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A. Is Literacy Linked to Poor Health? Dr. Irving Rootman, Director of the Centre for Health Promotion at University of Toronto, in 1991, noted that "literacy is becoming increasingly recognized by those working in the field of health as a critical determinant of health". Citing the conclusion of a report done by the Ontario Public Health Association, he said: "Virtually all health-related aspects of people with limited literacy skills are worse than for others (Rootman,1991,P.64)." Direct impacts of low literacy such as the inability to read prescriptions or medical directions have led to numerous hospitalizations, adverse drug reactions and medicine poisonings of children and of seniors with prescribed medications. (Preston, 1995, Internet). Information about healthy nutrition for babies, hygiene, common treatments for childhood diseases, is inaccessible to parents who can't read it. (Woodhouse, 1995. p.24). But the greatest detriment to low literacy are the lifestyle choices which have long-term impacts not only on the individual, but also on his or her family. For example, a study of smoking in Canada revealed that though well-educated people had reduced their tobacco use substantially in response to publicity through the 1970's, the poorly educated continued to puff their way toward lung cancer at the former rate (Manga, 1987, P. 644). "Illiteracy", Rootman argues, "leads to poor lifestyle practices, stress, unhealthy living and working conditions" as well as " to inappropriate use of medical and health service" (Rootman,1991, P. 65). These indirect lifestyle problems pose the long-term challenge to our health care system and defy easy resolution. Although the health effects of low literacy are difficult to quantify, circumstances in Manitoba today have unlocked data which are useful in linking literacy to health. Such a linkage may help us understand why there are so many under-educated people in the emergency ward and why, by teaching people to read better, we may reduce the medical costs for a significant portion of our population. It is difficult to isolate a population statistically so that it can be analyzed for the effects of low literacy. Nevertheless, thanks to data published by the Manitoba Centre for Health Policy and Evaluation at the University of Manitoba, it has become possible to compare areas of Manitoba according to the health and the literacy levels of their residents. B. The Relationship Between Health and Literacy Several years ago, the Manitoba government commissioned the Manitoba Centre for Health Policy and Evaluation at the Faculty of Medicine of the University of Manitoba to study the patterns of health care utilization in the province. Since Manitoba's Department of Health has collected records on citizens using the provincial medicare system since the early 1970's, there is a wealth of detailed information constituting one of the most reliable data banks in North America (Frohlich et al, 1994,P.ii). When literacy levels from the 1991 Canada Census are superimposed on the health regions designated by the Manitoba Centre for Health Policy and Evaluation, it becomes possible to draw some conclusions about health and literacy in Manitoba. The picture which emerges is startling. 1. Instances of disease and epidemic increase markedly in areas in which the literacy rates are low. The Thompson region has not only the highest rate of rural illiteracy at 38% (Map #1 ) but the highest rates for hospitalizations due to infectious disease (six times that of Winnipeg), pneumonia (six times that of Winnipeg), influenza (19 times that of Winnipeg), and tuberculosis (7 times that of Winnipeg). 2. Violent death is also more prevalent in low-literate areas that elsewhere in Manitoba. The Thompson region has many fatal accidents: four times the rate of motor vehicle accidents as Winnipeg, six times the rate of drownings, twice the rate of poisonings, five times the rate of death due to fire and flames (Cohen and MacWilliam, 1993, P. 39). The murder rate is five times that of Winnipeg. 3. Hospital usage by children is highest in low-literate communities. Demographic studies show that native Canadians "are in the midst of a baby boom" (Foot, 1996, P.199) and that "36% of the aboriginal population is less than 15 years of age". Children on reserves will soon become the most fertile population in Manitoba. Unfortunately, overcrowding, poor quality housing, impure sources of water, uncertain hygienic procedures and questionable infant and toddler nutrition combine to create a ticking health time bomb. A report prepared for Manitoba Health in 1992 indicated the prevalence of babies susceptible to chronic medical problems among those with lower literacy skill. "Mothers with the lowest education were twice as likely to have a low birth weight baby than mothers with university level education" (Health Advisory Network, 1992, P.36). Hospital usage is obviously going to increase as impoverished conditions continue and the population birthrate increases. 4. Already marked by the highest rates of pediatric hospitalization, the highest rates of hospitalization for infectious disease and the highest rates of accidental and violent death, the difficulties of low literate life on reserves are attested to by the virtual absence of old people in the population (Frohlich et al, 1994, P. 70). |