Health literacy is about more than being able to read a pamphlet or understand a doctor's instructions. It describes how well people can find, understand, and use health information to make decisions about their wellbeing.
For many people in Aotearoa New Zealand, including refugees and migrants, this is genuinely difficult. Health services can be hard to find. Forms can be confusing. Language barriers, unfamiliar systems, and cultural differences all make accessing care harder. This is not a personal failing. It is a structural one.
A lot of effort in health literacy has focused on changing individuals. Teaching people to read appointment letters. Giving them information sheets. Running health education sessions. These things can help, but they only go so far.
When the focus stays on the individual, the burden of navigating a complex system is placed entirely on the people who are already most vulnerable. For communities facing language barriers, cultural differences, and the lasting effects of trauma and displacement, this approach is not enough.
n New Zealand, this affects many communities directly. Refugees resettling in places like Palmerston North encounter health services that were not designed with them in mind. The systems demand a level of familiarity and literacy that takes years to build, and people are expected to manage this alone.
There is growing recognition that health organisations themselves must change. The concept of organisational health literacy asks: is our system easy to use for everyone, not just people who already know how it works?
In Australia, there has been significant investment in this area. Government bodies, including the Australian Commission on Safety and Quality in Health Care, have called for health services to prioritise removing barriers for marginalised populations. The NSW Health Literacy Framework 2019–2024 specifically acknowledged the need to support refugees and people from culturally and linguistically diverse backgrounds to access care that fits their needs.
Researchers have also developed practical tools, like the Organisational Health Literacy Responsiveness tool (Org-HLR), to help health services assess and improve how accessible they are. This kind of work shows what is possible when organisations take responsibility seriously.
The evidence from Australia points to common enabling factors: community engagement, peer health navigators, interpreter access, family involvement in care, culturally competent staff, and clear communication. These are not expensive or radical ideas. They are practical, and they work.
Despite this evidence, health literacy reform is slow. Research from both Australia and elsewhere shows consistent barriers within organisations: poor communication between health professionals and patients, limited training in cultural responsiveness, under-resourcing, and a lack of leadership commitment.
Frameworks get developed and published. But they are not always applied in practice. And the communities who face the greatest barriers, including African refugees and others from health systems very different to New Zealand’s, are often the least consulted in designing solutions.
New Zealand has its own context. The Māori concept of whakawhanaungatanga, the building of relationships and connection, speaks to something the evidence confirms: people access health care better when they feel known, trusted, and met where they are.
For refugee and migrant communities in Manawātu and across the country, this means health services that go beyond clinical care. It means navigators who understand your community. It means forms in your language. It means someone who can explain what is happening and why, not just what to do.
It also means asking the question that too few health systems have asked: are we designed for everyone, or only for some?
