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SUMMARY OF FINDINGS
The ALLS contained 191 health-related items across these four domains. Each of the items related to one of the following five health-related activities: health promotion (60 items), health protection (64 items), disease prevention (18 items), health care maintenance (16 items), and systems navigation (32 items). The five health-related activities are defined below:
(Canadian Council on Learning, 2007)
These health-related activities were used to code and analyse health tasks such as purchasing food and products, using products at home or at work, interpreting information about air and water quality, using medicine, applying for insurance, and offering informed consent. A list of these categories is provided below with selected examples of materials and tasks.
For each literacy domain, proficiency was measured on a scale ranging from 0 to 500 points. To facilitate analysis, these continuous scores were grouped into 5 skill levels (only 4 levels were defined for the problem solving scale), with Level 1 being the lowest measured level of literacy and 5 the highest. The relatively small proportion of respondents who actually reach Level 5 often results in unreliable estimates of the number of people at this level. For this reason, whenever findings are presented by skill level, Levels 4 and 5 are combined. Skill Level 3 is regarded by the survey developers as the 'minimum required for individuals to meet the complex demands of everyday life and work in the emerging knowledge-based economy' (Statistics Canada, 2005).
The score ranges for each level of proficiency for health literacy were:
For a full description of the levels please refer to Appendix 1. A summarised version of the framework used in the ALLS can be found in an ETS monograph, The International Adult Literacy Survey: Understanding What Was Measured (2001).
AUSTRALIA'S HEALTH LITERACY
Age and sex
Consistent with other literacy domains (prose and document literacy, numeracy and problem solving), health literacy generally increased from the 15 to 19 years age group up to the 35 to 39 years age group, and then generally decreased for those aged 40 years and over. Ageing causes physical, psychological and social change, and dependence on health care services and personal health care often increases. In such circumstances, the ability to effectively care for oneself, interact and communicate with health services, requires a reasonable level of health literacy. The graph below indicates that 83% of those aged 65 to 74 years did not achieve Level 3 or above on the health literacy scale. It is important to note that the steep decline in the older age groups may also be associated with the lower education levels of these older cohorts (American Council of Education, 2007), and may not necessarily be associated with a decline in health literacy over time for any individuals.
Both males and females achieved similar levels of health literacy overall, with 40% and 41% respectively achieving skill Level 3 or above. When examined by age, 48% of females aged 15 to 44 years achieved a health literacy of Level 3 or above, compared to 43% of males in the same age group. In contrast, 35% of males aged 45 and over achieved a health literacy Level 3 or above, compared to 32% of females of the same age.
Comparison between literacy domains
It is interesting to look at how health literacy compares to the other literacy domains. Approximately 59% of Australians aged 15 to 74 years achieved scores below Level 3 for the health domain. In comparison, 46% scored below Level 3 for the prose domain, 47% for the document domain, 53% for the numeracy domain, and 70% for the problem solving domain.
All literacy domains, including health literacy, were found to have similar relationships with characteristics such as educational participation and attainment. For example, those respondents who had completed a greater number of years of formal education achieved higher literacy scores across all literacy domains.
Health literacy by states and territories
There were no outstanding differences in skill levels for health literacy between the states and territories of Australia. The exception to this was the Australian Capital Territory, where there were significantly more people at skill Level 3 or above (56%) than other states and territories. The proportions at skill Level 3 or above in the other states and territories ranged from 43% in Western Australia to 37% in the Northern Territory and Tasmania. This is consistent with the findings for the other literacy domains.
Research has shown that people in lower socioeconomic groups are on average less healthy than those in higher socioeconomic groups (Australian Institute of Health and Welfare, 2004). Links have been established in American, Canadian and European research between health and markers of socioeconomic status such as educational attainment. In common with other literacy domains, people with higher formal educational attainment achieved higher levels of health literacy. Among those with 16 years or more of formal education, 69% achieved Level 3 or above. Of people with a Bachelor degree or above, 55% achieved Level 3, and 15% achieved Level 4/5, while 30% of those with an Advanced diploma/diploma or below achieved Level 3 and 3% achieved Level 4/5.
Completing Year 12 is also associated with achieving higher health literacy levels. Among people who had completed Year 12 or equivalent, 58% achieved Level 3 or above, and if a non-school qualification was also completed, 61% achieved Level 3 or above. In comparison, if Year 12 was completed but a non-school qualification was not completed, 50% achieved a health literacy Level 3 or above.
There were approximately 13.4 million people who reported participating in learning in the 12 months prior to the survey. Learning includes formal learning which is participating in an educational program to obtain a formal qualification. In addition, learning includes informal learning (but not as part of a course) which involves activities such as visiting trade fairs, professional conferences or expos, attending lectures, seminars or workshops, reading manuals or reference books or using computers or the Internet.
For health literacy, people who participated in informal learning (45%) in the 12 months prior to the survey were more likely to achieve scores at Level 3 or above than those who did not participate (13%). When considering formal learning in relation to health literacy, of the 6.7 million people who undertook an educational qualification and/or course in the previous 12 months, 54% achieved scores at Level 3 or above. In contrast, of the people who did not undertake an educational qualification and/or course in the previous 12 months, 30% achieved scores at Level 3 or above.
There are many studies on intergenerational relationships and the effects on development, health and various adult behavioural outcomes (Chevalier, 2004), which support a positive relationship between parental educational attainment, especially the mother's highest educational qualification, and the child/ren's educational outcomes (Behrman,1997; Behrman and Rosenzweig, 2002). In Australia, of adults whose parents' or guardians' highest educational attainment was a Bachelor degree or above, 68% achieved a health literacy Level 3 or above. This is compared to 58% of adults whose parents or guardians completed an Advanced diploma/diploma or below.
Labour force status and income
In Australia a significantly greater proportion of employed people achieved a health literacy skill Level 3 or above (47%), compared to those who were unemployed (25%) or not in the labour force (25%). It is also interesting to note the differences between the sexes based on labour force status. A higher proportion of employed females (50%) achieved Level 3 or above than males (44%). Among the unemployed, 27% of males achieved a health literacy Level 3 or above, while 23% of females achieved a health literacy Level 3 or above. For those not in the labour force, there was little difference between the proportion of females and males (both 25%) who achieved a health literacy Level 3 or above.
People who achieved higher health literacy levels were more likely to live in households with higher mean equivalised gross household incomes. When comparing people who achieved a health literacy skill Level 1 and those who achieved skill Level 3, there was approximately a $34,400 difference in their equivalised household incomes.
Health literacy by industry/occupation
Health literacy skills varied across the different industries and occupations in which people were employed. While these results are of interest, it is important to be aware of the differing roles and skills required across the range of industries and occupations. Each requires different qualifications and skill sets, such as particular academic or technical qualifications, or specialised skills.
In Australia, 72% of those employed in the Education and Training industry achieved a skill Level 3 or above in health literacy, and 68% in the Professional, Scientific and Technical Services industry. In comparison, 29% of those employed in the Transport, Postal and Warehousing industry achieved Level 3 or above for health literacy.
Differences are also apparent when examining occupations, where a high proportion of Professionals achieved Level 3 or above (71%). In contrast, 21% of Machinery Operators and Drivers achieved a health literacy Level of 3 or above.
Health literacy by self-assessed health status
Self-assessed health is commonly used to provide insight into health status in the absence of other measurement tools. While it is not equivalent to health status as assessed by a medical professional, self-assessed health does provide a measure of an individual's health at a given point in time. When analysing self-assessed health with other characteristics, insights can be provided into how people perceive their own health in relation to being overweight or obese, high risk drinking, smoking or having a sedentary lifestyle (ABS, 2007). The 2006 ALLS used the SF-12, a multipurpose short-form (SF) question module to measure self-assessed health. The 12 self-assessment questions related to mental, physical and social well being (please see the Glossary for more information).
Half (50%) of those who reported that they had a lot of energy a good bit of the time in the 4 weeks prior to the survey achieved a health literacy Level 3 or above. About half (48%) of those who reported that they felt calm and peaceful for a good bit of the time in the last 4 weeks achieved a Level 3 or above.This was in contrast to people who reported that they felt calm and peaceful for none of the time, only 19% of whom scored Level 3 or above. For people who felt that physical health or emotional problems interfered with social activities only some of the time in the last 4 weeks, 31% achieved health literacy skill Level 3 or above.
Health literacy by social participation
Social participation is another dimension associated with health literacy. Social participation incorporates many characteristics, with two being included in the ALLS: participation in a group or organisation and participation as an unpaid volunteer.
For people participating in different types of groups or organisations, over half (55%) of those who participated in a political organisation achieved Level 3 or above for health literacy. Of those people who volunteered in coaching, teaching or counselling, 56% achieved a health literacy Level 3 or above.
Of those who participated in any type of group or organisation, 48% achieved health literacy Level 3 or above. In contrast, of people who did not participate in any type of group or organisation, 30% achieved a health literacy Level 3 or above. Similarly, of those who did not participate as an unpaid volunteer, 33% achieved a health literacy Level 3 or above. However, of people who did participate as an unpaid volunteer, 51% achieved a health literacy Level of 3 or above. Those with high health literacy levels also had high levels of satisfaction with life. For those who were extremely satisfied with life, 50% achieved a health literacy of Level 3 or above, while 21% of those who were extremely dissatisfied with life achieved at this level.
Health literacy by migrant characteristics
A key social characteristic within migrant studies is country of birth, and more specifically, whether a person was born in an English speaking country. A similar proportion of people born outside of Australia in mainly English speaking countries (46%) scored at Level 3 or above on the ALLS health literacy scale as those born in Australia (44%). In comparison, of those born overseas in a mainly non-English speaking country, only 26% achieved Level 3 or above.
Health literacy by Remoteness
For people living in major cities in Australia, 42% achieved a health literacy skill Level 3 or above, with similar proportions of people living in remote regions and inner regions achieving at this level (39% and 38% respectively). For those people living in outer regions of Australia, 36% achieved a health literacy skill Level 3 or above. Note that the survey was not conducted in very remote parts of Australia. See paragraph 8 of the Explanatory notes for more information.
Comparison to Canada
It is possible to compare health literacy results between Australia and Canada. For each of the literacy domains in the ALLS, Australia and Canada were found to have very similar results, including health literacy. In the health literacy domain, 45% of Canadians achieved a health literacy Level 3 or above, compared to 43% in Australia.
It should be noted that the Canadian survey scope was for those aged between 16 and 65 years. For the purpose of the above comparison, Australian data was restricted to those aged 16 to 65 years. International results should also be interpreted with caution as different levels of non-response could impact on the comparisons. For Canada, the response rate of eligible dwellings was 66%, compared to Australia's 81%. Refer to paragraphs 12 and 13 in the Explanatory notes for further information on response rates.
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