A Complementary Perspective of Wellness-Related Literacies

INTRODUCTION The purpose of this editorial viewpoint is to serve as a call to action in the following three ways: 1) unify and amplify the messages of health literacy and physical literacy to educational leaders, health- and physical activity–related organizations, and decision makers; 2) recommend collaboration among leadership structures involved with each of these concepts through more comprehensive action and messaging; and 3) encourage advocacy efforts to influence policy changes to improve the health, wellness, and physical activity levels of the American public. Literacy has traditionally been defined in the dictionary as the ability to read and write. However, in recent decades, the United Nations Educational, Scientific, and Cultural Organization (UNESCO) has recognized “literacy” as a complex and dynamic concept interpreted and defined in a multiplicity of ways. They have stated that perceived norms of literacy are influenced by academic research, institutional agendas, national context, cultural values, and personal experiences (1). In other words, the concept of literacy has evolved and expanded in meaning. The perceived norms have encompassed broader social contexts and the acquisition of basic cognitive skills. Organizations around the globe have started introducing and implementing different literacy related to their particular fields. Terms such as “media literacy,” “computer literacy,” and “eco-literacy” are currently commonplace. Similarly, both health literacy and physical literacy have become more accepted and operationalized around the globe as well in the past few decades. These constructs are defined as follows: Health literacy is linked to literacy and entails people’s knowledge, motivation, and competencies to access, understand, appraise, and apply health information to make judgments and take decisions in everyday life concerning health care, disease prevention, and health promotion to maintain or improve quality of life during the life course (2). Physical literacy is the motivation, confidence, physical competence, knowledge, and understanding to value and take responsibility for engagement in physical activities for life (3). “Health literacy” and “physical literacy” are complementary concepts, but they often operate in silos that are not cross functional. In other words, collaborative efforts with a common purpose or outcome have not yet been attempted. We believe that a unified approach of promoting and advocating for health literacy and physical literacy will bring about a greater societal, cultural, and health impact if presented together. HEALTH LITERACY AND PHYSICAL LITERACY BACKGROUND The field of health literacy was introduced in the 1970s and is recognized by the Centers for Disease Control and Prevention as a complex phenomenon that involves skills, knowledge, and the expectations that health professionals have of the public’s interest in and understanding of health information and services. Health literacy requires knowledge from many topic areas, including an understanding of human physiology, healthy behaviors, and the workings of the health system (4–7). Sørensen et al. (2) conducted a content analysis of 17 different definitions of health literacy identified in the literature and combined them into the earlier mentioned comprehensive definition. This definition encompasses the public health perspective and accommodates an individual approach, especially by substituting the three domains of health—“healthcare, disease prevention, and health promotion”—from earlier concepts such as “being ill, being at risk and staying healthy” (2). Further, this definition provides the opportunity to introduce the concepts of trust and balance. In order for understanding and appraisal to effectively result in application, the recipient must trust the source, accept its relevance, and then prioritize its application to themselves. In addition, the concept of balance can be shared in a variety of ways (calories consumed and burned, sedentary vs physical activity time, and mental rest vs stressful situations). Although the term physical literacy was described sporadically in the literature since the 1930s, the concept gained significant attention when it was reintroduced and embraced by several countries in the 1990s (8,9). However, after broad consultation with leading organizations, particularly in Canada, it was suggested that a common definition of physical literacy with consistent language was needed to provide clarity for the development of policy, practice, and research. An evidence-informed consensus definition, as shown above, was adopted by the International Physical Literacy Association (3). The definition includes the following essential and interconnected elements adopted from Canadian Sport for Life (10): motivation and confidence (affective), physical competence (physical), knowledge and understanding (cognitive), and engagement in physical activities for life (behavioral). The relative importance of each of these elements may change throughout life. Although UNESCO, thus far, does not officially recognize health literacy and physical literacy, the organization does call for an understanding of the pluralities of literacy beyond being a simple process of acquiring basic cognitive skills. UNESCO argues that the cognitive skills of literacy should be used in ways that contribute to socioeconomic development and develop the capacity for social awareness and critical reflection as a basis for personal and social change (1). It is important to understand that taking responsibility from an organizational or structural perspective requires the time, resources, and physical space to engage in physical activity. Government systems, corporations, and relevant organizations can help provide and facilitate these opportunities (11). ADDRESSING THE PROBLEM OF PHYSICAL INACTIVITY One of the key intersections of health literacy and physical literacy is the growing pandemic of physical inactivity around the globe (12,13). It is our belief that, based on the development of new organizations, recognition in school systems, available research, and the increased use of terms such as health literacy and physical literacy, we will likely see a broadening acceptance of each of these concepts. Given this, we should find innovative strategies to implement related programs and activities to help our current and future generations live a healthier and more active lifestyle. For example, at the school level, new intervention models and methods have been proposed and applied, and policy intervention is often one of them. A systematic and integrated effort with government, schools, parents, and even students themselves concerning the development of policy and environment is clearly needed to make these models and methods effective (14). As it relates to the overall population, we know that although overall life expectancy is increasing, and the rates of the leading causes of death are improving (15), other indicators of the health and safety of the U.S. population remain poor. In fact, a study of a representative sample of the 1986 U.S. adult population (25 yr and older) elucidated some of the factors that influenced mortality over the next 19 yr. The results confirmed that mortality is strongly patterned by key social characteristics and prevalent health risk factors, which underscore the current emphasis on the need for health policy and clinical interventions focusing on the social determinants of health, especially ones that focus on income security, smoking prevention/cessation, and physical activity (16). Research also indicates that at the intersection of health literacy and physical literacy, frequent and regular physical exercise boosts the immune system; helps prevent cardiovascular disease, type 2 diabetes, and obesity; and improves bone health. Frequent, regular exercise also improves mental health and helps prevent depression (17). As a potential solution, we propose that collaborative efforts by member organizations relevant to the cause of supporting and promoting both health literacy and physical literacy, such as the American College of Sports Medicine and the Society of Health and Physical Education (SHAPE America) as well as other collective impact groups such as the Alliance for a Healthier Generation, the National Physical Activity Plan Alliance, and the National Coalition for Promoting Physical Activity can serve as the catalysts to achieving positive change in national policies. A CALL TO ACTION AND POLICY RECOMMENDATIONS Thus far, activities by organizations such as the Institute of Medicine, the Centers for Disease Control and Prevention, and the World Health Organization have achieved modest success in reversing the epidemic of both obesity and physical inactivity—both of which are associated with adverse health consequences (15,18–25). None of these efforts, to the best of our knowledge, have specifically focused on the combination of both health literacy and physical literacy concepts. A more comprehensive, collaborative approach unifying the messaging of health literacy and physical literacy may serve as a catalyst to global change. This will require key governmental departments, educational system, health and wellness professionals, corporations, organizations, and society, in general, to emphasize and inspire opportunities to promote and facilitate the incorporation of health literacy and physical literacy into life’s daily routines. It also should include the development of built environments such as bike lanes, walking/running trails connected to communities, bike racks on buses and trains, mass transit incorporated into mixed-use development plans, and community gardens. Another benefit of this approach is that it can, and should, apply to people of all ages, abilities, and backgrounds. Because literacy has meaning in school systems worldwide and new organizations are embracing the health literacy and physical literacy concepts, this new cross-functional focus would allow for an early start in affecting change along the full life span. Further, approaching health and physical activity under the umbrella of “literacy” would help to promote and develop a more all-encompassing approach, including the fields of nutrition, health education, physical education, and physical activity (26,27). At the other end of the spectrum, programs supporting health literacy and physical literacy need to be developed for older adults and seniors in developing the competence, motivation, confidence, and desire to stay healthy and physically active for the full life span (2,8,28). CONCLUSIONS AND SUMMARY COMMENTS Health literacy and physical literacy are increasingly noted in the academic literature and implemented through organizational activities. However, there has not been a corresponding cross-functional approach to collaborate through more comprehensive action and messaging by current structures and organizations involved with each of these concepts. We do not propose developing a new unified literacy term but rather a more unified overall wellness message for potential policy changes as well as greater impact and understanding by the public. Dudley et al. (29) propose four pillars in which “physically literate societies” should be developed and should become increasingly pertinent beyond agencies just offering access to physical activity. A similar approach to health literacy may be possible. As the concepts of health literacy and physical literacy are becoming more commonplace, particularly in the health-related, education, and sports sectors, collaborative efforts by key organizations and individuals to promote, implement, and influence healthier and more active lifestyles become more and more important. This includes providing a unified voice in advocating for necessary policy changes as well as the related professions in general. To accomplish these initiatives, we recommend the steps indicated in Table, Supplemental Digital Content 1, https://links.lww.com/TJACSM/A37, as a starting point.

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