Taking responsibility for one’s own health (and using health information for behaviours that promote good health) is inherent in nearly all definitions of what constitutes a health-literate person. But is health literacy more accurately viewed as a middle-class affectation and something that sits more happily with a conservative ideology than with progressive public health?
A 2003 paper by Andrew Singleton is critical of the role of self-help in ‘empowering’ men. Singleton notes the limits to self-help for men who are anything other than mainstream middle-class, and his description of the ideal men’s health self-help consumer sounds identical to the ideal health-literate man: a man who is motivated to access and utilize health information in pursuit of ‘the good life’.
In answer to a question from me about men’s health, Singleton has explained how the notion of ‘privatizing’ health, in the sense of making it an individual’s responsibility, is consistent with neo-liberal ideology:
“As a sociologist, I think that the best approach is structural change rather than reliance on individual action. Individual action suits a neo-liberal ideology in that it focuses on the consumer, but health care is a state, not an individual issue, because those who need it the most are the ones you take the least care (i.e. lower SES, men, etc.) In any case, I think that men don’t make good, responsible consumers. It is the opposite: notions of real masculinity are about being bad health consumers.”
This really challenges my thinking about health literacy, as:
a) I agree with him that — based on my discussions with Australian males of all ages and socio-economic groups, and particularly those in lower SES groups — it is difficult to find men who are actually interested in taking more responsibility for his own health or who is even particularly receptive to health-related information;
b) Singleton’s view seems to conflict with the prevailing ideology of health literacy (prominently advocated by Kickbusch and others), which alleges that health literacy is a key element of empowerment and building social capital, and seems to incorporate the assumption that people will want to have a high level of health literacy; and
c) Public health advocates, particularly those working on issues such as tobacco and obesity, have been strong advocates for structural and policy reform, as an acknowledgement that people’s decisions (and indeed, their available choices) are the products of the physical, social and economic environment in which they live. In contrast, the “individuals must take responsibility for their own health and that of their children” line has been used by politically conservative decision-makers, and by industry, as an excuse not to make the sorts of structural/policy changes that have been shown to be important for population-wide change.
Singleton’s position suggests to me that perhaps health literacy — particularly in its broad sense, rather than just literacy in a clinical setting — needs to be viewed more realistically, and even harshly, as something that will have only a limited role for people who are not at least ‘middle class’.
To the extent that we expend our energies in working out ways to improve people’s health literacy, and talk about the importance of doing so, are public health advocates simply being complicit in supporting the very ideologies that many of us have been arguing so strongly against?
- Margo Saunders
Public Health Policy Consultant
Canberra, Australia