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News & Events

Eating Between the Lines: Health and Literacy (Connections for Canadians)

42% of Canadians struggle with basic reading and writing. The International Adult Literacy Survey (IALS) (1995;2003) shows strong links among literacy skills, employment and poverty, and thus health...

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Think Before You Go Pink



June Tavenor-Brake’s article last March, “An apple a day keeps the doctor away,” outlined preventative health care, and stated that we don’t really want to “keep the doctor away.” To pick up on the theme started by Tavenor-Brake, I would like to suggest that we can begin promoting healthy patterns of preventative health care with four and five year old children. We can do this through literacy activities such as reading, writing, playing in the sandbox, taking photographs, and surfing the net.

I know what you are thinking: what does literacy or education have to do with health? Well, why do you think our generation and those preceding us (i.e. the baby-boomers) are constantly fighting the “battle of the bulge,” binge dieting, wondering, searching, and trying to discover the “secret” of living healthy? Why do we struggle with this? Why is it such a secret? Well, as I have alluded to before, there is no secret. It’s about educating yourself, Just Doing It, and the concept of positive reinforcement and motivation (basic learning theory) that will guide you through prevention of illness and general improved health. I am a firm believer that we can save future generations much time in figuring this out by educating them now. Is youth really wasted on the young? Well, I am hoping not. They soak up information “like little sponges”: three and four year olds have the capacity to learn video games in seconds flat. Why not take this into consideration and teach them how to be literate Canadians: to read, write, speak, and represent using, what we consider “common sense concepts” like, basic nutrition, balance, and making healthy choices as the “theme”?

Taking a Look at the Current State of Canadian Health

The Canadian Institute for Health Information (CIHI, 2004) reports that there is growing evidence that unhealthy eating patterns in both childhood and adolescence have contributed to an increased prevalence of diet-related risk factors for chronic disease and obesity. Knowing this, and that it just gets worse as children grow older, one would then assume that the greatest potential for the development of healthful dietary patterns rest with young children. In fact, I believe (and I am supported in this belief by many scholars) that preschoolers are ideal participants in preventative (health care) strategies because their food use is influenced strongly by parents and child-care providers.

The economic impact of obesity on the Canadian health system was last reported exceeding $1.8 billion, or 2.4% of the total health care expenditures. The psychosocial impacts of obesity on children (and adolescents) include many social factors: discrimination, emotional developmental distress, self-esteem issues, and distortion of body image, thus education, research, and prevention are current issues for future attention in the health system. (CIHI, 2004)

Current State of Literacy in Canada

The latest literacy study by Statistics Canada shows that a staggering amount of Canadians do not have the literacy skills they need to keep up with the rising demands of our society and economy: 42% of Canadians struggle with basic reading and writing. This alarming statistic has an impact on the social and economic well-being of individuals, families, communities and our country (Statistics Canada, 2005). The International Adult Literacy Survey (IALS) (1995; 2003) shows strong links among literacy skills, employment and poverty, and thus health.

The IALS (2003) has also revealed that forty-eight per cent of Canadian adults (approximately 12 million Canadians), age 16 and over, have low literacy. Another disturbing finding from the recent survey is that there was no difference in literacy (i.e. low literacy levels remained the same) from the 1994 survey. However, the number of people with low literacy has increased. Overall, the number of adults below level 3 increased from 7.7 million in 1994 to 8.9 million in 2003, an increase of 1.1 million adults.

This increase is because the working age population in Canada increased by three million between 1994 and 2003. So at the current rates of investment and with the current programming, any improvements achieved are slower than population growth nationally. If we keep doing what we do now, the number of people with low literacy will increase at the rate of about 100,000 a year (Satya Brink, 2005).

There is clearly a need for a continuation of literacy interventions and/or support for Canadians with the goal that they increase the literacy skills to enable them to reach potential and participate in all various aspects of a healthy and literate society.

Literacy as a Determinant of Health

According to the Public Health Agency of Canada, two of the key social determinants of health are education and literacy, and healthy child development. In fact, literacy skills predict health status even more accurately than education level, income, ethnic background, or any other socio-demographic variable (Ronson and Rootman, 2004). There is also evidence that literacy is directly related to both overall health status and to mental status, and that it is a requirement for many aspects of life, including: reading nutrition information on food packages; understanding instructions for taking medications or preparing infant formula; searching for information on specific health issues (e.g. nutrition or diseases); and interactions with pharmacists or doctors.So, given this, how can we set our children who are the future generation, apart from ours which is plagued by chronic disease and a health care system which does not satisfy our needs?

Defining Health

"the health of a population as measured by health status indicators and as influenced by social, economic, and physical environments, personal health practices, individual health capacity and coping skills, human biology, early childhood development and health services. (FPT Advisory Committee on Population Health, 1997).

Literacy as Social Practice

Revisiting the notion that the future of health care promotion is in the hands of our children, I would like to discuss the strategy of using literacy to do so. Before children get to the adult world of work, there is an opportunity in the rich world of early literacy for them. Preschool children speak, listen, view, represent, and even read and write in fundamentally literate ways and use these in a social way to explore the world around them (Doiron, 2006; Cooper et al., 2003 ). Lonsdale and McCurry (2004) emphasize the notion that literacy is a social practice with multiple purposes that can coexist such as learning to write, and learning to read about nutrition, for example.

Defining Literacy

There are many diverse definitions of literacy, going beyond traditional reading and writing models to include skills related to various multi-literacies (Human Resources and Skills Development Canada, 2005; Cooper & Kiger, 2003). More than 50 years ago, the United Nations (UN) declared literacy to be a basic human right. The UN also identified literacy as an important tool for developing other human rights, such as the right to adequate food, housing, and health care. The higher a nation’s literacy skills, the greater the opportunity for all its citizens to participate meaningfully in community life while leading productive, healthy, and satisfying lives. In 2003, UNESCO defined literacy as “a continuum of learning that enables individuals to develop their knowledge and potential, pursue and achieve their goals, and participate fully in society” thus implying that these multi-literacies are entrenched in multiple determinants of health (National Literacy Trust, 2006; Max Bell Foundation, 2006).

Children also use various literacy “tools” to explore the world and make sense of it in this social setting (Van Scoter and Boss, 2002). In the spirit of play, children of the twenty-first century are able to use technology in ways that our generation could not, and they have adopted to the fast paced world of imagery, gaming, and other media which may include digital cameras, tape recorders, portable keyboards, computers, scanners, and software to explore and create their early learning experiences. I think if we think of technology as something that can support literacy and language development and create an opportunity for children to learn about new concepts, build on previous knowledge, and use these new tools to advance their own learning, for example, surrounding healthy eating there is potential to provide health literacy education and work toward improving the health of Islanders, and Canadians.

The question is: How?

Well, as I have spoken to previously, I am passionate about health literacy. I also happen to know about a research project that exists called Eating Between the Lines: A Healthy Eating Literacy Program for Preschool Children and their Families, which uses the approach of education (literacy) and nutritional health information, with preschoolers.

Its goals are to:

to develop of a unique literacy and healthy eating program for preschool/ kindergarten children and their families

enhance understanding of the effectiveness of such a program on the key outcomes of 1) vocabulary development (word recognition and word meaning); 2) writing and representing skills; 3) oral language skills; and 4) basic nutrition knowledge

The project has been developed and piloted by Drs. Ray Doiron and Jennifer Taylor through a research grant at the University of Prince Edward Island, at Campus Kids Kindergarten which is housed on campus. The results will assist researchers in further refining the program so it will include many rich tools and resources (including technology) for teachers, parents, and the community. With any luck, it will be made available to other kindergartens in PEI, and to the rest of Canada in the future, thus working toward a new approach to health and literacy in Canada. It serves as a model, using literacy activities such as reading about nutrition (i.e. eating the alphabet), grocery shopping, writing, playing in the sandbox, taking photographs of fruit, taste testing, and surfing the net to design salads, and feed the monster. All the while, children learn basic concepts like word recognition, balanced nutrition, the concept of food groups, and the reasons why it’s important to eat healthy and how exciting literacy can be.

It’s a step in the right direction!

As Tavenor-Brake and I have both previously alluded to, living the good life, eating well, exercising regularly, sleeping, not smoking, and de-stressing area all important to health promotion. Educating our children, our friends, our parents, and yes, even grandparents about health matters are a way to get these messages out effectively and clearly. What used to be called “common sense” information (i.e. Canada’s Food Guide) is a novelty to some young adults these days (preschool children just love to “make their own food guide”). Given the statistics on the almost epidemic rates of obesity and the repercussions of low literacy in Canada, health literacy education is something that needs more attention in our government and policy-making world, and I believe it can start at the grassroots level with our preschool children.