We're making individuals more "health literate" but what about communities?

Résumé En

Health literacy (HL) is increasingly hailed as a strategy to improve the control individuals have over their health. So much so that HL is now ranked as a determinant of population health. A central critic of HL intervention is its over emphasis on individual level factors something recognised in the 2008 report of the Commission of Social Determinants of Health (SDoH) that recommended expanding the scope of HL to cover the SDoH.Our objective of our study was to assess the extent to which recent progress on HL captures the need for collective action on the SDoH.We conducted a scoping review on PubMed looking for review papers, published between 2013-2018 in English and French. The reference lists of the papers were also searched to find other relevant articles. The WHO website was also consulted. The most cited definitions were analysed against two main dimensions (i.e. locus of change of HL strategies and foreseen outcome of HL improvements).We identified 419 articles. Despite a number of authors calling for more research on HL interventions at the community level and an expansion of the definition to cover the SDoH, we found that the recommendation of the Commission has yet to be implemented. Even when the definitions include the capacities of individuals on distal determinants, both the locus of change and outcomes of HL improvement stayed focused on intra individual factors. It is noteworthy that communities were either framed as a setting outside of health care services or as an aggregate of individuals. We found no instance of HL intervention regarding communities as complex systems of actors sharing a common space and dynamic.We conclude by drawing attention on the research gap in addressing the upstream SDoH through HL actions. We propose some elements of definition of HL reflecting the need for interventions to build capacities for collective action on the SDoH and develop measurements at the community level.