Health literacy: Empowering children to make healthy choices

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1 No. 41 Term 3, 2006 Developing health literacy will empower children and students to make informed choices and decisions about their health and wellbeing. Tricia Knott, Program and Policy Officer, H&PE, DECS In this issue: Dr Ilona Kickbusch, Global Health Consultant Rita Alvaro, CHP Tricia Knott, DECS Jo Payne, CHP Sonya Warren and Brad Williams, Moorook PS Anna Michael, Pennington JPS Phyllis Mitchell, CaFE Enfield Please distribute to your: Leadership team Teachers Canteen staff OSHC staff School Governing Council Families Local health and community agencies Health literacy: Empowering children to make healthy choices Diana Skott, Health Information Coordinator, Centre for Health Promotion Health literacy is a relatively new term which in its earliest days was about literacy, or being able to read and understand medical and health pamphlets. More recently, the concept has broadened to one of empowering people with knowledge and skills to make informed choices about their health and wellbeing, to influence events in their communities and to have greater control over their lives. 1 Ilona Kickbusch (p2) says that health literacy is about the life skills we need to navigate modern society, and the choices we make in everyday life that influence our health and wellbeing. Health literacy does not just happen. It needs to be created by measures which increase individual knowledge and skills, and supported by policies and environments which encourage healthy choices. This concept is illustrated in the diagram below. Schools and care settings have opportunities to develop children s health literacy through Choices Supportive Environments and Empowerment Health Literacy the curriculum and the supportive environments they provide. This issue of Virtually Healthy focuses on the curriculum, and developing students ability and confidence to critically appraise health they are exposed to on television, the internet and in print, and to act on it in their own lives. We particularly focus on the skills to critique television food advertisements as these have been shown to influence children s food choices and their health. Tricia Knott (p5) also provides ideas for developing health literacy skills such as debating health issues, participating in health events and setting up displays and websites. We trust that this issue will inspire ideas for your teaching practice. It reminds us of the strong links between learning and health, and that better learning and being health literate supports better health and wellbeing. 1. Nutbeam, D (1999). Literacies across the lifespan: Health Literacy. Literacy and Numeracy Studies 9(2) Policies Skills Knowledge Supportive Environments and Policies

2 Health literacy: Skilling students for better health Dr Ilona Kickbusch, Global Health Consultant We are delighted to provide this article from Dr Ilona Kickbusch who has had a distinguished career with the World Health Organisation in public health, health promotion and global health. She is well known for her work on the Ottawa Charter for Health Promotion and will be visiting Adelaide in 2007 as a Thinker in Residence. We live in a health society. Health is everywhere: newsagents overflow with specialised health wellness and fitness magazines health is one of the most popular search items on the internet health books head the bestseller lists television and radio engage in a multitude of health programs the market is expanding with products that claim an added health value. At the same time childhood obesity has reached unprecedented proportions, and the expenditures for health care systems in OECD countries continue to grow. 1 Life skills Increasingly health skills are a part of the life skills needed in modern societies and at the same time many life skills are critical for health. Yet paradoxically societies do not prepare their citizens well to navigate a complex new health environment. Indeed, if we look at the list of critical literacies for 21 st century societies - media, consumer and financial literacy, digital literacy and society literacy and health and environmental literacy none of them feature very prominently in the school curriculum. 2 Making choices Nearly every choice we make throughout the day is relevant to health in some way what we eat, how much we move, what products we buy. Much of this is established through learning by doing in everyday life through norms and routine behaviours adopted as a child within the family and social context. Because of this everyone with an agenda tries catching them young and marketing to children has grown significantly. For example, in Australia children under 18 have an average of $31.60 to spend each week and they influence more than 70% of their parents clothes and fast food purchases. 3 Health literacy entails the ability to make sound health decisions in the context of everyday life at home, in the community, at school, at the workplace, in the health care system, in the market place and in the political arena. It is a critical empowerment strategy to increase people s control over their health, their ability to seek out and to take responsibility. Supportive environments Health literacy does not just happen: it needs to be created and supported by a range of policy and other measures which increase individual knowledge and skills and, in particular, provide supportive environments to make healthy choices. Health literacy involves far more than using the health care system well. Schools The educational system provides vital intervention points for improving health literacy within its curriculum, and in particular through the way the school or pre-school lives health through its policies, practices and the environment or ethos of the school. 4 Today we are starting to realise that: soft drinks at school can be as dangerous and habit forming as cigarettes getting children to move is as important as their cognitive development teaching them to respect one another has important mental health dimensions. Today, families are pressured by the onslaught of advertising, the lack of time inherent to modern lifestyles and changing family structures. Therefore, we cannot just relay the responsibility for the development of health literacy into the family context. Educational settings provide opportunities to increase general literacy as well as other critical literacies. They can also help to develop life skills, criteria for judgment and choice and offer supportive and safe environments that make the healthier choice the easier choice. If given the opportunity in schools, children can learn about what creates health and what are the most important health determinants. The improvement of health literacy can also contribute to lowering and overcoming inequalities in health. Empowerment Motivation and interest, selfesteem, critical abilities, perceived control and intentions to act, influence and support health literacy through empowerment. Continued page 3 Page 2

3 Teaching health literacy through TV foods ads Facts about TV food ads Rita Alvaro, Senior Nutritionist, Centre for Health Promotion Schools play a very important role in developing students health literacy, and in particular their understanding of messages about food they see in the media. Teaching about TV food ads, and critically appraising the marketing techniques they use and they provide, will help children make more informed choices about the foods advertised. This can be addressed through the English, Health and PE, Mathematics, Arts, and Design and Technology Learning Areas. Some lesson ideas are provided below. Teaching about TV food ads can: help develop critical literacy skills help develop an understanding of the types of foods promoted in TV food ads help develop an understanding of the marketing techniques used in TV food ads be linked with learning about healthy eating, media literacy, and a number of learning areas. Lesson ideas What foods are promoted in TV food ads? Students watch an hour of TV over a set time period. They record the number of food ads seen, and what food group they belong to according to the Australian Guide to Healthy Eating, (p.8). As a class discuss How many food ads did you see in the hour? What types of foods were advertised most? As a class collate the above. Students construct a pie graph, showing the proportions of different foods advertised. Compare this pie graph with the Australian Guide to Healthy Eating. Continued from page 2 Not always are these dimensions associated with our school system. Yet it is empowerment that supports children to become engaged citizens and critical consumers who act not only as individuals but who engage jointly for common rights, access and safety. Most critical of all is to realise that this is no longer just an issue of importance to the health sector and its outcomes, but critical to the future development of our societies and social systems. What marketing techniques are used in TV food ads? Discuss Do you ever ask for a food product that you saw on TV? As a class watch some TV ads and discuss marketing techniques used, such as: Cartoon characters: Do you recognise any of the characters? Do they appeal to you? Music and jingles: Can you remember any of the jingles? Misleading messages: Will you be happier, stronger and more popular if you eat the product? Develop your own ad for a healthy food using popular marketing techniques. References 1. Organisation for Economic Co-operation and Development 2. European Commision. (2001) Making a European Area of Lifelong Learning a Reality education/policies/lll/life/ communication/com_en.pdf 3. Powell, S. & Zuel, B. Marketers influence over young challenged, Sydney Morning Herald, 3 September National Academy of Sciences. (2004) Health Literacy: A Prescription to End Confusion, Eds. L. Nielsen-Bohlman, A. M. Panzer & D. A. Kindig, /html/R1.html Children watch TV an average of 23 hours per week, viewing up to 4 hours of advertisements during that time. A study of 13 OECD countries showed that Australia has the highest number of TV food ads per hour during children s programming (12/hour); more than the USA (11/hour) and the UK (10/hour). Sweden had the least (less than 2/ hour). Food advertising is consistently represented in the top ten revenue raisers for commercial television stations. A study in SA found that 76% of advertisements in the 4-5pm timeslot were for food. More than 75% of foods advertised during children s programs were for foods that dietary guidelines recommend children consume only sometimes or in small amounts, including items high in fat and/or sugar (48%) and fast food meals (28%). Children under 8 years do not understand the persuasive intent of advertising. Advertising increases children s requests for advertised products (pester power). Techniques used to attract attention and increase desire for a product include giveaway offers, competitions, prizes; jingles, cartoon characters; emphasising fun, happiness, excitement; implying the product makes you special or superior. Reference: Children s health or corporate wealth? Coalition on Food Advertising to Children (CFAC) 2003 (see p.8) Page 3

4 Health literacy in SA school settings: Much more than H & PE Tricia Knott, Program and Policy Officer, H & PE, DECS Health literacy is essential to making decisions about our health and wellbeing. It can be thought of as having three, interrelated dimensions: operational the way we use language to gather health sociocultural the way we communicate and share health critical the way we question and analyse health. The more we are able to use these dimensions, the more health literate we are, and the better skilled we are to take control of our own health. Schools, preschools and childcare sites can all play a part in developing health literacy in children and young people by creating healthy environments, encouraging role models, and through the curriculum. Teachers from different learning areas and subjects can work collaboratively to develop a cross curriculum approach to health literacy and wellbeing. There are also opportunities through the Essential Learnings and Enterprise and Vocational Learning to develop the understandings, capabilities and dispositions related to becoming a health literate citizen. The H & PE learning area makes an important contribution to the development of health literate individuals. Key ideas and outcomes address a range of issues including: physical activity and participation, identity, relationships, growth and development, safety, nutrition and states of health. The H & PE learning area provides opportunities for students to: investigate and use a wide range of health and physical activity related vocabulary and symbols explore web page design and navigation and multiliteracy conventions related to health and wellbeing recognise and process and ideas to read aloud, discuss, brainstorm, develop concept maps and highlight terms, key ideas and note take critically assess the authenticity and reliability of explore health inequities and possible solutions. Health literacy learning can be further enhanced when schools and preschools work in partnership with health professionals, health organisations and relevant community members. A number of government and non-government agencies and organisations have worked in partnership with teachers and schools to enhance the health and wellbeing of students and teachers in schools, preschools, Out of School Hours Care and Vacational Care. It is important for students to demonstrate their learning through engagement and being proactive in their school community and local area. Students can practise health literacy in relevant and authentic situations, eg: designing posters and brochures, writing reports, surveys and articles for school newsletters and local newspapers performing plays debating health issues developing videos and films addressing health issues setting up displays and health rooms and websites within their school and community establishing a health and wellbeing committee which includes representatives of students and parents being involved in Student Representative Council, fundraising and organisation of school events such as sports days, Physical Education week, Jump Rope for Heart, safety, health and wellbeing days developing a range of healthy initiatives related to school canteens and occupational health and safety. Developing health literacy will empower children and students to make informed choices and decisions about their health and wellbeing. It will also assist them to clarify and understand the health, social, ethical and environmental issues that exist within their communities. Furthermore, it will prepare them for effective participation in their local, national and global environments and enable them to seek appropriate pathways and support for their own and others health and wellbeing. Page 4

5 Health on the internet: Can we be sure it s credible? Jo Payne, Health Promotion Officer, Centre for Health Promotion Health contributes to health literacy and empowers individuals to make informed, healthier choices. Therefore, it is important that health which influences these choices is credible. As research evidence shows, health and health based websites are among the most widely used on the internet. 1 Additionally, most internet users only explore the first few links offered when searching for health through a search engine. 2 We need to be discerning about what websites and we can trust. For example, some health sites may have purposes other than providing credible health such as, marketing pharmaceuticals and other health products. They may also have paid to ensure that their site appears in the first few hits of a search when particular words are used in a search engine. People use the internet to find about: health conditions health services managing or treating a health condition. When using internet we need to take in to account: Purpose Why has the site been created? Who has developed the site? Who is the site intended for? Does the site clearly indicate the organisation it is associated with? Authority Who is the author? Who is responsible for the content? Is the author from a known and reputable organisation? Are there contact details and are the authors easily contactable? Coverage Is the complete and in-depth? Is the balanced and unbiased? Is the presented in a clear style? Is the referenced? Up-to-date Is the current? Does the site provide about when it was last up-dated or modified? Ease of use Is the site easy to navigate? Is the easy to find? Food ads: Keep your children out of the firing line Young Media Australia (YMA), Australia s peak body in the field of children and the media, is urging parents to keep their children out of the firing line of television food advertising. To create an environment in the home that is supportive of healthy food choices, YMA recommends that parents reduce the amount of commercial television their children watch by switching to the ABC, or by building or borrowing a selection of videos and DVDs. Research shows that TV food advertising influences what children want to buy and want to eat, and that much of it is unhealthy. Reducing commercial TV may not be the whole solution to the problem, but for many families switching to another channel is more realistic than banning TV altogether, and it will help! For more call the national freecall Young Media Australia Helpline ( ) or visit the YMA website References 1. Wilson, P. (2002) How to find the good and avoid the bad or ugly: a short guide to tools for rating quality of health on the internet, British Medical Journal, vol. 324, pp Eysenbach, G. & Köhler, C. (2002) How do consumers search for and appraise health on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews, British Medical Journal, vol. 324, pp Assessing online health These sites have tools for assessing the quality of health on the internet. Discern Online: Quality criteria for consumer health. HealthInsite. How_to_Assess_Health_Information_Online QUICK the quality check list. NETSCORING: Criteria to assess the quality of Health Internet Information. Page 5

6 Moorook PS takes a look at TV food ads Sonya Warren, Principal and Brad Williams, Teacher As part of the Healthy Eating curriculum in term 3 at Moorook PS, students in the Year 5, 6, 7 class took part in a unit of work on nutrition and TV food advertising. The unit began with an exploration of the Five Food Groups and looking at the nutritional content of a number of different foods and drinks. The aim was to introduce the concept of TV food advertising. It was important that students were given the tools to make informed decisions about the products they were buying as a result of seeing them advertised on TV. To begin with the students read and discussed from the Coalition on Food Advertising to Children website and a Centre for Health Promotion workshop. The regulation of TV food advertising to children - Children s Television Standards (CTS) - and how these regulations are failing to protect children were a key focus. Students then watched a collection of TV food advertisements on video and completed two handouts after watching each advertisement. The first handout asked students to indicate which food group the product being advertised came from. The second handout asked students to answer the following questions: Does the food advertised fit in with the Australian Guide to Healthy Eating? What techniques are used to sell the product (eg prizes, animation)? Year 6 students Ami and Josh, review TV food advertisements. Do you think this advert breaches any of the CTS? If yes explain how. The discussion and learning that took place was quite phenomenal. Students learned about the Australian Guide to Healthy Eating and how to critique the food advertisements they were watching on TV. Students were given the tools to make informed decisions about what it was that they were buying from the shops or fast food outlets. The most pleasing aspect of the unit was that in the following weeks, a number of parents commented that their children were making healthier choices about the foods they were putting into their lunch boxes. Using music to develop health literacy skills in young children Anna Michael, Pennington JPS In the same way that advertising jingles and tunes are remembered health messages can be easily learned and retained when presented in chants, rhythms, poems and songs. At Pennington JPS, songs are used to enhance learning in the area of health as well as to support language acquisition in the school s large English as a Second Language and Newly Arrived community. A wide variety of musical forms are used, and children s attention can be held with both simple and more complex songs. Some examples include: Breakfast, water, healthy food sleep an echo song with a very simple repetitive chorus to enable easy learning of these four key ideas, Rubbish is Yuk - a rap, Yummy Scrummy Fruity Fun a Calypso tune and When you cross the road a Zydeco tune. Songs can be simple or more complex. They can be written to particular themes and events and can be original or innovations on a well-known tune. They are particularly effective if devised by the students themselves. And most of all they are a lot of fun and easy to learn. Anna is part of a singing and performing group called Taz Razzle, who write and perform original songs for young children. Page 6

7 Learning Together and health literacy Phyllis Mitchell, Learning Together Coordinator, CaFE Enfield Learning Together is a program for families with children aged from birth to three years, focussing on early literacy development. It is a DECS initiative that began in 2003 which draws on a strong research base about the importance of families in children s literacy development and the critical nature of wellbeing and involvement in children s early learning. Learning Together projects are located in areas of aggregated disadvantage and based in school settings at Carlton Aboriginal School at Pt Augusta, Fraser Park School at Murray Bridge, Para West Adult Re-entry School at Davoren Park, Christie Downs/O Sullivan Beach Schools and CaFE Enfield. Each program has evolved differently as community consultation is pivotal to the development of programs. All programs have considerable enrolments of Indigenous families and have multi-agency involvement. Activities include supported playgroups, book making using digital technology, video making and both formal and informal study groups with multiple pathways in and between activities within each centre. There are three dimensions to the project: adult learning and support adult and child engagement child involvement. All work with families uses a strengths based approach. The aims of the program include: improving early learning opportunities for children assisting parents to support their child s early learning and development supporting parents own learning and determination strengthening communities through interagency collaboration and coordination in the provision of family focussed programs and services promoting and supporting positive relationships between families and early childhood services and schools. At CaFE Enfield parents are empowered through the development of their own critical literacies which are enhanced by informal study groups within playgroup sessions. Parents have also had access to formalised study/adult learning pathways including adult literacy, Information Technology, SACE and TAFE Accredited courses. There are links with local High Schools/Adult Re-entry Campus where parents use their Learning Together experiences within their SACE study. Learning Together recognises the empowering role of improved literacy for parents. It provides the confidence, skills and knowledge to help parents make healthier choices for themselves and their children. Parents in the groups have developed close relationships with each other and together have worked to mentor others. They have become volunteers within community organisations and some have moved to part-time employment within the community. Experiences have been shared through community forums and speaking engagements with their peers in secondary schools. Although the focus of Learning Together is children s literacy, the program recognises the importance of supportive environments with a focus on the family, education and the community. This has allowed parents to gain the skills and knowledge to make positive choices that affect their own health and the health of their children and others. Walk and Talk is a language, literacy and physical activity program for young children, developed by the Centre for Health Promotion in collaboration with Noarlunga Health Services. It is suitable for preschools, junior primary schools, OSHC and child care. It is based on children, teachers/carers and families undertaking a walk and talk in the local community. The program includes: A manual with learning activities and everything you will need to plan and conduct your walk 1 Walk and Talk backpack for your walk 1 Wowie bear (28cm) 1 rubber stamp 4 Walk and Talk A3 posters to promote your walk. Available from the Centre for Health Promotion Cost: $73.70 Ph: Page 7

8 About us Resources Centre for Health Promotion Children, Youth and Women s Health Service 8 th floor, Samuel Way Building Women s and Children s Hospital 72 King William Road North Adelaide SA 5006 Ph: (08) Fax: (08) Virtually Healthy Promoting children s health in the community This newsletter is published each school term and: supports learning, health and wellbeing in school communities advocates the health promoting schools approach shares effective practice is prepared in collaboration with key agencies. Free copies are sent to all South Australian schools, OSHC services, community health and school dental services. Also available on the Centre for Health Promotion website. Your feedback and input is welcome! Contact Virtually Healthy Coordinator, Diana Skott. Kickbusch Health Consult Dr Ilona Kickbusch is a world recognised public health, health promotion and global health expert who is committed to the promotion and understanding of health literacy. Her website provides links to several papers about health literacy. Young Media Australia This site has useful about the affects of media experiences on children s development. YMA are an advocacy group committed to the promotion of healthy development for Australian children. The Parents Jury An internet site which is based on a network of parents and people concerned about the food and physical activity environments of Australian children. The site includes the latest news, a discussion forum, media and useful links. Australian Guide to Healthy Eating Smith, A., Kellett, E. & Schmerlaib, Y. (1998) Commonwealth of Australia. wcms/publishing.nsf/content/ health-pubhlth-publicat-documentfdeduc-cnt.htm Sing Along, Move Along A teaching resource that uses nutrition themes with music, movement and dance. A great health literacy resource for junior primary students. Contains: Teacher s booklet of song lyrics, activity ideas and health 1 CD of six original songs. Cost: $22.00 Available from the Centre for Health Promotion. Join the SA Health Promoting Schools Network A free network for those interested in Health Promoting Schools. Go to Health Information Centre Drop in or contact us for quality health on a range of topics. Kermode Street entrance, WCH. Ph: Coalition on Food Advertising to Children (CFAC) CFAC is a national advocacy group of key organisations and prominent individuals concerned that advertisements targeting children for foods and beverages high in fat, sugar and salt are a threat to children s nutrition and future health. Their site includes and useful ideas for students, teachers and parents. Includes Children s health or corporate wealth? (click on the CFAC link in the left hand column). Developing quality health The Centre for Health Promotion has developed these tools to help you produce and evaluate written health. other/health_prom/ develop_health_info.html Developing quality consumer health Readability and health Evaluating health resources with consumers

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