A Systems Approach to

Strengthening Health Literacy:

Recent Immigrants Living
in Rural Nova Scotia
  Philip Girvan
 
pgirvan@stfx.ca
Presentation Objectives:

1. Define Health Literacy

2.Define Systems Approach
3.Discuss significant health literacy issues
for recent immigrants living in a rural
setting, e.g. having a first language other
than English or French
4.Explore collaborative opportunities to
improve health literacy suggested by
English as a Second Language teachers
Teacher's health definitions

Good health or bad Health involves the

health...in a physical whole person so I guess
disease.  Don't it’s your physical, your
automatically think  of psychological, your
emotional health or emotional, and your
psychological health.  spiritual and your social
Physical health...first and your cultural …
thing that comes to being pain-free  ...
mind. Health is what allows
you to do the things you
want to do freely
Teachers' health literacy definitions
Is it speaking knowledgeably to your
physician?   People have to be in a
large part responsible for their own
health and they have to be literate to
be able to have a discussion with the
doctor about symptoms and about
maybe anything else that comes with
that what your options might be for
your health.  … I think that the more
you know about the subject the better
you are and the more literate you are.
literacy is our ability to interpret and
understand our environment so if you
put it to health literacy then it's the
ability to understand  health what
health means and also what one
needs to do to stay healthy and that's
health again in that broader
definition
 
professionals who do know have to
take into account that people will
have different literacy levels so they
have to make very specific and very
clear information related to [?] and if
that happens if professionals can do
that then definitely people can become
healthier.
Conceptual model of health literacy as a clinical risk (Nutbeam, 2008).
 
 
Conceptual model of health literacy as a personal asset (Nutbeam, 2008).

 
Expert panel on health literacy's
definition (2008)
The ability to access, understand,
evaluate, and communicate
information as a way to promote,
maintain and improve health in a
number of settings across the life-
course.
Systems Approach

There are individual and systems barriers affecting health

literacy.
 
 
Health literacy is an issue that transcends the individual.

Health literacy also transcends the clinical encounter.

The Expert Panel on Health Literacy
notes system barriers such as:

1. lack of affordable English/French as a Second Language

programs and community-based literacy upgrading
programs; 
2. inadequate workplace training and education; 
3. confusing or conflicting health information from the media
and the Internet; 
4. complex health systems; and, 
5. lack of awareness and knowledge about health literacy
among health and literacy professionals.
Health literacy issues for ESL communities may include, but are
not limited to:

• the role of socio-economic determinants of health,

• linguistic and cultural competence of ESL populations and
health service providers and institutions,
• the legibility of the health care system and ability of both to
overcome barriers to health care and conditions and effects
of health inequities
Setting is important

Physical and social environments are non-medical

determinants of health.

The majority of new immigrants to Canada move to large urban

areas (Census Metropolitan Areas) for a number of reasons
including greater opportunities for employment, members of
the same ethno-linguistic community.
 
 
… I just feel that it’s a really hard place to come to when you
don’t know… people are lonely. 
 
Teacher discussing Antigonish as a place for newcomers
Definitions of rural versus urban

Urban area:  Area with a population of at least 1,000 and no

fewer than 400 persons per square kilometre.  
 
Rural area includes: 
 
• small towns, villages and other populated places with less
than 1,000 population according to the current census
• rural fringes of census metropolitan areas and census
agglomerations that may contain estate lots, as well as
agricultural, undeveloped and non-developable lands
• agricultural lands
• remote and wilderness areas.
 
Geographic Total Non-immigrant Immigrant Immigrated Immigrated Immigrated Immigrated
name Population population population before 1991 between between between
1991 & 1996 & 2001 &
1995 2000 2006

Canada 31 241 030 24 788 720 6 186 950 3 408 420 823 925 844 625 1109980

Nova Scotia 903 090 854 495 45 190 30 305 3 540 4 445 6900

Halifax, CMA 369 455 339 840 27 410 16 590 2 460 3 295 5055

Cape Breton, 104 655 102 800 1 730 1 370 80 125 150
CA

Truro, CA 44 580 42 720 1 810 1 370 140 115 190

New 35 755 34 805 885 750 15 20 95

Glasgow, CA

Kentville, CA 25 800 24 780 1 010 815 45 50 100

Antigonish, 18 715 17 835 810 640 40 40 85

CD
Geographic Total Non- Immigrant Immigrated Immigrated Immigrated Immigrated
name Population immigrant population before 1991 between between between
population 1991 & 1995 1996 & 2000 2001 & 2006

Canada 100% 79.3% 19.8% 10.9% 2.6% 2.7% 3.6%

Nova Scotia 100% 94.6% 5.0% 3.4% 0.4% 0.5% 0.8%

Halifax, CMA100% 92.0% 7.4% 4.5% 0.7% 0.9% 1.4%

Cape Breton,100% 98.2% 1.7% 1.3% 0.1% 0.1% 0.1%

CA

Truro, CA 100% 95.8% 4.1% 3.1% 0.3% 0.3% 0.4%

New 100% 97.3% 2.5% 2.1% 0.0% 0.1% 0.3%
Glasgow, CA

Kentville, CA 100% 96.0% 3.9% 3.2% 0.2% 0.1% 0.3%

Antigonish, 100% 95.3% 4.3% 3.4% 0.5% 0.3% 0.9%

CD
Antigonish:  Hitting above its weight

What's the attraction?

 
Untested Hypothesis:  
 
St. Francis Xavier University and the Coady International
Institute attract individuals unlikely to move to larger urban
centres in Nova Scotia such as Kentville, New Glasgow, Truro,
etc.
she’s from Argentina and quite often the doctor
doesn’t listen to her maybe because the doctor
doesn’t have time to listen very carefully to the
way she’s saying things and the doctor doesn’t
have the time to get her accent to make sure what
she’s saying is clear so I think that maybe that
some doctors don’t have the time or the
inclination to listen to a non-English speaker

Teacher recounts a student's experience at a

doctor's office
Health Literacy Issues for Immigrants

Communication issues, e.g.,

• Language barriers
• Timidity 
 
Acclimatizing to Western model(s) of health
• Social construction of health, e.g., mental illness is not
necessarily recognized as illness by all cultures
 
Social networks (may or not not be support networks)
Collaborative opportunities

Note the different conceptions of health & health literacy

(Slides 6 & 7).  
 
Developing the model of health literacy as a personal asset
involves actors outside traditional health fields, e.g. ESL
teachers, promoting health literacy

Difference between clinical & preventative health.  Teachers

may not necessarily be comfortable discussing clinical but can
show where to buy healthy food and go hiking...  Teacher’s
suggestion about what she can do to promote health literacy
References

Nutbeam, D.  “The Evolving Concept of Health Literacy”. 

Social Science & Medicine 67.  2008.  2072-2078.
 
Rootman, I. & Gordon-El-Bihbety, D. A Vision for a
Health Literate Canada: Report of the Expert Panel on
Health Literacy.  Canadian Public Health Association.
2008.

Statistics Canada. 2006 Census. 2007.

 

Thank you