William G.Brozo. Emeritus Professor of Literacy, George Mason University, USA
Gail Andrews. Past Chief Operating Officer, National Department of Health, Cape Town, South Africa

An Elinet blog.  

The connection between literacy and health has been recognized by the medical and public health professions for several decades (Dewalt, Berkman, Sheridan, Lohr, & Pignone, 2004).

This connection came into stark relief for the two of us—a career South African public health policy expert and an American literacy professional—when the most recent Progress in International Reading Literacy Study (PIRLS) scores were published in 2023, showing once again the rock-bottom reading levels of South African children. At the same time, the persistence of diseases and other serious health challenges largely eradicated in other regions of the globe (Achoki, 2022) alerted us to take a closer look at the comorbidity of these conditions in South Africa.

How Literacy and Health Intersect

The literature tells a grim story about children who struggle to learn to read and their health outcomes. Not only do these children have impaired academic achievement, but are at an increased risk of social, emotional, and mental health problems (Maughan & Carroll, 2006); are more likely to leave school early (McArthur & Castles, 2017); are prone to engage in unhealthy behavior as adolescents (Zullig, Ubbes, & Mann, 2013); are susceptible to low health literacy as adults (Perazzo et al., 2022); and, ultimately, may have shorter life expectancy as compared to competent and engaged readers (Bavishi, Slade & Levy, 2017).

South Africa at the Bottom of the PIRLS League Table

South Africa has participated in all PIRLS cycles since 2006. The country’s continued poor showing on PIRLS 2016, particularly the finding that 78 percent of children could not read for meaning, prompted President Ramaphosa to issue a call to action to make elevating literacy competencies a national priority.  Despite his expressed concerns, the results for PIRLS 2021 strongly suggest little if any progress has been made.  The figure below reveals South African grade 4 students over 200 score points below the international average and a full 300 points below the highest performing nation, Singapore. What is more, grade 6 South Africans, although about 100 score points better than the fourth graders, performed significantly below the PIRLS center point of 500, even though the intended test takers are 9-year-olds or fourth graders, the level of most other students from the 57 participating countries. 

South African Grade 4 and Grade 6 Achievement on PIRLS 2021 Compared to Grade 4 Average Scores of Other Countries*

*From: Department of Basic Education. (2023). PIRLS 2021: South African Preliminary Highlights Report. Department of Basic Education: Pretoria.

Persistent Public Health Challenges in South Africa

Concomitant with depressed literacy skills among far too many youths in South Africa are ever-present diseases and chronic illnesses associated with overall poor health maintenance and care, especially in high-poverty regions of the country. Despite some small areas of improvement, South Africa continues to experience unacceptably high numbers of deaths from communicable, maternal, perinatal and nutritional conditions (46%), noncommunicable diseases, such as cancer, stroke, chronic respiratory and cardiovascular diseases, and diabetes (38%). Meanwhile, HIV infections, tuberculosis, and Hepatitis B remain at stubbornly elevated levels. From a mental health perspective, South Africa’s deaths by suicide (among the 10 highest countries globally; 3^rd highest in Africa) and homicide (six times the global average) remain at epidemic proportions.

Policy Recommendations for Reversing Cycles of Low Literacy and Poor Health

1. Improved health outcomes in South Africa will only come about as a result of sustained and long-term efforts focused on improving literacy for children and youth.
2. An all-hands-on-deck approach to eradicating literacy challenges for young people is needed to have a national impact on the crisis in South Africa.
3. Better approaches to early detection of literacy and related problems (i.e., dyslexia, neuro-developmental issues, learning disabilities, ADHD) are needed.
4. School counselors and psychologists need to include documentation of young students’ reading performance in order to explore how challenges with reading may be impacting mental health.
5. Keeping children and youth in school will have a positive impact on reading achievement and lead to healthier lifestyles.
6. Children identified as literacy challenged, along with their caregivers, should be provided specific reading training using health documents and related content as source material.
7. South Africa’s most vigorous efforts to bring about positive change in both general and health literacy should be focused on children, youth, and adults from underserved groups.
   

Read the extended article here

References

Achoki, T., et al. (2022). Health trends, inequalities and opportunities in South Africa’s provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study. Journal of Epidemiology and Community Health, 76(5), 471–481.

Dewalt, D. A., Berkman, N. D., Sheridan, S., Lohr, K. N. & Pignone, M. P. (2004). Literacy and health outcomes: A systematic review of the literature. Journal of General Internal Medicine, 19, 1228–1239.  

Bavishi, A., Slade, M., & Levy, B. (2017). The survival advantage of reading books. Innovations in Aging, July (Suppl 1), 477. https://doi.org/10.1093/geroni/igx004.1696

Maughan, B., & Carroll, J. (2006). Literacy and mental disorders. Current Opinion in Psychiatry, 19, 350–354.

McArthur, G., & Castles, A. (2017). Helping children with reading difficulties: Some things we have learned so far. Science of Learning, 2, 7. https://doi.org/10.1038/s41539-017-0008-3

Perazzo, D. et al., (2022). Chronic pediatric diseases and risk for reading difficulties: A  narrative review with recommendations. Pediatric Research, 92, 966–978.

Sheridan, S., Lohr, K. N. & Pignone, M. P. (2004). Literacy and health outcomes: A systematic review of the literature. Journal of General Internal. Medicine, 19, 1228–1239.

Zullig, K.J., Ubbes, V.A., & Mann, M. (2013). Early adolescent literacy influences, reading ability, and preventative health behaviors. American Journal of Health Studies, 28(3), 134–141.