Blogging from the University of California, Berkeley

By Felicity Porritt (Head of Communications)

7/11/15

Day five of Michael’s book tour across the US was at University of California, Berkeley. It was an occasion I wanted to witness, in person. Forty years ago Michael’s journey into public health started at Berkeley where he earned his MPH, then his PhD on acculturation and coronary heart disease in Japanese Americans. Forty years ago the University of Sydney, where he studied medicine, suggested Michael asked too many questions about why patients kept coming back for treatment. Forty years since Michael first noticed it was his patients social circumstances that were making them sick.

As Michael waited in the lobby of the David Brower Centre at Berkeley, old faces kept appearing. Like long lost friends there were greetings after greetings. They’d travelled from far and wide from around the San Francisco bay area, and beyond, just to say ‘hello’. The atmosphere was one of a homecoming.

Michael’s former supervisor, the great Professor Len Syme, introduced Michael. The whooping started. The audience could barely contain their excitement. The event was vastly oversubscribed. The lucky 120 clapped and cheered as Len welcomed Michael up to the lectern. Despite jetlag, Michael’s face was the picture of rude health – a huge smile from ear to ear. He clearly felt he’d come home.

Over the last eight years as head of communications at the UCL Institute of Health Equity I've listened with rapt attention to my boss speak, numerous times. But this was different. Michael may have been awake from 3am (he arrived in the US from Taiwan on Monday to two speaking engagements in Seattle, hot footed it east to Chicago for two more talks, then back West for two more) but you’d never have guessed. The passion and energy behind his messaging, as he marched stage right to stage left and back again, was stronger than ever.

The organisers told him ‘five more minutes’, then ‘one more minute’. ‘Oh come on’, exclaimed the orator. Clearly the audience too wanted more. As Michael rapped up his 45-minute lecture, the room erupted. It was a huge privilege to have witnessed this homecoming. But then it continues to be a privilege to work for such a great man who, bit by bit, is changing the world.

As Len Syme whispered to me just before Michael began to speak ‘they say Michael is the most influential person in public health, across the world, you know’. ‘I know’, I whispered back. ‘Then let’s communicate better’ exclaimed the 83 year old, whose guiding supervisory role is clearly as sharp as ever. That was me told!

Health information that’s difficult to find, understand and use can lead to worse health for all ages and widen health inequalities.

By Jill Roberts, author of 'Improving Health Literacy to Reduce Health Inequalities'.


Following years of assessing evidence, there’s general agreement that the biggest contributor to health is the wider determinants of health - so, where and how we live, and the social and economic conditions around us, starting from the womb. Inequalities in these social determinants give rise to unfair differences in health, so to have the greatest impact on health inequalities we need to address these social determinants.

How we find, understand and use information about all aspects of health – healthcare, health behaviours, genetics, and crucially, the social determinants of health - underpins our ability to both prevent and treat ill health. This is often referred to as ‘health literacy’. Health literacy is therefore one of the pathways to good health, but it is influenced by the social determinants of health.

This week IHE have published a paper, commissioned by PHE, which sets out why we all need to have the appropriate skills, knowledge, understanding and confidence to be able to find, understand and use health information – be that making GP appointments online, to understanding dosage instructions on medicines, leading a healthy lifestyle or even lobbying for safer, greener environments.

But ‘health literate individuals’ alone are not enough: we also need ‘health literate organisations’. This means that employers and all services with the potential to influence people’s health – such as GP services, hospitals, children’s centres and local councils, to housing and adult education services - need to provide clear, accessible information for all, and make a particular effort to reach, engage and serve those people and population groups with the worst health. They also need to advocate for healthy social, economic and environmental conditions.

A well-educated person can have limited health literacy when required to understand and use unfamiliar language and concepts in unfamiliar healthcare settings, and when navigating health information online, especially when illness makes them more vulnerable. Research has found that in England, 42% of working-age adults are unable to understand and make use of health information, rising to 61% when numeracy skills are also required for comprehension. Basic literacy and numeracy skills are therefore essential necessities for adequate health literacy, but they are not sufficient.

It is, however, the people and population groups with limited financial and social resources – those people with no work or unstable work, no or low income, poor quality housing, limited social support networks, for instance - who are more likely to have limited health literacy, and, at the same time, who are less likely to be adequately served by those services that influence health. These vulnerable groups, including more disadvantaged socio-economic groups, migrants and people from some ethnic minorities, older people, people with long-term health conditions and disabled people, are, in turn, more likely to have a poor diet, to smoke and not exercise, and to have an increased risk of morbidity and premature death.

Improving health literacy can have a range of benefits, including building resilience, encouraging positive lifestyle changes and empowering people to effectively manage long-term health conditions; all of which can help to reduce the burden on over-stretched health and social care services, improve everyone’s general health and wellbeing, and reduce unfair differences in health.

We’ve therefore set out simple, effective and cost-effective examples of health literacy strategies that are known to improve health outcomes. These include: the ‘teach-back’ method, which involves professionals asking service-users to repeat the information they have just received to check for understanding; local areas adopting an early-intervention approach to health literacy promotion, and; community-based, peer-support approaches to help distribute health literacy among social networks.
Even small changes to the way we communicate health information can make a big difference. 

Whether you’re a professional who works to improve the conditions in which people are born, grow, live, work and age (across all tiers of an organisation), or a community-member, we all have a role to play in making sure that the information people need for a healthy life touches, and is understood and used by everyone, but especially those who have the most to gain.

Dr Angela Donkin Responds to Alarming New Data from Joseph Rowntree Foundation

Today JRF published alarming data that illustrate again an increase in the numbers of households not able to afford an acceptable standard of living. Of all the households studied, there has been an increase in those unable to afford an acceptable standard of living, from 21% in 2008/9, to 24.8 % in 20011/12, and now to 27.3% for this year.

For families with children it is more worrying.  In 2008/9 30.6% were unable to afford a minimum standard of living, now the figure is at 39%.

In the Marmot Review we made it very clear that having a sufficient income to lead a healthy life was a key social determinant of health. Therefore increasing numbers living below acceptable standards will be bad for health outcomes, and inequalities in health.

Not having enough money makes it difficult to afford a healthy diet, decent housing, fuel for heating and cooking, appropriate clothing, and to pay for any exercise that carries a cost.  Items such as travel and birthday cards that are important for social integration, are often out of reach. Alongside the associated health impacts of inadequate nutrition, and cold and damp housing, not having enough money, and particularly being in debt, is associated with increased stress and depression.  Increased stress and depression have been linked to a range of negative health outcomes, and can have a negative impact on children’s development.

It is deeply embarrassing to live in a country where nearly 4 out of 10 households with children cannot afford a decent standard of living.  We support JRF’s call for improvements in income and efforts to moderate the costs of essential goods.