Critical health literacy and the COVID-19 crisis.

Applying critical health literacy has never been more needed than in these days when an infectious disease crisis arrives at a time of information excess and high expectations of controlling health. Public health personnel have generally assumed that knowing about the risk factors of infectious diseases has always been key to controlling and preventing an epidemic infectious disease’s devastating consequences. What is different with COVID-19 is that we live in an age when expectations about mastering health—and here that means specifically, controlling risks of a deadly infectious disease—are higher than ever. These advanced expectations meet with another unique condition: never in human history has there been such an abundance of health information available from numerous more or less trustworthy sources.

In these conditions, for the public to understand what public health experts and politicians say or try to convey poses a range of challenges. Making sense of COVID-19 news and official recommendations is particularly difficult given the current high degree of knowledge uncertainty on many levels. A major challenge comes as to how the individual can integrate this sea of information into personal behavioural actions. Critical health literacy is needed in light of such basic challenges.

Societies built on libertarian principles tend to rely on individuals making the ‘right’ choices on their own. Thus, they depend on the individual to adopt proper behaviours based on reasoned choices. Yet, today we see people in all countries over- and under-reacting: panic shopping in grocery stores or not following any rules for safe practices are just two examples of this. Simply knowing about the risks (i.e. ‘functional’ health literacy) is insufficient when scientific knowledge on COVID-19 is still limited, when interventions are complicated or inconsistent and when fundamental values of self-interest versus communal solidarity clash.

In the exploding market of COVID-19 facts and fiction, individuals need to know how to assess critically the information with which they are overwhelmed. The best scientific knowledge on COVID-19 needs time to grow, and particularly the understanding of the appropriate public health interventions are bound by time constraints. Therefore, as difficult as it may be, health experts themselves are challenged to help the public accept uncertainty where it is a yet unavoidable fact. Similarly, political action is difficult to define not only for the uncertainty in the scientific basis of COVID-19 but also due to the profound changes in the social conditions of dealing with infectious disease crises. In addition, the societal response is at least as challenging; a response which also requires public health experts to learn about this response. Thus, public health concepts such as ‘herd immunity’ need to be carefully conveyed to a public challenged to understand. While accepting to sacrifice some part of one’s own individual freedom for the sake of a collective good may be seen as a matter of humanistic social values, in the case of the COVID-19 pandemic there is little time for philosophical rationales. Although critical health literacy argues that individuals put into context the information available and evaluate that against their basic values, in the case of an urgent pandemic an emphasis on concerted action is critical as well. Reflection should focus, for the moment, on the pandemic itself and how the individual defines their role in it. The hope, of course, is that such prompt attention to this event will promote self-reflection on the role of health literacy in one’s own life.

To ultimately understand the current crisis as an individual and societal learning process is key. Public health experts from all disciplines should contribute to creating a broader understanding that allows accepting complexity and a high degree of unpredictability in arising global health challenges. Included in forward thinking should be efforts to strengthen values and attitudes of collective responsibility to reduce carelessness and prevent over-reactions. Critical health literacy understood as individuals’ ability to reflect on complex health issues and critically assess the information available, can be a piece in the puzzle on how to promote, enhance and encourage behaviours that are (more) adequate during a crisis such the current COVID-19 crisis.