Studying health literacy was a turning point in my journey as a researcher and health professional. It happened during data collection for my master's degree in nursing. I asked a patient with chronic kidney disease, who had been in predialysis treatment for 10 years, why her kidneys had stopped working. Surprisingly, she replied with a question: Are my kidneys not working? At that moment, it seemed to me that all the work I had done up to then did not make sense. Then I began to wonder: How could that woman not know why she was in follow-up treatment in an outpatient clinic for chronic kidney disease? After all, we distribute folders with detailed guidelines on chronic kidney disease and offer advice about the disease and treatment during consultations.
At first, I thought this was an isolated phenomenon, but over the course of many interviews, I realized that most of the patients in the clinic had a hard time understanding basic information about their health and did not know the cause of their kidney disease. I realized that there was something wrong, and that just providing health information was not enough. There was a need for in-depth analyses of individual/collective limitations; the structure of health services related to access; and understanding and use of health information. This was needed to provide better health conditions and prevent diseases (Kindig, Panzer, & Nielsen-Bohlman, 2004). Therefore, we needed to know the population's health literacy. I changed the subject of my master's thesis and began to investigate the health literacy level of patients with chronic kidney disease.
Up to that time, health literacy had been a virtually unexplored topic in Brazil. Although I was anxious about entering an uncharted area, the more I learned about health literacy, the more certain I became about the need to explore the subject in the context of Brazilian health practices. In fact, our study of 60 patients with chronic kidney diseases in an outpatient clinic of a hospital financed by Brazil's Unified Health System found that all of them had inadequate health literacy (Moraes et al., 2017). This finding supported the need to talk about health literacy in Brazilian health practices. However, 4 years after this study ended, health literacy is still largely unexplored in Brazil. There are no national surveys estimating the health literacy level of the population, nor does the government or any public policies recognize its importance for improving the population's health conditions (Passamai, Carvalho Sampaio, Dias, & Cabral, 2012).
Brazil is a country of continental dimensions with widespread social inequalities; it has approximately 208 million inhabitants with an average life expectancy of 74 years. Among the 143.7 million Brazilians who are age 15 to 64 years, the mean years of schooling is merely 7.2 years (Jahan, 2016). This is alarming because we know health literacy shows strong associations with education and age (Kindig et al., 2004). Brazil has a dynamic, complex health system (the Unified Health System), and most of the population relies on it exclusively for their health care coverage. Currently, I am part of it. I am a nurse on primary care, the first point of contact between the population and the health system. Every day I see people with difficulties in accessing, understanding, and using health information correctly. We know that awareness of health literacy is essential on first contact with patients, because that is when barriers to navigating and using the public health system and strategies for support are identified. Therefore, the incorporation of health literacy into the public health system in Brazil is more than my motivation—it is my obligation.
It is my belief that the Brazilian public health system will only achieve universal access with comprehensive and equitable care practices for the population when the challenge of health literacy is addressed in those services. Unfortunately, this is not a situation that is exclusive to Brazil. Many other countries are in similar situations in relation to the incorporation of health literacy in their health practices.
Brazil needs to be awakened to the health literacy issue and understand that its incorporation into health practices can create important opportunities for the development of a universal, comprehensive, and equitable health system. Only in this way can Brazilian health practices “reduce the distance between what is said and what is done, up to the given moment that your speech becomes your practice” (Freire, 1998).
- Freire, P. (1998). Pedagogy of freedom: Ethics, democracy, and civic courage. Lanham, MD: Rowman & Littlefield Publishers.
- Jahan, S. (2016). Human development report 2016. Retrieved from United Nations Development Programme website: http://hdr.undp.org/sites/default/files/2016_human_development_report.pdf
- Kindig, D. A., Panzer, A. M. & Nielsen-Bohlman, L (Eds.). (2004). Health literacy: A prescription to end confusion. Retrieved from National Academies Press website: https://www.nap.edu/catalog/10883/health-literacy-a-prescription-to-end-confusion
- Moraes, K. L., Brasil, V. V., Oliveira, G. F., Cordeiro, J. A., Silva, A. M., Boaventura, R. P. & Ribeiro, C. M. (2017). Functional health literacy and knowledge of renal patients on pre-dialytic treatment. Revista Brasileira de Enfermagem, 70(1), 155–162. doi:10.1590/0034-7167-2015-0169 [CrossRef]
- Passamai, M. P. B., Carvalho Sampaio, H. A., Dias, A. M. I. & Cabral, L. A. (2012). Letramento funcional em saúde: reflexões e conceitos [Functional health literacy: Reflections and concepts on its impact on the interaction among users, professionals and the health system]. Interface - Comunicação, Saúde, Educação, 16(41), 301–314. doi:10.1590/S1414-32832012005000027 [CrossRef]