We are facing an epidemic – one that, ironically, both damages our healthcare system and stems from the healthcare system itself. This epidemic is a large contributor to the variability of healthcare effectiveness, the perception of overall health status, and the presence of higher mortality rates. The system we initially established to help others is being crippled by our own negligence of one of the most important factors of healthcare – health literacy.
Health literacy is traditionally defined as the set of skills that one possesses which determine his/her ability to find and use medical information.
For people who lack basic literacy skills, health literacy is unattainable for two reasons. Health literacy levels are, firstly, largely contingent on basic reading and interpretation skills. Secondly, as Dr. Catina O’Leary of Health Literacy Media (HLM) points out, lack of basic literacy may lead to embarrassment that prevents individuals from asking pertinent questions, posing another roadblock in patient-provider communication. This results in health literacy issues heavily residing in uneducated populations. Even if people do have the educational background allowing for basic information comprehension, many live in places that lack resources or access to health centers. For those who do have health centers, these health centers may not cater to their cultural or linguistic backgrounds. We may, thus, think of this issue as targeting specific disadvantaged groups, but it is vital to understand that these issues are widespread. Older adults, regardless of background or demographic, tend to have more health-related issues and are novices in navigating the very complex health system at an age where their cognitive and physical abilities have significantly changed. Younger populations, on the other hand, may lack the general experience needed to make informed and strategic healthcare decisions. The fact of the matter is, as Dr. O’Leary states, “we’re all at risk.”
Understanding that health literacy issues are incredibly pervasive is the first step in addressing them. An expression of health literacy can be seen in something as simple as depictions on prescription bottles. For example, a picture of a body with an ambiguous circle inside of it indicates that the drug should not be taken while pregnant. Another example is a picture of an eye which indicates that the drug may cause drowsiness. Though these types of pictures may indicate certain side effects or instructions, they are only valuable if the patient can comprehend their meaning. If these pictures are interpreted incorrectly, patient compliance and the effectiveness of his/her treatment are negatively affected. Interpretation issues can lie in certain instructional phrasing on the bottles as well. For example, a bottle that says to take the medication “once a day,” may be interpreted as eleven times a day by a Spanish speaker. Dr. O’Leary points out that, just as issues arise on a small scale and provide a large impact on the compliance of the patient, fixing these issues is just as simple and impactful. This leads to the question of why, if these problems are easily fixed, have they not been readily corrected? Why have there not been regulations in place to prevent them?
One explanation lies in the fact that people falsely give too much credit to their superficial understandings of others. This situation can be likened to the statements, “I’m not racist because I have a black friend” or, “I can’t possibly be sexist; my wife loves me.” Speaking from a place of privilege, people make the case that they are empathetic of others’ situations when, in actuality, whether a conscious fallacy or not, they don’t completely understand. No one can understand the experience of a working, single mother living in a bad neighborhood, unable to go to the grocery store in the day due to her schedule and limitations in transportation. For someone like her, it’s incredibly difficult to be proactive in attaining health literacy.
“People get comfortable with their own frame of reference [which makes it] easy to point fingers and say ‘if only they were smarter or less lazy, they could have had the same job I had,’” states Dr. O’Leary. “People are very quick to diminish the advantages that they have and overlook the fact that other people didn’t have the same; we pretend that we all started in the same place when, in fact, many of us started on second or third base; some people started sliding into home and other people aren’t even out of the parking lot to get on the field.”
If we don’t consider disparities in opportunity, we retain a skewed perspective of how people’s experiences determine their ability to become health literate. These limited opportunities are the means through which they develop certain skills such as literacy, and following that, health literacy. Thus, it’s important that we increase our attention to the differences between people and act accordingly from those acknowledgements. We must ensure our system of communication, including the system of healthcare communication, doesn’t exclude real people.
If you’re questioning how we can remedy an issue rooted in an underlying social norm, the answer lies in being more empathetic and aware. Initiatives such as those sponsored by HLM, which train professionals to utilize certain communication strategies, ensure stronger patient-provider relationships. Their programs are centered around educating providers in contextualizing patient conditions and treatments, expressing instructions without the use of medical jargon and utilizing teach-back methods, which ensure patients can repeat provider instructions without intimidation or hesitation. Practicing these methods provides benefits to both the provider and the patient. People would not only be more inclined to show up for their appointments, but they would genuinely understand information and make educated healthcare choices. This would have lasting results because it would translate to patients getting well, improving daily aspects of their lives.
Dr. O’Leary states, “They would be able to show up to work and get paid a living wage and participate in their family and make sure their kids are at school and do all the things to diminish the challenges of poverty and complexities of hard lives.”
Providers would be better able to connect with their patients through health literate conversations; as a result, people would be less apprehensive of their providers and more likely to follow their directions. Additionally, providers wouldn’t have to worry about lawsuits and malpractice insurance to the extent they do now. This would combat overall burnout as patients would be more receptive to their advice.
“If we were all in a situation where we could be productive and engaged at the level that we should be based off our skills and opportunities and interests, I think the world would probably be much less angry and challenging,” says Dr. O’Leary.
She believes that we should combat health literacy issues by connecting them with broad topics that matter to a wide array of people, ranging from climate change to immigration issues. With a changing environment comes health consequences, and with changing health consequences, there will be more of a need to understand what these consequences entail. With immigration issues, there are many health factors that impact the ability of immigrants to travel safely. By helping people make these connections between health literacy and important social issues, we provide them with the opportunity to truly realize the meaningful nature of health literacy. In this way, it conveys that this is a community issue, intertwined with every person’s daily lives and values.
As Dr. O’Leary puts it, “We’ll all need healthcare at some point, but before we need healthcare, we’ll need lots of other things, and it’s all related.”
Edited by: Kenneth Peng
Illustrated by: Victoria Xu