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In this chapter the literacy-mediation hypothesis – that the acquisition of academic literacy influences health literacy and health navigation skills – is tested in the four-country data and the UNICEF Nepal survey. The hypothesis is supported by multivariate analyses, not only in regard to the comprehension of printed health messages but also in the comprehension of radio messages and in producing an intelligible illness narrative – though both of the latter are oral communication tasks. These findings suggest that literacy instruction in school promotes a woman’s health literacy and navigation skills beyond those that involve reading and writing, and point to a more general ability to communicate in bureaucratic settings like schools and clinics and to a tendency to accept the authority of health professionals. The UNICEF Nepal survey shows health knowledge and media exposure to be involved in the causal sequence.

Most stakeholders in the health care system—doctors, patients, and policy makers—have not been taught to apply evidence-based information to the many decisions that must be made daily. Little awareness of this problem exists, yet a better use of evidence could improve outcomes for patients, increase patient satisfaction, and lower costs. This chapter considers how the use of information that emerges from evidence-based medicine could be improved. Health literacy is the first step. After a discussion of the barriers that exist to health literacy, possible remedies are presented. Raising health literacy by targeting individual stakeholder groups is debated as is the option of focusing on change in the overall health system. What is required to achieve a change both at the individual and system levels? Solutions are unlikely to generate systemic changes in center-based treatment variations. However, a change at one level may set off change in another. Finally, increasing awareness beyond the immediate professional community is necessary if systemic changes are to be made. The promotion of health literacy requires careful consideration to reach the various stakeholders throughout the health care system.

This chapter explains how literacy problems complicate the process involved in making informed decisions. Many people are unable to read many disclosures because they are not literate or numerate enough to decipher them with reasonable effort. This is both because levels of literacy and numeracy are surprisingly low and because the reading levels of disclosures are surprisingly high. The chapter argues that sector literacy—understanding a decision's context and an industry's practices as only proficients do—poses a major problem in terms of trying to understand mandated disclosures. It emphasizes the need for sector literacy and reviews evidence from the areas of health literacy and financial literacy. It concludes by asking whether the illiteracy, innumeracy, and sector illiteracy problem can be solved.

This chapter begins with an overview of the encoding, storage, and retrieval of memories. Important to the encoding process are attention, focus, understanding, and the agility of the working memory. The role of emotion in memory storage is reviewed, with examples of how heightened emotion can enhance memory, or may interfere with it, if the emotion is too strong. Factors that bias our recall (such as cultural and other experiential elements, as well as the tendency toward self-enhancement), along with other characteristics (e.g., age, gender, lack of sleep) that are sometimes thought to be related to memory, are reviewed. Strategies for enhancing memory, including tailoring the information to the patient’s characteristics, considering health literacy, avoiding jargon and information overload, mnemonics and chunking, and multimedia memory aids, are given.

Patients’ health illiteracy is, in part, a consequence of how the health care system has been set up. Conversely, the flaws of the health care system and the interest groups it caters to can only exist to the degree that patients remain uninformed. Thus, to improve health care, two strategies are presented. The first involves changing the health care system by introducing new, and enforcing existing, guidelines and procedures designed to reduce funding and reporting biases as well as financial conflicts of interests. If a health care system can be freed of these problems, patients, independent of their health literacy level, will be able to get good health care, simply by trusting their doctor and the information provided. The second requires educating the public to increase knowledge about how their health care system works (health system literacy). If patients become more health system literate, they will be able to identify if and why evidence is missing, incomplete, or unreliable and will get better health care because they are not easily misled by nonmedical interests acting within their health care system.

There is a large range of national public funding support for health research across countries. By contrast, allocations for overall funding for health literacy and related research areas are limited. Health research agendas and resource allocation are policy decisions that involve the use of power. There are strong incentives to maintain the status quo, especially in the face of level or declining funding. Many macro- and microlevel factors influence research agendas and funding support. These range from broader societal values and health care delivery systems, to the individuals themselves who make decisions. There is a great need for more research in areas such as implementation of simple interventions in “real-world” settings and the effects of communication technologies on receipt, processing, and seeking of health information by the public. There is some reason for optimism: awareness and support for more transdisciplinary and applied research relevant to health literacy is increasing, and some countries have adopted effective approaches to assess new health technology and treatment prior to introduction into clinical and public health practice.

Efficient health care requires informed doctors and patients. The health care system inherited from the 20th century falls short on both counts. Many doctors and most patients do not understand the available medical evidence. Seven “sins” are identified which have contributed to this lack of knowledge: biased funding; biased reporting in medical journals; biased patient pamphlets; biased reporting in the media; conflicts of interest; defensive medicine; and medical curricula that fail to teach doctors how to comprehend health statistics. These flaws have generated a partially inefficient system that wastes taxpayers’ money on unnecessary or even potentially harmful tests and treatments as well as on medical research that is of limited relevance to the patient. Raising taxes or rationing care is often seen as the only viable alternative to exploding health care costs. Yet there is a third option: by promoting health literacy, better care is possible for less money. The 21st century should become the century of the patient. Governments and health institutions need to change course and provide honest and transparent information to enable better doctors, better patients, and, ultimately, better health care.

This chapter considers the individual and the population approaches to assessing health outcomes. Death, hospitalization, quality of life, cost, disability, inequality, and health literacy are considered and compared as health outcomes. A scheme for the critical appraisal of outcome measures is presented. The importance of focusing on outcomes, rather than process, in assessing a health policy is stressed.

This chapter describes the impact of social injustice on oral health. It defines oral health and describes the oral disease epidemic. A box in the chapter describes social inequalities in oral health internationally. The chapter discusses national priorities, local and state priorities, school programs, dental public health infrastructure, the dental workforce, and practices of the food and tobacco industries. It describes what needs to be done to improve oral health and reduce the impact of social injustice on oral health.

This report calls for a change in health care, while acknowledging that health care systems are highly complex systems for which there is no simple solution. The starting premise is that one needs to launch and reinforce positive developments among both clinicians and patients. To this end, a vision is offered to transform medical schools into health professional schools; specific ways of leveling the knowledge playing field between clinicians and patients are described to empower patients to ask more questions and dissuade clinicians from “avoidable ignorance.” The Wennberg three-step action plan is proposed to demonstrate how a patient-centered health care paradigm can work for important process and outcome measures. To foster patients’ engagement within the health care system, an existing model that teaches health literacy to children in primary schools is described and possibilities are proposed to foster the delivery of quality health care information via the media and online communities, with the Internet being the technology that is most likely to complete the change in the dynamic of doctor– patient interaction. The 21st century is viewed as the century during which reform ushers in an adult conversation between patients and doctors.

This chapter contains three modules that cover principles of communication, barriers and stressors that impact patients’ adherence, and cultural competence. The goal of healthcare providers should be to communicate in a way that educates the patient, while also uplifting her sense of self-efficacy and motivating her to take control of her health. To improve follow-up rates among low-income women of color, providers must be aware of adherence facilitators (e.g., spirituality, social support) as well as barriers (e.g., psychosocial needs, stressors), particularly given that many of these barriers exist at the system level and providers are often responsible for initial cancer screenings. Cultural competency represents the foundation of health communication. Providers must be culturally competent so they can help women solve problems, make informed decisions, feel empowered, and place trust in their healthcare providers and the healthcare system.

This chapter starts by describing the importance of interpersonal communication and relationships between patients and clinicians for ensuring high quality health care, drawing upon numerous studies that report better clinical outcomes with better communication. It then presents various challenges to interpersonal communication between patients with disabilities and clinicians, ranging from issues such as attitudes of clinicians to lack of accommodations for persons who are blind, experience low vision, deaf, or hard of hearing. The chapter presents examples of inadequate or damaging interpersonal communication. It raises particular concern about discussions of potentially sensitive topics, such as sexuality and reproductive health, mental health, and substance abuse.

Empirical evidence shows that a correlation exists between several dimensions of social inequality and health. The central dimension of social inequality that influences most life chances is education. We therefore discuss theories of the social mechanisms that are responsible for the health-determining effect of education. These approaches deal with human capital and health literacy, personality traits that interfere with education and health simultaneously, and aspects of the school context such as classroom composition and teacher behaviour. In the concluding section we ask which conditions of the macro-context of educational systems and their characteristics differences in educational achievement will result in higher inequalities of health. As this question has not so far been analysed empirically, we call for more research in this area.

Shared decision making (SDM), health literacy, and patient empowerment are related, partially overlapping constructs, all associated with patient-centred care. SDM focuses on the communication and deliberation process between provider and patient during a health care encounter that aims to support effective decision making about treatment or health behaviour. Health literacy includes functional, critical, and interactional aspects, including the social skills needed to communicate effectively with health providers, and may be a prerequisite for SDM. Patient empowerment has been described as both a process of becoming empowered, and as a state of being empowered, and may be a valued health care outcome for people with long-term conditions. Patient empowerment can be achieved through patient-centred care, including SDM. However, patients can also empower themselves through participation in patient groups, and by improving their health literacy through self education. Relationships between the constructs may therefore be reciprocal.

People are frequently faced with the task of making a variety of health decisions, from decisions about preventative screening, to taking medications, or deciding whether or not to have a surgical procedure. For many health decisions, there is no single best option, and people need to be informed about their chances of experiencing the benefits and harms of each option. However, risk information is not always easy to find and numbers can be used to mislead, emphasizing benefits or reducing harms. Balanced and transparent presentation of risk information is essential for promoting risk literacy to help people understand and make good decisions about health risks. The Facts Box is a simple decision tool that presents data about the benefits and harms of treatments in a summary table and has been shown to facilitate comprehension and understanding of health information. Facts Boxes can be used by patients and health professionals alike.

This chapter will outline young people’s music listening engagement, particularly those who have mental illness, who are often seen to be isolated and disengaged from school and everyday life. Their engagement with preferred music in music therapy during a stay in an acute adolescent mental health facility provides a rationale for the development of a music-based e-platform in a multimedia youth health portal. Technological advances and current trends in online engagement influence the ways young people engage with each other and mental health promotion. These will be discussed to highlight the importance of connecting in meaningful and relevant ways beyond therapy to improve youth mental health literacy and promote pathways to help-seeking and adolescent wellbeing.

Chapter 5 tackles the next stage of the OCD “career,” more specifically, the shift from interviewees’ perceiving themselves as having a personality issue, spiritual problem, or some other type of difficulty to believing they a have mental disorder called “OCD.” Sometimes years passed between interviewees deciding they had a “problem” and their arriving at this label. Many happened upon information about OCD that led them to conclude they had the disorder, and some diagnosed themselves. This is partly the result of lack of information about OCD, including among healthcare professionals. This chapter reiterates how diagnosis is a double-edged sword, giving people with OCD an explanation for their thoughts and behaviors, but also labeling them with a disorder. Public perceptions of the disorder are now personal. The chapter uses the concept of stigma hierarchy to illustrate how all disorders are not perceived equally by the public. Because OCD is both stigmatized and trivialized, the chapter presents survey data from undergraduates to show how improving the public’s mental health literacy regarding OCD is tricky. Showing the public the potentially serious nature of the disorder may reduce trivialization but may inadvertently increase misunderstanding and stigma.

Part II traces the trajectory of people’s experiences from first perceiving they had a problem, to labeling it OCD, to seeking help, and learning to live with the disorder. This is the illness “career.” Chapter 4 focuses on the pre-OCD experience, or the first stage of the OCD “career.” This stage depicts what life was like for people before they realized they had a mental disorder. The central question for people was, “Am I experiencing thoughts, urges, and behaviors that are ‘normal’ or not?” The chapter shows how we have to consider people within social contexts, examining the behavior of those around them to evaluate themselves, and using their existing knowledge to ascribe meaning. It discusses the factors that pushed people to perceive their thoughts and/or behaviors as atypical. They did not always define what they were experiencing as negative, but eventually all but one interviewee perceived some of their thoughts or behaviors as problematic. They commonly hid what they were experiencing from others and struggled to explain these thoughts and behaviors; the meanings and causes they gave to them included religious explanations and believing it was just them, an aspect of their personality or self.

The Model of Positive Education is a flexible, science-informed framework for supporting the flourishing of students, staff, and school communities. This chapter explores the primary objective of Positive Education at Geelong Grammar School, namely learning to flourish. It is introduced by Professor Felicia Huppert, who explains how mental health and wellbeing exist on a spectrum from languishing to flourishing, and then discusses the empirical basis of flourishing and the understanding of optimal wellbeing as both feeling good and functioning well. The school’s definition of flourishing as “feeling good and doing good” is proposed, and it is emphasized that Positive Education encourages students and staff to think of how their actions can have positive consequences for others and the community. The chapter also discusses the vital role that building awareness around mental illness, and supporting students and staff who are struggling, plays in creating a nurturing and caring school community.