Part 1 Three Theories at the Foundation of Health and Health
Literacy To respond to increasingly urgent national and international
calls to improve health literacy, research and practice must originate from
current scientific understanding of health and literacy. First consider
concepts of health. DOHaD: Developmental Origins of Health and Disease Healthcare systems, and health literacy research, have been
slow to respond to the conceptual convergence and empirical evidence that have
ushered in the third era of modern healthcare and with it, the emergence of health
literacy improvement as a pragmatic intervention to promote health and reduce
disease and disparities worldwide. The first era of modern
healthcare (1900s) grew out of germ theory and understanding of health as the
absence of disease. Practice aimed to achieve survival from infectious
diseases. The second era (1950 —) began with discovery of gene theory and
understanding of health as a combination of genetic makeup and adult lifestyle
choices. First-era practice was overlaid with chronic disease treatment and
emphasis on quality of life, patient activation, informed consent, and
self-care. The current third era of modern healthcare began around 2000 with
the convergence of theory and research from multiple fields into under-standing
of the Developmental Origins of Health and Disease (DOHaD) LCHD: Life Course Health Development Understanding of DOHaD led to a nuanced concept of health as
constantly developing and socially determined. Life course health development
theory describes how health
and disease originate in early development in utero and childhood and follow a
trajectory through increasing function in adolescence, to maintenance of
function in adulthood, to decline in old age. Health literacy challenges and tasks evolve along the same
trajectory, so that a person's or a community's health literacy progression is
lifelong and evolving. SDoH: Social Determinants of Health The Social Determinants of Health are factors that determine
whether and how developmental predisposition to adult disease is
expressed. Health influences and
is influenced first by our parents' and then our own income, education,
nutrition, transportation, and physical and social environments including
healthcare access and health literacy .
SDoH also are determinants of health literacy. Implications for research Health literacy research grounded in these theories would
view health literacy as constantly developing and socially determined. It
would put maternal health literacy
at the forefront, and focus on intervention to promote health literacy over the
life course for disease prevention and health promotion as well as disease
treatment and healthcare. It would expect and measure improvements in risk
behaviors, preventive practices and health services utilization as the outcomes
of interest. Next: Part 2
Theories of literacy and health literacy References: 1 Wadhwa P, Buss C, Entringer S, Swanson J. Developmental
origins of health and disease: Brief history of the approach and current focus
on epigenetic mechanisms. Seminars in Reproductive Medicine. 2009;27(05):358–368.
doi:10.1055s-0029-1237424 Halfon N, Hochstein M. Life course health
development: An integrated framework for developing health, policy, and
research. Milbank Quarterly. 2002;80(3), 433-479. Wilkinson,
R. G., & Marmot, M. G. (2003). Social determinants of health: the solid
facts. World Health Organization. |
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