Turning kidney health literacy into action

Improving health literacy should not be seen as simply providing people with more information. Education alone cannot protect individuals if communities lack resources to support them, and environments limit their ability to act on their kidney health knowledge. Instead, health literacy should be thought of as a multidimensional concept with shared responsibility across three levels.^1,2,3

For individuals, this means being able to access, appraise, and use information, services and tools relevant to protecting their kidneys during periods of rising heat exposure.⁴ With good kidney literacy, people should be able to answer four practical questions: Am I at risk? What symptoms should I look for? What can I do? When should I seek help? Within communities, it requires ensuring that health care professionals and community leaders can clearly convey heatwave risk-reduction strategies and provide resources based on the patient's needs and understanding. More broadly, the environments in which people live and work should allow individuals to translate kidney health literacy into protective measures.

Maria Eugenia V Bianchi, president of the Fundación Renal del Nordeste Argentino, echoed this sentiment: “Good kidney health literacy extends beyond knowledge of kidney diseases to the ability to understand and use that knowledge to make decisions and take action. This depends not only on individual capacities but on social, cultural, economic, environmental and institutional conditions in which people live and work.”

The gap between kidney protection and its application

Heat exposure poses a significant risk to many vulnerable populations. Older people, children and those living with long-term illnesses are susceptible to heat stress, while low-income urban residents and workers face additional risks from the urban heat island effect and hot working environments, respectively.^4,5 

Current messaging intended to raise awareness of heat exposure and kidney protection falls short. Dr Bianchi notes, “A recommendation could be scientifically correct and still impractical.” This is because instructions encouraging individuals “to stay hydrated” or “to stay cool” are arguably too generic, often overlooking distinct and structural barriers. For instance, telling outdoor workers to stay hydrated is difficult to act on if clean drinking water is not always available. This was a major barrier faced by outdoor workers in northwest Nicaragua.⁶ Similarly, telling people to stay cool may not be realistic when access to cooling is limited. In India, only 15.8% of rural households possessed an air-conditioner or air-cooler in 2019-21.⁷ As pointed out by Vasundhara Raghavan, CEO of Kidney Warriors Foundation, “In Mumbai during the heatwave, people living in apartments could turn on their air-conditioners, but what about the people living on the streets? What were they going through?”

Making kidney health advice actionable 

Effective protection begins with ensuring that people can understand and act on information about their own heat-related risks. Tailoring resources to individuals' literacy and numeracy levels has shown improved outcomes across other long-term non-communicable diseases (NCDs), such as diabetes, and could be a useful model for supporting vulnerable groups exposed to rising heat exposure.² This could form part of a broader health literacy approach, linking kidney health advice with messaging on wider NCD risks rather than treating it in isolation. In one study of college students in India, a comprehensive NCD health-literacy programme led to an 18.5% greater improvement in health-literacy scores than in the comparison group.⁸ At the individual level, people should be able to understand results and recognise heat-related symptoms. But individual understanding is only one part of the response. Turning that knowledge into protection also requires support within the communities where people live, learn and receive care.

In communities, measures need to move beyond broad population-wide advice and respond to vulnerable groups. While interventions towards the general population can be broad, as Ms Raghavan suggests, “Climate alerts can be accompanied with advice on the consumption of water-rich fruit and vegetables.” Initiatives for vulnerable groups should be adapted to their contexts. For older people, children and those living with chronic illnesses, well-ventilated spaces and hydration stations could be prioritised. Determining what those adaptations should look like requires moving beyond a one-size-fits-all approach and involving communities themselves. In addition, communities should have a role in co-designing interventions so that specific challenges related to living and working environments, as well as perceptions and behaviours, can be adequately addressed.⁹

Community participation can help identify local needs, prioritise practical solutions and shape how support is delivered. A key community measure, highlighted by Dr Bianchi, includes scholarship programmes. These can help train community leaders to visit care homes or schools to measure blood pressure and hydration levels. Such a system can also provide a channel for communities to pinpoint which messages and communication channels are best suited to their context, helping translate broader public-health advice into practical guidance that people can use daily.¹⁰

The same principle of adapting interventions to local circumstances extends to the environments in which people live. For residents of low-income urban areas, environmental measures could focus on creating heat-resilient homes, through white or reflective roof painting.¹¹ Community efforts could communicate the importance of household adaptation and heat-mitigation strategies. 

This interaction between environmental protection, community support and personal knowledge is equally relevant in workplaces, where heat exposure may form part of working conditions. For heat-exposed agricultural workers, workplace interventions could prioritise access to water, regular hydration and rest breaks and mid-harvest kidney-function screening.¹² Ms Raghavan added that in India, “Cooling drinks such as lassi or buttermilk should be encouraged to help workers stay hydrated.”  Some interventions could focus on empowering workers to use pocket urine-colour charts to check their own hydration. 

 A shared responsibility 

Improving kidney literacy requires coordinated action and shared responsibility. Resources and interventions should be tailored according to the needs of vulnerable groups, local contexts and socioeconomic conditions. Advice should come directly from trusted voices in communities and should be endorsed by workplaces, public services and policies. As global temperatures continue to rise, protecting kidney health is possible only if advice is actionable.