approach to Strengthening Health Literacy

Recent Immigrants Living in Rural Nova Scotia

Philip Girvan pgirvan@stfx.ca

Presentation Objectives: 1. Define Health Literacy 2.Define Systems Approach 3.Discuss significant health literacy issues for recent immigrants living in a rural setting, e.g. having a first language other than English or French 4.Explore collaborative opportunities to improve health literacy suggested by English as a Second Language teachers

Teacher's health definitions
Good health or bad health...in a physical disease. Don't automatically think of emotional health or psychological health. Physical health...first thing that comes to mind. Health involves the whole person so I guess it¶s your physical, your psychological, your emotional, and your spiritual and your social and your cultural « being pain-free ... Health is what allows you to do the things you want to do freely

Teachers' health literacy definitions
Is it speaking knowledgeably to your physician? People have to be in a large part responsible for their own health and they have to be literate to be able to have a discussion with the doctor about symptoms and about maybe anything else that comes with that what your options might be for your health. « I think that the more you know about the subject the better you are and the more literate you are. literacy is our ability to interpret and understand our environment so if you put it to health literacy then it's the ability to understand health what health means and also what one needs to do to stay healthy and that's health again in that broader definition professionals who do know have to take into account that people will have different literacy levels so they have to make very specific and very clear information related to [?] and if that happens if professionals can do that then definitely people can become healthier.

Conceptual model of health literacy as a clinical risk (Nutbeam, 2008).

Conceptual model of health literacy as a personal asset (Nutbeam, 2008).

Expert panel on health literacy's definition (2008) The ability to access, understand, evaluate, and communicate information as a way to promote, maintain and improve health in a number of settings across the lifecourse.

Systems Approach
There are individual and systems barriers affecting health literacy. Health literacy is an issue that transcends the individual. Health literacy also transcends the clinical encounter.

The Expert Panel on Health Literacy notes system barriers such as:
1. lack of affordable English/French as a Second Language programs and community-based literacy upgrading programs; 2. inadequate workplace training and education; 3. confusing or conflicting health information from the media and the Internet; 4. complex health systems; and, 5. lack of awareness and knowledge about health literacy among health and literacy professionals.

Health literacy issues for ESL communities may include, but are not limited to:
‡ the role of socio-economic determinants of health, ‡ linguistic and cultural competence of ESL populations and health service providers and institutions, ‡ the legibility of the health care system and ability of both to overcome barriers to health care and conditions and effects of health inequities

Setting is important
Physical and social environments are non-medical determinants of health. The majority of new immigrants to Canada move to large urban areas (Census Metropolitan Areas) for a number of reasons including greater opportunities for employment, members of the same ethno-linguistic community. « I just feel that it¶s a really hard place to come to when you don¶t know« people are lonely. Teacher discussing Antigonish as a place for newcomers

Definitions of rural versus urban
Urban area: Area with a population of at least 1,000 and no fewer than 400 persons per square kilometre. Rural area includes: ‡ small towns, villages and other populated places with less than 1,000 population according to the current census ‡ rural fringes of census metropolitan areas and census agglomerations that may contain estate lots, as well as agricultural, undeveloped and non-developable lands ‡ agricultural lands ‡ remote and wilderness areas.

Geographic Total Non-immigrant Immigrant name Population population population

Immigrated Immigrated Immigrated before 1991 between between 1991 & 1996 & 1995 2000 3 408 420 30 305 823 925 3 540 844 625 4 445

Immigrated between 2001 & 2006 1109980 6900


31 241 030 24 788 720 854 495

6 186 950 45 190

Nova Scotia 903 090

Halifax, CMA 369 455

339 840

27 410

16 590

2 460

3 295


Cape Breton, 104 655 CA Truro, CA 44 580

102 800

1 730

1 370




42 720 34 805

1 810 885

1 370 750

140 15

115 20

190 95

New 35 755 Glasgow, CA

Kentville, CA 25 800

24 780

1 010





Antigonish, CD

18 715

17 835






NonGeographic Total name Population immigrant population Canada 100% 79.3% 94.6% 92.0% 98.2% 95.8% 97.3%

Immigrant population

Immigrated Immigrated Immigrated Immigrated before 1991 between between between 1991 & 1995 1996 & 2000 2001 & 2006 10.9% 3.4% 4.5% 1.3% 3.1% 2.1% 2.6% 0.4% 0.7% 0.1% 0.3% 0.0% 2.7% 0.5% 0.9% 0.1% 0.3% 0.1% 3.6% 0.8% 1.4% 0.1% 0.4% 0.3%

19.8% 5.0% 7.4% 1.7% 4.1% 2.5%

Nova Scotia 100% Halifax, CMA100% Cape Breton,100% CA Truro, CA 100%

New 100% Glasgow, CA

Kentville, CA 100%







Antigonish, 100% CD







Antigonish: Hitting above its weight
What's the attraction? Untested Hypothesis: St. Francis Xavier University and the Coady International Institute attract individuals unlikely to move to larger urban centres in Nova Scotia such as Kentville, New Glasgow, Truro, etc.

she¶s from Argentina and quite often the doctor doesn¶t listen to her maybe because the doctor doesn¶t have time to listen very carefully to the way she¶s saying things and the doctor doesn¶t have the time to get her accent to make sure what she¶s saying is clear so I think that maybe that some doctors don¶t have the time or the inclination to listen to a non-English speaker Teacher recounts a student's experience at a doctor's office

Health Literacy Issues for Immigrants
Communication issues, e.g., ‡ Language barriers ‡ Timidity Acclimatizing to Western model(s) of health ‡ Social construction of health, e.g., mental illness is not necessarily recognized as illness by all cultures Social networks (may or not not be support networks)

Collaborative opportunities
Note the different conceptions of health & health literacy (Slides 6 & 7). Developing the model of health literacy as a personal asset involves actors outside traditional health fields, e.g. ESL teachers, promoting health literacy Difference between clinical & preventative health. Teachers may not necessarily be comfortable discussing clinical but can show where to buy healthy food and go hiking... Teacher¶s suggestion about what she can do to promote health literacy

Nutbeam, D. ³The Evolving Concept of Health Literacy´. Social Science & Medicine 67. 2008. 20722078. Rootman, I. & Gordon-El-Bihbety, D. A Vision for a Health Literate Canada: Report of the Expert Panel on Health Literacy. Canadian Public Health Association. 2008. Statistics Canada. 2006 Census. 2007.

Thank you

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