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Update Health Literacy Research for the Third Era of Modern Healthcare

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

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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