Health and Literacy

If you are reading this blog, you are like me in the sense that we take reading and vocabulary for granted. This is somewhat like cultural sensitivity. If you are a mainstream majority person, meaning middle class, and reasonably well educated, there is a tendency to not appreciate the challenges faced by people of minority culture who cope with English as a second language. Those in the majority (myself included) are often blind to discrimination. It doesn't happen to us, so we don't see it, especially in more subtle forms.

National surveys of adult literacy have been done in the U.S. since the early 90s. For measurement purposes, literacy is divided into categories. Prose literacy is the ability to read and comprehend passages of sentences and paragraphs. Document literacy is the ability to navigate through non-continuous text, such as a job application or a medical history form. Numeracy is the ability to use simple numbers in every day application, such as figuring a tip at a restaurant or working with numbers in a set of instructions. The other dimension of measurement is levels of proficiency (below basic, basic, intermediate, proficient). As a nation, approximately 14% of adults are significantly limited (below basic) in the various types of literacy, according to the most recent national survey. This translates into millions of people. Of course, limited literacy is clustered in low income, poorly educated, those living in rural communities, minority groups, those whose primary language is not English, and senior citizens. Seniors have twice the prevalence of below basic literacy while at the same time making up a disproportionate share of the patient population. We have also learned that many people whose first language is not English have limited literacy in their own language.

Overlaid on this general problem of limited literacy is the challenge of comprehending health and medical information. Because health information often is expressed in very technical and specialized language, even people who are otherwise well educated have trouble. Not all, but some of the popularity of unfounded alternative treatments and unproven health boosting advice is due to the promoters being able to communicate in clear and compelling ways, whereas people leave their doctor's office scratching their heads.

This is a problem in which everyone is invested. Unless you live in a very rarefied social circle where everyone is well educated and affluent, you know, perhaps without realizing, someone who struggles with understanding medication label instructions or patient education materials about a chronic disease. If you are a health care provider or allied health professional, you may need to examine your manner of speaking and the nature of printed materials you routinely give to patients. The rest of us should care about this because this gap in understanding between patients and health care workers translates into excess illness and death. When someone cannot understand how to take a medication or doesn't comprehend how to follow a therapeutic diet, they run a greater risk of failing to benefit from treatment, failing to control illnesses, and suffering consequences including premature death. This is a human loss, but also an economic one, adding to the already out-of-control cost of our health care system.

The health care system is beginning to respond to this problem. More and more hospitals, physicians and other practitioners, insurers, and nonprofit organizations are trying to be more user-friendly for all consumers. It is a more difficult challenge to bring about community circumstances so that all adults obtain more adequate reading and numerical skills. This illustrates that education reform has wide repercussions.

Note also that improving health literacy, working from both sides, is still only a partial solution. People follow or do not follow health advice for very complex reasons. Information understanding is required, but is not sufficient in itself. Health literacy is a good place to start as the nation continues to push toward health for all.