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Health Literacy: An Introduction

August 14, 2013

This is the first installment of a short series on what I consider an enormously important subject.

Health literacy is a little known and poorly understood key ingredient to a long and happy life. It is a rare commodity, but not because an evil person found the mother lode and cornered the market. It is man-made, but there just isn’t a lot of it in circulation yet.  It is, however, a public health imperative.

The conscientious Europeans conducted a recent survey and found that nearly half of all adults in the eight European countries tested have inadequate or problematic health literacy skills. Interested readers can find a discussion of the survey as part of a much broader exploration of the subject in the 2013 IOM publication, Health Literacy: Improving Health, Health Systems, and Health Policy Around the World: Workshop Summary. If you follow the publication link provided, you might also want to take a moment to visit the page of the IOM Roundtable on Health Literacy, and familiarize yourself with the Roundtable’s various activities and publications since 2006.

If 47% of surveyed Europeans were found wanting in health literacy, the situation on this continent isn’t likely to be much better. About 11 million adults in the U.S. do not have basic literacy, and 30 million adults have below basic English skills.

The World Health Organization, in a wonderfully titled document, Health Literacy: The Solid Facts, declares a “health literacy crisis in Europe and beyond.” The authors cite a health decision-making paradox whereby we are encouraged to make healthy lifestyle choices and to navigate the unspeakably complex and opaque healthcare systems—virtually impossible for even the best-educated people—but are not being prepared for these challenges.

What kinds of challenges specifically? Among many other examples, there could be problems:

  • understanding what the doctor or nurse says to you;
  • understanding labels on prescription medicines;
  • knowing in advance (or even after getting a bill) what a medicine, procedure or hospital stay costs;
  • assessing whether information about illness in the mass or social media is reliable;
  • finding information on how to manage mental health problems such as stress, anger or depression (particularly that caused by going three rounds with the healthcare system itself);
  • understanding information on food packaging; or
  • participating in activities in your community that improve health and well-being.

We are increasingly bombarded with health information and misinformation. The U.S. shares with New Zealand the dubious distinction of being the only nations that permit direct-to-consumer marketing of pharmaceutical products, advertising directed toward “patients” rather than healthcare professionals. Modern societies also promote unhealthy foods and lifestyles, and vigorously defend their products and messages with scientific obfuscation, legal tactics, and extremely sophisticated marketing tools and techniques.AJPM

Boy reading in the libraryHealth literacy deserves a prominent place alongside a person’s knowledge of other arts and sciences that constitute the main curricula of life. These include:

  • basic literacy and numeracy;
  • cognition (the mental processes of knowing, perceiving, remembering and reasoning);
  • psychology (emotional and behavioral characteristics);
  • communication (to exchange or impart, to sense or transmit, to have sympathetic mutual understanding);
  • ethics (values relating to human conduct); politics (the art of government);
  • civics (the rights and obligations of citizenship); and
  • environmental, geographic, cultural and economic literacies.

Poor health literacy adversely affects a person’s health, and is one of the strongest predictors of health status, along with age, income, employment status, education level and race or ethnic group. Weak health literacy can result in less healthy choices, riskier behavior, poorer health, less self-management, and more hospitalization and costs. Strengthening health literacy has been shown to build individual and community resilience, help address health inequities and improve health and well-being.

In subsequent discussions on this topic, I will broadly sketch the defining characteristics of health literacy, and suggest how it can be effectively acquired. The discussion will include a close examination of food literacy as an important aspect of health literacy. It will include a review of actions that health professionals can take to communicate more effectively with patients, and the general role of plain language in removing barriers to health literacy. I will also present some of the promising results in different settings, including schools, the workplace, the marketplace, healthcare settings, and in the mass and social media. Stay tuned.

— Michael Lytton, AJPM Blog Editor

Further Reading in AJPM

Freedman DA, Bess KD, Tucker HA, et al. Public Health Literacy Defined. Am J Prev Med 2009;36(5):446-51.

Gazmararian JA, Curran JW, Parker RM, et al. Public Health Literacy in America: An Ethical Imperative. Am J Prev Med 2005;28(3):317-22.

Rothman RL, Housam R, Weiss H, et al. Patient Understanding of Food Labels: The Role of Literacy and Numeracy. Am J Prev Med 2006;31(5):391-8.

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