Health Literacy
and Health Promotion～The working document for discussion
at the 7th Global Conference on Health Promotion
及び自身のUgandaでの経験をもとに～

10MN011

水谷真由美
1Reference
引用・参考文献• Mayagah Kanj; Wayne Mitic. Health Literacy and Health
Promotion - Definitions, Concepts and Examples in theEastern Mediterranean Region.
• This paper was prepared as a working document fordiscussion at the 7th Global Conference on Health
Promotion "Promoting Health and Development: Closing
the Implementation Gap", Nairobi, Kenya, October 2009.
• 5 main tracks discussed in the conference: Community
empowerment, Health literacy and health behavior,
Strengthening health systems, Partnerships andintersectoral action, Building capacity for healthpromotion
2

内容
1
１．Literacy とは？
2
２．Health Literacy とは？
３．なぜHealth Literacyが人々の健康に重要か？ 3
４．Health LiteracyとHealth Promotionの関連 4
５．Health Literacyの測定方法
5６．Health Literacy改善方法
6
７．Health Literacy Conceptual Framework
7（Rootman, 2009)から考える
UgandaのHealth Literacy Determinants
3１．What is Literacy?
Literacyとは？
• UNESCO(United Nations Educational, Scientific & Cultural Organization)"ability to identify, understand, interpret, create, communicate,compute and use printed and written materials associated withvarying contexts. Literacy involves a continuum of learning inenabling individuals to achieve their goals, to develop theirknowledge and potential, and to participate fully in theircommunity and wider society“
多様なコンテクストに関連して書かれた資料を、識別、理解、解釈、創造、伝達、計算、使用できる能力。リテラシーは個人が目標達成し、知識と潜在能力を発展させ、コミュニティや社会に参加するための学習の連続を含む。
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２．What is Health Literacy?
Health Literacyとは？
• In this paper,“The degree to which people are able to access,understand, appraise and communicate
information to engage with the demands ofdifferent health contexts in order to promote andmaintain good health across the life-course”「生涯を通じて良い健康を促進し維持するために、人々が異なるヘルスコンテクストの要求に連動する情報にアクセスし、理解し、査定し、伝達できる程度」
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３．Why is Health Literacy Important forPopulation Health?
なぜHealth Literacyが人々の健康に重要か？
①The large numbers of people affected
多くの人々に影響②Poor health outcomes
健康のアウトカム③Increasing rates of chronic diseases
慢性疾患の増加率④Health care costs
医療費⑤Health information demands
ヘルスインフォメーションの要求⑥Equity
公平性6

①The Large Numbers of People Affected
多くの人々に影響• UNESCO
About 16 per cent of the world’s adult population lackbasic literacy skills.
世界の成人の16%にBasic Literacy Skillsが欠如。
About two-thirds of these are women.
そのうち3分の2が女性。

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Global Literacy Rate by MDG Region
世界の地域別リテラシー率<Source: International Literacy Statistics 2008, UNESCO> 8

②Poor Health Outcomes
健康のアウトカムにつながるから• Limited literacy is linked to several adverse healthrelated variables, including knowledge about health andhealth care, hospitalization, global measures of health,and some chronic diseases.
限られたリテラシーは、健康関連の変数（健康やヘルスケア、入院、慢性疾患についての知識を含む）と負の相関関係にある。

9

Correlation Between Inadequate Health Literacy
and Increased Mortality
不十分なヘルスリテラシーと死亡率増加の相関関係

10

③Increasing Rates of Chronic Diseases
慢性疾患の増加• 60% of all deaths are due to chronic diseases.
<Source: Preventing chronic diseases: a vital investment, WHO,
2005>

世界における死亡原因の6割が慢性疾患• Health literacy plays a crucial role in chronic disease
self-management.
ヘルスリテラシーは慢性疾患のセルフマネジメントに重要な役割

11④Health Care Costs
医療費• Public hospital patients with limited health literacy had higher
rates of hospitalization than those with adequate healthliteracy.

公立病院の患者で、ヘルスリテラシーの低い者は、高い者に比べ入院率が高い。
• The additional costs of limited health literacy range from 3 to
5% of the total health care cost per year. (Eichler et. Al, 2009)
ヘルスリテラシーが低いことにより追加コストは1年間で総医療費の3～5％かかる。
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⑤Health Information Demands
ヘルスインフォメーションの要求• Mismatch exists between the reading levels of the healthrelated materials and the reading skills of the intendedaudience.
健康関連資料が要求する読解力と読み手の読解力のミスマッチ• The use of jargon made many health-related resources
unnecessarily difficult to use.
専門用語の使用が健康関連資源の使用を不必要に困難にする• 81% of physician-patient encounters contained at least one
jargon, with a mean of four such terms used per visit.
患者の81%が1回の診療で少なくとも1つの専門用語に出くわす
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⑥Equity 公平性• Low levels of health literacy often mean that a person isunable to manage their own health effectively, access healthservices effectively, and understand the information available
to them and thus make informed healthy decisions.
低いヘルスリテラシーは、人が効果的に健康をmanageし、ヘルスサービスにアクセスし、情報を理解し、informed decisionをするのを不可能にする。

• Improving the health literacy of those with the worst healthoutcomes is an important tool in reducing health inequalities.
健康アウトカムが最も悪い人々の、ヘルスリテラシーの改善は不公平性を減らすのに重要なツールである。
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４．How Are Health Literacy&Health Promotion Related?
ヘルスリテラシーとヘルスプロモーションの関連• Today health literacy is considered an important concept, notonly among health education practitioners, but also among
those involved in the broader aspects of health promotion.
ヘルスリテラシーは健康教育実務者のみならずヘルスプロモーシ
ョンの広い側面での参加者にも重要なコンセプトであると認識。
• 5th WHO Global Conference on Health Promotion,"…resolved to widen the glossary definition to include
dimensions of community development and health related
skills beyond health promotion, and to understand healthliteracy not only as a personal characteristic, but also as a
key determinant of population health".
第5回会議で、ヘルスプロモーションはコミュニティ・ディベロップメントの側面も含み、ヘルスリテラシーは個人だけでなく集団の健15康の重要な決定要素だと定義が拡大された。

５．How is Health Literacy Measured?
ヘルスリテラシーの測定方法• The REALM (Rapid Estimate of Adult Literacy in Medicine)and TOFHLA (Test of Functional Health Literacy in Adults)
are the most frequently used tools to measure health literacy.
• REALM asks participants to read a list of medical terms withvarying degrees of difficulty and scores them on their abilityto do so.
• Unfortunately, none of these tools completely capture healthliteracy as reflected in the health promotionrelated definitionsof health literacy.
ヘルスプロモーションに関連したヘルスリテラシーの定義を反映したヘルスリテラシーを完全にとらえたツールはない。
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６．What Methods Exist
to Improve Health Literacy?
現存するヘルスリテラシー改善方法• Simplifying reading material by using clear language,
pictures and symbols is the most widespread initiative
reported in the literature to influence literacy levels, yet there
is little evidence that this improves health outcomes.
リーディング・マテリアルを平易にする→エビデンス殆ど無し。
• Multimedia presentations may improve knowledge of people
with both low and high literacy skills, but these do not appear
to change health-related behaviours.
マルチメディアによる提示→健康関連の行動変容をおこさない。
• Community-based and participatory approaches seem toshow some promise.
コミュニティに基づいた、参加型アプローチは見込みがある。 17

What Methods Exist to Improve Health Literacy?
(Cont.)
ヘルスリテラシー改善方法(続き）• Although evaluations of health literacy interventions todate do not provide clear answers on how best to createa health literate population, there are hints of potentiallypromising directions. Some recent research findings on
the determinants of health literacy also point to possibledirections.
明確な答えは無い。いくつかの最近の研究でヘルスリテラシーの決定因子についての説示がある。

18

What Methods Exist to Improve Health Literacy?
(Cont.)
ヘルスリテラシー改善方法(続き）• For example, the Canadian Council on Learning found thatreading practices in daily life (e.g., reading books,
newspapers, magazines, letters, notes or e-mails) arestrongly related to health literacy. 日常生活における読書週間• The second strongest factor to explain health literacy
proficiency (independent of reading practices) waseducational attainment. 教育の到達度• Conversely, a mother tongue that was different from thelanguage of assessment had a strong negative impact on
health literacy score.

反対に、母語がアセスメントの言語と異なると、ヘルスリテラシースコアにネガティブ・インパクトとなる。
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7.Health Literacy Conceptual Framework（Rootman, 2009)から考えるUgandaのHealth Literacy Determinants

20ウガンダ共和国の都市部と農村部

KampalaTororoPercentage of Children Age 12-23 Months
Who Received All Basic Vaccination<Source: Uganda Demographic & Health Survey 2006>

Urban:51%

Rural:45%

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多民族多言語• 妊婦健康手帳に教育レベル及び民族記載欄あり。

• 私の任地は多民族で構成され、民族により使用言語が異なる。
Tribe of Pregnant Women at ANC, Tororo Hosp.

N=49922

ジェンダー

男性は外で過ごし情報を得る機会がある。

女性は家で過ごし情報を得る機会が少ない<Source: Uganda
Demographic & Health 23Survey 2006>

Educational Attainment of Ugandan People

小学校でのドロップアウトが多く、卒業するのは全体の約20%<Source: Uganda Demographic and Health Survey 2006>24

Percentage of Children Age 12-23 Months Who
Received All Basic Vaccination
by Mother's Educational Level (%)

母親の教育レベルと子供の予防接種率には相関関係がある。
<Source: Uganda Demographic and Health Survey 2006>25

Low Health Literacyに対する（と私が考える）
服薬方法提示の工夫～抗マラリア薬～

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