By Penelope A. Domogo, MD
Everyday, people make decisions that would affect their health and the health of others- for better or for worse. The state of your health and that of your family and community is affected by your decisions. These decisions are made at home, in the workplace, in government offices, in school, in church, in the sari-sari store and market, in the drugstore, in the clinic or hospital, in the doctor’s office, or in the bus or jeep, in the bar or restaurant- anywhere that people are in. At this time of covid lockdown, much responsibility is at the hands of our government authorities. Making a decision means choosing between at least two options. I say at least two because many decisions would be choosing between doing something or not doing it. Like choosing to eat or not to eat? If you choose to eat, will your choose rice and beans or rice and egg or? to take the medicine or not? to construct a sidewalk or not? to do health education or not? to stay home or not? to lockdown or not? to require vaccines or not? to distribute food packs or not? what kind of food will you distribute if you decide to distribute? Will we allow people movement in open spaces like payeo, um-a, mountains, beaches and parks?
Deciding which action to take would largely depend on what you know about your options. For example, if you need to distribute food at this time, will you buy munggo and rice or canned goods and noodles? Your decision will depend on what you know about beans and canned goods. If what you know is that canned goods are the same as beans, then perhaps you will buy canned goods, even if it is more expensive, it is full of questionable chemicals, the packaging is not environment-friendly and it is made in the factory not your constituent. If you are mildly sick with a virus, will you decide to seek hospitalization or use home remedies? If we go by the science of how this virus (and other germs) acts, open spaces are safer than enclosed malls.
Whether as an individual deciding for yourself or a government official or employee deciding for your barangay, municipality or province or country, your decision will mainly be determined by your level of health literacy. I mean, it should be determined by your health literacy so that it is scientific. At the community level, especially at this time, decisions should be made with the short and long-term wholistic welfare of the community in mind. Decisions should not be determined by personal interests. This is why challenging times like this are trying times- it tests people and their motives.
Health literacy is defined as “the wide range of skills and competencies that people develop over their lifetimes to seek out, comprehend, evaluate and use health information and concepts to make informed choices, reduce health risks and increase quality of life.” (Zarcadoolas, Pleasant, and Greer, 2006).
The World Health Organization (WHO) states that “Health Literacy goes beyond a narrow concept of health education and individual behaviour-oriented communication, and addresses the environmental, political and social factors that determine health. Health education, in this more comprehensive understanding, aims to influence not only individual lifestyle decisions, but also raises awareness of the determinants of health, and encourages individual and collective actions which may lead to a modification of these determinants. Health education is achieved therefore, through methods that go beyond information diffusion and entail interaction, participation and critical analysis. Such health education leads to health literacy, leading to personal and social benefit, such as by enabling effective community action, and by contributing to the development of social capital.” Quite a mouthful but it is important for our own sake to understand this.
WHO states further that this approach to health education also “recognizes the issue of power and how power relations affect access to information and its use.”
Are people being informed correctly of what covid is, how viruses behave, how our bodies behave, how to prevent disease, etc etc? Is there knowledge flow from and across the grassroots to the hallowed halls of decision-makers, whether it is the barangay, municipal, provincial, national or global? In short, is there access to correct information about this pandemic so that people are empowered to make wise choices? Is there interaction (by whatever means) and critical analysis of data so that people now should be more confident that their behavior will lead to good health? Or are people just being fed fear up to now and are just waiting for guidelines from government?
Knowledge is power and with the internet, anyone can access this powerful knowledge. I am sure policy-makers are keeping their eyes and ears open for the unfolding of the covid drama while critically analyzing what we know so far. The fact that almost all places have now the virus is consistent with the nature of the virus- that it is airborne through droplet infection, that it can be harbored by healthy individuals. As long as people move from one infected area to the other, then we expect transmission. So, then should we just all stay in the village? Perhaps in the past when our Igorot communities were small and self-sufficient, puede pa. But we have become larger communities thus more complicated and we have become interdependent with outsiders. We have dependent on goods outside our community’s production like clothing, factory medicines, refined flour, soap, shampoo, milk, refined sugar, etc. We go to college. We have a bureaucracy that stems from Manila so people from the provinces still go to Manila.
According to a report of the Institute of Medicine (2004) (US), low health literacy negatively affects treatment outcome. At the individual level, people with low health literacy have a higher risk of contacting disease, have longer hospital days, less likely to comply with treatment, more likely to make errors in medication and have a harder time managing chronic diseases like high blood pressure and diabetes. So check yourself if you fall into any of these kinds of people. “Obtaining, communicating, processing, and understanding health information and services are essential steps in making appropriate health decisions; however, research indicates that today’s health information is presented in ways that are not usable by most adults.” (Center for Disease Control, USA). WHO thus exhorts governments and all concerned with health education to go beyond information dissemination and actively engage individuals and communities in discussion and critical analysis.
Health care professionals, like doctors, nurses and midwives, can also have poor health literacy skills such as poor ability to clearly explain health issues to patients and the public. Misunderstanding the doctor’s orders or the instructions given by the nurse can lead to grave medication errors. Lack of health literacy among health advisers may lead to inappropriate policies of government.
I would like to quote Wikipedia “Where there are adequate levels of health literacy, that is where the population has sufficient knowledge and skills and where members of a community have the confidence to guide their own health, people are able to stay healthy, recover from illness and live with disease or disability.” May we continue to learn well!***
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“Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres.” 1 Corinthians 13: 6-7
