Huber et al 2012 – “Top down versus bottom up: The social construction of the health literacy movement”
In contrast to bottom-up approaches to widespread healthcare awareness and understanding, health literacy has traditionally been given motive from the top down – a cause driven by economists and policy makers, and likewise drawing a top-down incentive from the trillions-of-dollars cost of limited health literacy in the United State.
The dynamic of resistance to authority-imposed change is a familiar one, and one which should be well-considered by proponents of health literacy in their efforts to expand it. Huber et al. are quite direct in observing that health as a government-driven ideal is nowhere near as effective as causes which emerge from the perspective of the patient – such as the consumer health information movement.
Huber et al. claim argue that efforts from the top of the chain down which have struggled so in recent years could be made more effective by framing the patient as a stakeholder in the matter of their own health literacy, rather than simply the recipient of yet another government-incentivized education initiative. They suggest tackling problems first from those patients’ perspectives and reaching out toward big-picture goals, rather than handing them obligations and promises that their struggles have been addressed.
The authors also spend time on a particularly interesting notion: the model of the patient navigator. A navigator in this paradigm falls into a sweet spot between medical consultant and peer mentor, translating a person’s medical decisions and conditions into terms they can more easily understand upon which they can more rationally act.