Rowlands Gillian, Dodson Sarity, Leung Angela, Levin-Zamir Diane
Institute of Health and Society, University of Newcastle, UK.
The Fred Hollows Foundation, Australia.
Stud Health Technol Inform. 2017;240:359-391.
Accessible and responsive health systems are critical to population health and human development. While progress has been made toward global health and development targets, significant inequities remain within and between countries. Expanding health inequities suggest a widespread and systemic neglect of vulnerable citizens, and a failure to enshrine within policies a responsibility to tailor care to the variable capabilities of citizens. Implementation of health and social policies that drive the design of accessible health systems, services, products and infrastructure represents the next frontier for health reform. Within this chapter we argue the need to consider health and health literacy across policy domains, to operationalize the intent to address inequities in health in meaningful and pragmatic ways, and to actively monitor progress and impact within the context of the Sustainable Development Goals (SDGs). We contend that viewing and developing policies and systems within a health literacy framework will assist in placing citizens and equity considerations at the center of development efforts. In this chapter, we explore the relationship between health literacy and equitable access to health care, and the role of health system and policy reform. We first explore international policies, health literacy, and the SDGs. We then explore national policies and the role that national and local services and systems play in building health literacy, and responding to the health literacy challenges of citizens. We discuss the World Health Organization's (WHO) Framework for Integrated People-Centered Health Services and the way in which health services are being encouraged to understand and respond to citizen health literacy needs. Each section of the chapter ends with a summary and a review of health literacy research and practice. Throughout, we illustrate our points through 'vignettes' from around the world.
可及且响应性良好的卫生系统对于人群健康和人类发展至关重要。尽管在实现全球卫生与发展目标方面已取得进展，但国家内部和国家之间仍存在重大不平等现象。不断扩大的卫生不平等表明对弱势公民存在广泛而系统性的忽视，并且未能在政策中确立根据公民不同能力提供量身定制护理的责任。实施推动可及卫生系统、服务、产品和基础设施设计的卫生与社会政策是卫生改革的下一个前沿领域。在本章中，我们主张有必要在各个政策领域考虑健康和健康素养，以切实可行的方式落实解决卫生不平等问题的意图，并在可持续发展目标（SDGs）的背景下积极监测进展和影响。我们认为，在健康素养框架内审视和制定政策与系统将有助于把公民和公平考量置于发展努力的核心位置。在本章中，我们探讨健康素养与公平获得医疗保健之间的关系，以及卫生系统和政策改革的作用。我们首先探讨国际政策、健康素养和可持续发展目标。然后我们探讨国家政策以及国家和地方服务与系统在培养健康素养以及应对公民健康素养挑战方面所发挥的作用。我们讨论世界卫生组织（WHO）的以人为本的综合卫生服务框架，以及鼓励卫生服务机构理解并回应公民健康素养需求的方式。本章的每个部分都以对健康素养研究与实践的总结和回顾作为结尾。在整个过程中，我们通过来自世界各地的“小插曲”来说明我们的观点。
