Critical health literacy: a case study from China in schistosomiasis control

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Abstract
Health education in China has been characterized by centrally led, top-down messages and methods. This is exemplified by the Patriotic Health Campaign, established in the 1950s and still operating today. Through this campaign, millions of Chinese were told what they should and should not do in order to improve their health. These traditional public health efforts have been successful in contributing to a reduction in some infectious diseases, but have had limited impact on others, notably in the control of schistosomiasis. This paper argues that health education in China has to further evolve to respond to social and political changes over the years. Health literacy is introduced as a new concept which implies a more participatory and more locally empowering approach to health education and communication than was typical of past efforts. Improving the control of schistosomiasis is used as a case study to illustrate how improved health literacy can lead to improved health outcomes. It is argued that health education programs aimed at increasing critical health literacy involve more than simply the transmission of health information. They should also provide information on social, economic and environmental determinants of health as well as assessment of opportunities to promote policy and organizational change. The paper concludes by outlining some of the challenges involved in adopting this new approach, indicating that it will require formative research and the re-training of health educators.

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