Wilkinson, R. G., & Marmot, M. G. (2003). Social determinants of health: the solid facts. World Health Organization.

“The building blocks of good health have their foundation in social and emotional skills learned during early childhood,” 

Natalie McGill, The Nation’s Health, August 2016

 

 Health literacy is one of those building blocks for good health that develops from social and emotional skills learned in infancy and toddlerhood. Building blocks for heath and health literacy are emerging life skills that enable individuals to deal effectively with the demands and challenges of everyday life: problem solving, planning ahead, considering consequences, taking turns,asking questions, listening, providing information, getting help, learning from experience.

Lucky children learn these skills early from everyday interactions with their parents,  and then in preschool through daily routines, games, stories, conversations and planned and impromptu learning activities. 

Before they learn to read, lucky children learn to apply their emerging social and emotional skills to protect and promote their health: Wash your hands. Brush your teeth. Get plenty of sleep. Eat your vegetables. Drink your milk. Cover your sneeze. Put tissues in the trash. Wear shoes outside. Use sunscreen and a hat…. These early skills and health practices place lucky children on a trajectory to healthy adulthood. They develop to keep adults on a trajectory to healthy old age.

 

This idea of a health trajectory across the life course, from preconception to old age rises from increasing understanding of the Developmental Origins of Health and Disease —DOHaD.  Today’s defining heath challenge is non-communicable disease with origins in early development: heart and lung disease, diabetes, obesity, some cancers —the leading causes of death worldwide. Parents’ health at conception, risk behaviors and healthcare in pregnancy and beyond, parenting practices, and healthcare utilization combine to define their child’s adult health. 

The Social Determinants of Health (SDoH) —especially parents’ income and education—also influence a child’s health trajectory and can change it.  For example, say Dad gets a new job. The family moves to a better zip code. The child goes to a better school and plays outdoors more, has access to higher quality food and better healthcare, and enjoys more attention from less stressed parents. That lucky child grows up healthier than the child who continues to accumulate social disadvantage in the old neighborhood. 

 

Parents who did not learn foundational skills cannot pass them on to their children. Even if they read well, they face strident challenges to use information and services in ways that maintain or promote health. They are more likely to live in poverty, and to report poorer health status. They are more likely to have children with developmental delays and less likely to participate in Early Intervention services. They are less likely to have access to quality early learning programs for their children, and less likely to talk and read to their children. So their children are likely to be less healthy and less socially, emotionally, and cognitively ready for school compared to their luckier peers.  Like their parents, they are less likely to understand basic health concepts, eat well, or engage in preventive practices.  So they are more prone to disease as adults.

 

Health literacy, and other building blocks for a lifetime of good health, have their foundation in social and emotional skills learned during early childhood. Children learn these foundational skills in everyday interactions with parents. Develop parents’ foundational skills along with their  health literacy to put them and their children on a trajectory to healthy adulthood and old age.

 

 

When we promote patient choice, we must acknowledge the conditions in which those choices will be made and carried out. Then we must respect patients' choices and adapt healthcare services accordingly.

The campaign defines patient empowerment as a process that helps people gain control over their own lives and increases their capacity to  act on issues that they themselves define as important.”   Heath literacy is considered an aspect of empowerment; it helps people gain control over their health and its determinants.  Information and resources are considered tools for empowerment. If we consider information and services as tools for empowerment, how would we design them differently? What if the purpose of Informed Consent was to empower patient choice rather than legally protect providers?

A body needs about 500 mg per day. The American Heart Association recommends not more than 1500 mg per day. The average American adult consumes 3400 mg per day. The average 4 year old consumes 2500 mg. More than 2300 mg is linked to high blood pressure, hypertension, PMS, and kidney dysfunction. Can you name it?

These challenges are part of the reason the FDA is working with restaurants and food producers to lower the amount of sodium in the food supply over the next ten years. You can read the proposed guidelines and comment on them. For best consideration comment within 90 days.  Meanwhile, health educators, any way a person can reduce salt intake even a little is likely to enhance their health.