Promoting health literacy during the COVID-19 pandemic: economic and political perspectives

 
Professor Padmore Adusei Amoah
Research Assistant Professor, Institute of Policy Studies, Lingnan University

The COVID-19 pandemic has exposed serious cracks in global and national health-related institutions and services in unprecedented ways. While most of them faltered at the beginning before bouncing back (albeit still weak) as was seen in renowned health systems such as those of Italy and Spain the responsiveness of health systems continues to be tested. In many places in Europe (e.g. UK) and North America (e.g. USA), Asia (e.g. India) and South America (E.g. Brazil) poor preparations from the onset rapidly led to overwhelmed health systems as evidenced by the still high daily cases compared to China and Singapore as shown in Figure 1. Projections show that the rising trend and the associated mortality will continue in the foreseeable future if effective measures are not implemented while the world awaits a vaccine. Thus, the virus is expected to be with us for a considerable period and requires systematic health promotion strategies and economic incentives to ensure that people are well-equipped to protect themselves and their acquaintances.

In particular, given the rise in infodemic amidst the pandemic, health systems cannot take for granted the need to empower populations as regards health. According to the World Health Organization, infodemic is ‘an overabundance of information – some accurate and some not – that makes it hard for people to find trustworthy sources and reliable guidance when they need it’. This implies that public and private institutions and agents concerned must ensure that the right information reaches people. Suppose people are left to their own devices to seek information about COVID-19. In that case, they are likely to be overwhelmed by the volumes of available information, which can increase the chances of misinformation and misapplication of COVID-19 information. When they occur, misinformation and confusion about the validity of available information are said to worsen health outcomes by complicating emergency responses. One effective way of addressing these potential adverse effects of infodemic and empowering populations in the fight against COVID-19 is through health literacy.

Figure 1: New cases recorded as of 29 October 2020 for India, United States, Brazil, United Kingdom Singapore, and China
Source: Financial Times Covid-19 trajectory charts

Health literacy is about the capacity of individuals and groups to obtain, process, understand and apply basic health information and services needed to make appropriate health decisions. Mostly, having sufficient health literacy can lead to better health outcomes during this pandemic because it leads to better chances of obtaining, understanding and applying preventive and even management protocols effectively. Happenings from the onset of the pandemic point to a substantial public health deficiency as regards health literacy of populations globally as it was challenging to educate the public and have people adhere to the preventive protocols in many places. On the one hand, this can be attributed to the novelty of COVID-19, which can make even those with prior sufficient health literacy become health illiterate. On the other hand, the deficiencies observed (and still being observed) only bring to fore hidden gaps in health systems. Notwithstanding, given the challenges of infodemic, and the pressure on health systems and governments to eradicate the pandemic, having a health literate population remains the best bet towards slowing down the spread of the virus and healing those already infected. However, health literacy has not been central to strategies to fight the virus in many places.

Hence, while various health systems have painstakingly explored and provided evidence-based protocols to prevent and treat the COVID-19, the public has not always been on the same wavelength as medical professionals as regards the adoption of such measures. Partly this can be attributed to various forms of uncoordinated services as part of the shock to the health system. The definition of health literacy as provided above put a significant responsibility on health systems to ensure that people develop the ‘capacity’ in all aspects of accessing, understanding and applying available information to prevent and deal with COVID-19. Recent reports in many advanced nations, where literacy—a foremost determinant of health literacy—is often high, indicate that adoption of preventive measures such as mask-wearing and social distancing are unfortunately low with sections of populations even protesting against the measures, while others openly flout them as observed in the US, Japan and UK. These emphasise the need to do more to promote health literacy amidst the pandemic as the public’s understanding of the disease is questionable in many places. However, health literacy cannot be pursued in isolation. More must be done to understand the underlying reasons for the challenges in empowering populations. Below I discuss two of these issues relating to political and economic dimensions of health literacy amid the pandemic.

First, the pandemic has caused drastic economic downturn globally. The global GDP is expected to contract by 5.2% in 2020, the largest contraction since 1870. Even economic superpowers such as the US and China have witnessed significant adverse impact. Indeed, the words advanced economies are expected to shrink around 7% compared to 2.5% in developing economies. Correspondingly, economic hardships, particularly among the workforce in the informal sectors and travel and hospitality industries have been excruciating. The recent staff retrenchment by Hong Kong’s largest local airline, Cathay pacific is a typical example as about 5000 people lost their jobs with the airline. Similar trends have been observed in the US and other places where permanent job losses are already being discussed in the media. With these economic challenges, it is undoubtedly difficult for governments to implement common preventive measures such as social distancing protocols and even lockdowns without resistance from sections of the public who still need to make a living. Hence, one could and rightly argue that the success of the fight against the pandemic will partly depend on how governments and concerned groups garner available resources to support populations economically in a bid to demotivate them from completely disregarding various preventive measures such a mask-wearing and limiting their movement. Initial COVID-19 relief packages often in the form of cash payments to householders in places like Hong Kong, the Philippines, USA and other countries must be revisited as the pandemic, and its effects on livelihoods appear not be backing down in many places. However, this time around, bureaucratic bottlenecks that prevented householders from timely accessing such the relief packages must be addressed.

Moreover, existing social protection mechanisms such as social assistance programmes must be expanded rapidly to accommodate more of the households that are falling into poverty daily. Without these provisions, it is likely that even people with sufficient health literacy regarding COVID-19 and its prevention protocols are likely to disregard safety measures. However, in places where the pandemic is improving such as Hong Kong, Singapore, Mainland China, and Taiwan, easing restrictions for economic activities must not come at the expense of the gains. This is because the experiences in Europe, US and many Asian societies, as shown in Figure 1 indicate that resurgence of the virus is never far off if governments and people let their guard down.

The second point relates to the significant role that differences in political positions and ideologies have played in resistance or support for various anti-COVID-19 measures. A classic example now can be found in the US where differences in political stance more or less dictate one’s attitudes towards COVID-19 and measures to control it. Specifically, we see favourable attitudes towards preventive measure (e.g. mask-wearing) among Democratic Party leadership and their followers—even if rhetoric—, while the Republican Party faithful appear more conservative about the regulations. In extreme situations, these political positions and ideologies dominate people’s perception to the extent that they are ready to disregard the disease and preventive measures. Indeed, it has been suggested that followers of political parties are likely to adhere to COVID-19 preventive protocols and perhaps learn more about the disease if party leadership ask them to or even lead by example. Therefore, some attribute the political aspect of COVID-19 health literacy to the issue of trust. However, situations in the US and other places indicate that the dis/trust in governments or political leadership is not always a recipe for positive outcomes regarding the pandemic. For instance, the months leading the pandemic in Hong Kong saw persistent protests against the government’s proposed extradition bill leading to tensions and distrust in the government. However, these tensions have not stopped the people from adhering to the numerous tough COVID-19 measures imposed by the Hong Kong SAR government, including mandatory mask-wearing, and quotas on public gatherings. Commentators attribute the situation in Hong Kong and other parts of East Asia to knowledge and previous experience gained through the SARS epidemic in 2003 rather than ideological and confrontational factors. Thus, political positions matter for health literacy promotion among the public. It must be instrumentalised in health promotion strategies dealing with the pandemic, as such strategies are more likely to be effective if they are built on previous country/city experiences. Without such pragmatism, promoting COVID-19 related health literacy in complex political environments is likely to yield poor results.