Representative Kukuh Napaki/Unsplash.
The “invisible pandemic” of non-communicable diseases (NCDs) is one of the leading causes of mortality, killing approximately 41 million people worldwide. Though the general use of the term ‘NCD’ encompasses various ailments, the WHO has restricted it to four major disease groups: cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. These are linked by four common risk factors: tobacco, unhealthy diet, physical inactivity and alcohol consumption.
According to the US Centres for Disease Control and Prevention (CDC), seven out of ten deaths around the world can be attributed to NCDs, with 85% of the premature NCD deaths occurring in low- and middle-income countries. (Evidence also suggests that nearly 80% of premature heart diseases, strokes and diabetes are preventable.)
This ever-increasing burden of NCD-related morbidity and mortality has created a need to prevent risk factors from developing as well as to avert the onset of diseases. Experts are undertaking prevention strategies through multi-sectoral public policies, health education, promoting healthier lifestyles, implementing food regulations, fiscal policies etc. They are exploring more cost-effective interventions as well.
As a result, the concept of health literacy – which refers to the skills needed to apply what we learn in health education – has gained importance in recent years as an effective tool with which to tackle NCDs. Don Nutbeam, head of the college of health sciences at Sydney University has said that the conceptualisation of HL’s benefits are rooted in research on literacy, concepts of adult learning and health promotion.
Thus far, the focus has primarily been on enhancing adult health literacy – but it might be time now to consider why we shouldn’t begin earlier.
Imparting health education during developmental years – during childhood itself – could be instrumental in steering individuals towards adopting a healthier lifestyle. Health literacy can be an effective approach to help children make more informed health choices by themselves, instead of being told what to do. This has the potential to be a useful strategy, with the premise that lifestyles adopted by one’s own choices are easier to follow and maintain than those prescribed by others.
Currently, the onus of improving a child’s health and taking decisions for their wellbeing lies entirely with the child’s caregivers (parents or guardians). A research paper published in April 2016 pointed out that there is a lot of academic discourse pertaining to the importance of enhancing parental health literacy, literature focusing on child-centred health literacy is scarce.
A 2010 study of the relationship between child health literacy and body mass index (BMI) in overweight children suggested the need to consider health literacy in the intersection between self-efficacy and behaviour change when planning interventions to improve child BMI. Yet another study, published in 2018, conducted with 302 children and adolescents aged 12 to 18 years in the Czech Republic found inadequate health literacy in 11.3% and problematic health literacy in 41.3% of the participants.
Incorporating health education in school curricula is one approach being implemented in various countries across the world. However, this is a difficult task: meeting children’s explicit needs arguably requires information delivery to be such that young students can easily access the information and understand it.
According to a December 2016 paper, children don’t absorb health messages passively; instead, they engage critically to create meaning. So presenting them with unidimensional health messages could fall short of giving them the opportunity to learn by active participation. Starting with children’s own ideas, and understanding as well as recognising that they are already active health-literacy practitioners, can help clearly convey a holistic picture of the complexities.
In effect, we need to study and practice simple but interesting approaches to advance health literacy among children. For example, we could introduce them to the concept of a kitchen garden, and help them start and maintain one. We could involve them in cooking dishes with various ingredients – or making them read and comprehend food labels to decide what to eat. We could also include them in age-appropriate talks about the importance of exercising and diet.
Such encouragement to participate in taking decisions about their own health and habits could impart a sense of autonomy. If they grow a vegetable or fruit or helped to prepare a particular dish, they are likely to appreciate the food more.
Elementary though they may seem, these steps and others like them could go a long way towards reducing the opportunities for NCD risk factors to take root and develop. And since these steps are being implemented at an earlier age, doing so could also curb intergenerational effects. Investing in children’s health literacy by working directly with children could thus lead to better health outcomes among future global citizens.
Arathi P. Rao, Parul Malik, Sudhamshi Beeram and Urvashi Priyadarshini