Is it critical if you don’t also question the value?

Thanks to Marie’s weekly round-up, I was lead to a post on Critical Health Literacy by the Breast Cancer Consortium. Initially, I really liked that they were tackling the idea of critical health literacy, but then as I read through the post I felt like something was off. I realized that they were defining critical in a narrow way. They linked critical health literacy directly with evidence medicine and a need for patients to understand the ways evidence-based medicine works in order to help patients make healthcare decisions. Sounds fine, except …

The word ‘critical’ has a completely different meaning when taken in the context of social science. It isn’t about evaluating sources for their scientific merits, rather it is about critically examining sources to appreciate the biases that go into the sources – and this critical examination includes examining the biases that go into the scientific-based sources.

Philosophically, the scientific worldview is that there is a one truth – and that it is possible to do science in an unbiased way, where in critical theory there is an appreciation that there is no such thing as unbiased. It is impossible to do things without bias, as each thing we do involves so many individual decisions, that you cannot completely remove bias.

I’m challenged also by the different value systems at play here. One of the value systems that I am constantly fighting is the view that scientific knowledge is more value than non-scientific knowledge – you see this in medical research when you hear things like how randomized control trials (RCT) are the gold-standard. It puts a value for that type of knowledge generation which doesn’t necessarily apply to all situations. It doesn’t account for the complexity or variability of human bodies. Even in a RCT, someone gets to decide what variables are being measured. Someone gets to decided what it means to be successful. Those decisions impact the inherent biases in the RCT results.

The scientific method attempts to take the human element out of the equation, and yet, when we are dealing with healthcare is it all about the human element. So, a narrow definition of critical health literacy that privileges scientific knowledge without questioning it, is a definition that is fundamentally missing the critical worldview.

I think health literacy needs to look beyond what science has to offer, and needs also to look at what other social sciences and humanities can offer – health literacy should be looking at ways to improve the human condition, not just to improve some criteria that some group of people (e.g. physicians, researchers) deem to be important.

What I’m calling for is a critical look at critical health literacy!

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