Illiteracy – fighting the hidden epidemic

Not so many years ago, certain conditions that adversely affected people’s health and happiness were either not discussed in polite society or were mentioned only in whispers. The list included venereal disease, mental illness of any kind, extramarital pregnancy and cancer. Every age has its particular taboos, and, until recently, the issue of illiteracy and its profound impact on human health, wealth and happiness were rarely discussed and certainly under-appreciated. It is difficult to pinpoint what brought the issue out of the closet, but Canada’s 1994–95 National Literacy Survey (1) was certainly one factor. That survey showed that nearly 40% of Canadians had significant deficits in literacy – ie, difficulties reading and understanding printed information (it is no longer politically correct to invoke terms such as ‘functionally illiterate’). No matter what descriptive terms we choose, the fact is that most people who have significant problems with literacy or numeracy are destined for the lowest paying jobs (or no jobs at all), and will be over-represented on welfare rolls and as users of health services. It is, therefore, in our selfish national interest to improve the literacy and numeracy skills of as many Canadians as possible. As paediatricians, it is our responsibility to help parents foster literacy skills in their children, beginning in the earliest months of their young lives.

In this issue, the statement by the Psychosocial Paediatrics Committee of the Canadian Paediatric Society (pages 398–403) reminds us that many people used to believe that children would simply learn to read when they started school. But the scientific evidence indicates that the first three or four years of a child’s life are even more important than the ensuing preschool and early school years in shaping the child’s acquisition of literacy skills. For one thing, those first three or four years are the period of greatest proliferation of neuronal synapses. The number and longevity of those interneuronal connections depend largely on the frequency and intensity with which they are stimulated. Those that remain unstimulated and unused presumably fall victim to the process of pruning that follows the proliferative phase. An extensive, active synaptic network is probably the essential foundation of memory, including, of course, the child’s memory for words that are seen and heard.

One of the most compelling studies of children’s language acquisition was conducted by Betty Hart and Todd R Risley (2) in Kansas City, Missouri. They tape-recorded a large number of 15-min samples of children’s spontaneous utterances over several years and subjected the recordings to computer analysis. The growth rate of a child’s vocabulary closely paralleled his or her growth in cognitive function. But their most arresting finding was that by three years of age, the average child from a family in a higher socioeconomic group had heard about 30 million words, whereas a child from a lower socioeconomic group had heard an average of only 10 million! Even more compelling was their discovery that the rate of growth of a child’s vocabulary seemed to be fairly unalterable after four years of age.

Paediatricians have a major role to play in improving children’s literacy levels within the families and communities that they serve. How can we help? One example (and there are many other good ones) is a program called “Read to Me!”, initiated in Nova Scotia in January 2002. Under this program, parents of every baby born in the province are presented on the day of birth with an attractive canvas book bag, bearing the slogan “Read to Me!”. The book bag contains starter books (in English, French or Miq-Maq, as appropriate), information for parents on regional library and literacy resources and, most important, the child’s first library card. Concurrently, a book gift program will soon be initiated in the emergency department of the IWK Health Centre in Halifax, Nova Scotia, which receives about 30,000 paediatric visits per year. In this program, every child six years of age or younger will receive a gift of an age-appropriate book at every emergency department visit. All books distributed under the “Read to Me!” program are carefully selected by experts in children’s literature.

Other moments and events that punctuate the schedule of infants’ and children’s preventive health care offer ideal opportunities for new initiatives to foster child and adult literacy – visits to doctors’ offices, clinics, home visits by public health nurses or day care settings are just a few examples.

For paediatricians, family physicians and everyone involved in the care of infants and very young children, this is a clarion call for leadership. Encouraging early childhood literacy could turn out to be our most potent ‘immunizing’ agent. It confers a high degree of lifetime immunity against poverty, ignorance, educational failure, low self-esteem and poor health. Can you think of any vaccine that offers such a high level of lasting protection against so many serious human afflictions?