Skilled for Health
A win-win approach to tackling health
inequalities and improving adult basic skills
Sylvia Summer
Outline
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Policy context
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Evidence from cohort studies and health literacy research
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The Skilled for Health initiative:
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Background
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Progress
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Where next?
‘I’m Not Scared Now’ DVD from Harlow Skilled for Health
project
Policy Context - Skills for Life
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Skills for Life – www.dfes.gov.uk
In England, 5.2 million adults aged
16-55 have literacy levels below
Level 1 (the level of skills required
to achieve a GCSE at grades D – E)
(UK population size: 59,778,002)
14.9 million have numeracy skills
below this level.
In addition:
? 0.5 million struggle with English
because it is not their first language
Ref: The Skills for Life National Needs and Impact Survey of Literacy,
Literacy, Numeracy and IT
skills, October 2003
Policy context – Skills for Life
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Government has committed to improving the literacy,
language and numeracy skills of 2.25 million adults by
2010, with interim targets of 1.5 million by 2007 and
750,000 by 2004.
The 750,000 target was exceeded as 862,000 learners
achieved their first literacy, language or numeracy
qualification by 2004.
Approximately 20% of this figure comprised ESOL learners.
Policy Context – Choosing Healthmaking healthy choices easier
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Public Health White Paper – www.dh.gov.uk
Underpinning principles:
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Informed choice
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Personalisation
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Working together
Overarching priorities:
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Reducing the numbers of people
who smoke
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Reducing obesity and improving diet
and nutrition
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Increasing exercise
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Encouraging and supporting sensible
drinking
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Improving sexual health
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Improving mental health
Policy Context
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Delivering Choosing Health:
? action on health and health inequalities
? 45 ‘big wins’ – key interventions which the evidence and
expert advice suggest will make the greatest impact on health
in the shortest period of time
? Big Win: Skilled for Health, focusing first on the most deprived
areas
Neighbourhood Renewal
Strategy (2001)
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Neighbourhood Renewal Strategy www.renewal.net
Aims to narrow the gap between
outcomes in deprived areas and the rest
Within 10-20 years, no-one should be
seriously disadvantaged by where they live
6 main themes:
? Education
? Worklessness
? Health
? Crime and antisocial behaviour
? Housing and prevention of homelessness
? Liveability
Evidence from cohort studiesnew research
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1970 British Birth cohort study
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Preliminary findings based on 7180 cohort members, aged
34
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Assessed members’ literacy and numeracy to coincide with
Skills for Life standards:
? Level 2 (5 GCSEs at grades A-C, Govt wants all adults to
reach this minimum)
? Level 1 (reading age of 11 year old)
? Entry levels 3, 2 and 1 in declining order of literacy
Ref: Bynner, J. and Parsons, S. (forthcoming)
"NEW LIGHT ON LITERACY AND NUMERACY: results of the Literacy and Numeracy
Assessment in the Age 34 FollowFollow-up of the 1970 Cohort Study (BCS70)".
London: National Research and Development Centre for Adult Literacy
Literacy and Numeracy
Cohort Studies - findings
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Disadvantage increases steadily as you travel down the
steps of illiteracy
Fortunes plummet for people in Entry level 2 (4% of the
adult population)
Far more likely to:
? suffer severe depression
? have no job
? be unable to find partners
? see their children end up at the same level
Findings from Cohort studies
Literacy levels
Entry level 2
Worst %
Entry level
3%
Level 1
%
Level 2
Best %
Single, never married
Men
Women
60
42
36
34
41
31
38
31
With 3+ children
Men
Women
4
27
6
18
8
15
6
11
Smoking cigarettes daily
Men
Women
40
42
39
37
31
27
23
19
Symptoms of depression
Men
Women
28
32
14
24
12
22
11
16
Dissatisfaction with life
Men
Women
36
31
28
28
22
18
16
15
Evidence from health
literacy research
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The first published study of functional health literacy in
America, found:
? 42% of patients could not understand directions for taking
medication on an empty stomach
? 26% were unable to understand information on an
appointment slip
? 43% did not understand the rights and responsibilities
section of a Medicaid application and
? 60% did not understand a standard informed consent.
A 2-year follow-up study found patients with inadequate
literacy were nearly twice as likely to have been hospitalized
during the previous year (31.5% vs 14.9%)
Ref: Baker, D W et al (1998)
Health literacy and the risk of hospital admission
Journal of General Internal Medicine, 13, 791791-798
The Skilled for Health initiative
Background
? Launched January 2003 by public health and adult learning
ministers
? Links the Skills for Life Strategy (Dept for Education and Skills)
with Choosing Health priorities (Department of Health)
? Embeds language, literacy and numeracy (LLN) in health learning
? Can people improve their LLN skills by learning about their heal th?
? Can people improve their health by improving their basic skills?
? What is the synergy between the two?
8 Skilled for Health
pilot programmes
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Harlow- young parents attending an All Day Breakfast Club
Thurrock- community mothers trained as basic skills tutors
Norfolk Age Concern- older people with arthritis in rural
communities
Calderdale Age Concern- older people in care settings
Camden Primary Care Trust- older Bengali-speaking people with
diabetes
Leicester Primary Care Trust- Somali refugees access to primary
care
Derbyshire Sport Active- keeping well and fit for the over 50s
Shropshire- supported living for people with mental health
problems
Skilled for Health – so far…
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Pilot programmes reaching
completion by March 2006
All pilots have produced support
materials. Example from Shropshire
National evaluation on-going
Pilot sites at different stages of
planning local sustainability
Skilled for Health – where next?
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Writing national guidance materials for learning and health
providers
Choosing Health delivery plan? New funding for every PCT to run a local Skilled for Health
programme
? Further wave of Skilled for Health in workplaces, prisons,
young people leaving care
? New health literacy collaborative
DVD – Harlow Skilled for Health
Project 2004/05
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‘I’m Not Scared Now’ – featuring learners from the All Day
Breakfast Club
Contact: chrissie.hawkes@gmail.com
Skilled for Health – key contacts
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Caroline Blondell, project manager, Dept for Education and
Skills : caroline.blondell@dfes.gsi.gov.uk
Mike Horah, Dept of Health : michael.horah@dh.gsi.gov.uk
Sylvia Summer and Jonathan Berry, ContinYou
sylvie@sylviasummer.net
jonathan.berry@continyou.org.uk
Skilled for Health
A win-win approach to tackling health
inequalities and improving adult basic skills
Sylvia Summer