This non-exhaustive list aims to provide an overview of some of the activities in health literacy worldwide.

United Nations and other agencies

United Nations
The United Nations (UN) has declared that 2003-2012 is the UN Literacy Decade: Education for All. While not focused on health literacy, the plan includes aspects of childhood care and education with one of the expected outcomes of the initiative being an improvement in quality of life.

World Health Organization (WHO)
Having worked with literacy and health for many years, the organization has started to adopt the term health literacy. The WHO definition (see pxxx) links health literacy with empowerment and the potential for better health. The different regional offices of WHO have projects with health literacy components.

World Bank
In the belief that education and health go hand in hand, the World Bank posts on its website different projects on literacy and non-formal education (outside a school setting). The organization has published a number of studies on the links between literacy and HIV/AIDS.

United Nations Educational, Scientific and Cultural Organization (UNESCO)
UNESCO linked the themes of health and literacy in 1997 at a conference on combining health education with adult learning. It has recently given an award to a scheme started in 1997 by the UN Population Fund (UNFPA) and the Peruvian government in Cuzco, Peru, in which over 200 women learned to take care of their reproductive health while learning to read and write in two languages, Quechua and Spanish.  The success of the pilot scheme convinced the project designers that bi-literacy training worked. In 1998, UNFPA and the Bolivian Ministry of Education set up the scheme in the Andean regions of Chuquisaca and Potosí, where illiteracy rates and mother and infant mortality have reached alarming proportions.

UN Children’s Emergency Fund (UNICEF)
UNICEF’s programme, Focusing Resources on Effective School Health (FRESH), launched in Senegal in 2000, includes health, hygiene and nutrition as part of basic education. It focuses on the development of the knowledge, attitudes, values and life skills needed to make and act on the most appropriate and positive decisions concerning health.

Joint UN Program on HIV/AIDS (UNAIDS)
UNAIDS has been instrumental in fostering many information campaigns to promote HIV/AIDS prevention and destigmatization. While the organization has not labelled its material as promoting health literacy, in actual fact it has put into place material and information that ensure easy understanding.

World Education
World Education, Inc., is a not-for-profit group based in Boston, in the United States. With funding from USAID, the organization often works alongside the UN High Commission for Refugees (UNHCR) on health and literacy work in many countries, including Mali, Egypt, Nepal, and the US.

Health professional associations

World Medical Association (WMA)
Although the World Medical Association does not currently have a policy on health literacy, its Secretary General Delon Human says that it is concerned with the issue and he highlights the immense efforts being made by the American Medical Association (see pp.7-8).

International Council of Nurses (ICN)
ICN is fully aware that health literacy is an important determinant of health and illness. The Council incorporates health literacy, advocacy and lobbying into position statements and fact sheets that call on nurses to teach individuals and families and to focus especially on vulnerable populations.

International Pharmaceutical Federation (FIP)
The International Pharmaceutical Federation (FIP) has produced guidelines on maximizing readability and understanding of medicine labelling. A recent pledge from FIP was that all pharmacists become equipped to educate children, adolescents and their parents about medicines.

Selected examples worldwide

It is imperative that health literacy, as a whole, links with cultural beliefs throughout the world. Simple translations are not enough. Various words and concepts are not represented in certain cultures and this needs to be addressed.

Kidney Disease
A UK patients’ organization, the National Kidney Research Fund, is targeting a prevention and screening project at South Asian and African Caribbean groups who are at up to five times the risk of developing kidney disease than those of European origin. A pilot study was set up in a multi-ethnic London suburb. Advertising for the free screening for kidney disease was aimed at the local Asian and Black communities. 500 bilingual posters were put up at local community venues, in libraries, places of worship (with the full support of religious leaders) and doctors’ surgeries. Slots on local radio and television programmes and in local newspapers were taken. Personal letters were sent through a neighbourhood Indian Association. Almost 400 people took part in the pilot study, two thirds of whom were Asian and around 20% Black. Initial screening led to 78 people, mostly Asian, requiring further investigation. The full, three-year project is now going ahead.

Alzheimer’s
Cultural themes are also a part of a project being run by the Alzheimer's and Related Dementias Association in South Africa. Kathy Beukes from the Association said that in less developed parts of the country, Alzheimer’s disease was sometimes viewed with great superstition and often not recognized as an illness.

The charity developed a poster, aimed at a non- or low literate public, which was displayed on the streets at bus shelters in Soweto. The posters illustrate a man who cannot recognize his son, an elderly woman who cannot find her home, which is just behind her, and a woman incorrectly dressed, with her underwear on top of her clothes. The charity’s volunteers stop on the street and explain the campaign to passers-by and give out booklets, again aimed at those with low literacy.

Although there is little help available from the healthcare system for those with low income, specially trained nurses could advise on helping to manage a relative with Alzheimer’s disease. Around a fifth of dementia-like behaviour may be reversible with simple interventions from primary healthcare workers. The campaign urged relatives to seek help in this way.

Alzheimer’s Disease International member Dr. Ravi Samuel, based in Tamil Nadu, India, has developed a series of cartoons on dementia for non-literate relatives. The illustrations are based on real life stories from his clinic at a not-for-profit hospital. Responses from the family members have been overwhelming. They are able to understand the progressive nature of the illness, the need for specific education and the focus on care rather than cure. Even the educated population appreciates the cartoons.

Cancer
The American Cancer Society (ACS) has several projects including new “touch screen kiosks” set up at clinics, libraries, and shopping malls. It is hoping these “Wellness Links” will help reach underserved communities where the message of cancer detection and prevention often goes unheeded. The format used helps make low-literacy learning easy and enjoyable, the ACS says.

The kiosk content, regularly updated, now includes information in English and Spanish about 40 kinds of cancers. Information includes advice on the risk, cause, diagnosis and treatment of diseases such as breast cancer and prostate cancer. Users select what they want to hear about through an interactive touch screen display. They then watch, hear and read the facts provided. Recently, 23 short videos co-produced with Discovery Health Channel were added to the kiosks to address the needs of visual and audio learners.

To download TPN Issue 18 in full as a PDF file, please click here.

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