HEALTH LITERACY

Knowledge is Power

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

 

Limited health literacy affects people of all ages, races, incomes, and education levels, but the impact of limited health literacy disproportionately affects lower socioeconomic and minority groups.

 

It affects people’s ability to search for and use health information, adopt healthy behaviors, and act on important public health alerts. Limited health literacy is also associated with worse health outcomes and higher costs.

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A Call to Action to Improve Health Literacy in

Greater Englewood

Excerpt from the National Action to Improve Health Literacy by the U.S. Department of Health and Human Services Office of Disease Prevention. Edited for the Greater Englewood

Elements of the Plan

The Action Plan should be based on 2 core principles:

  • All people have the right to health information that helps them make informed decisions

  • Health services should be delivered in ways that are easy to understand and that improve health, longevity, and quality of life

 

The Action Plan should contain these 7 goals that will improve health literacy and strategies for achieving them:

  1. Develop and disseminate health and safety information that is accurate, accessible, and actionable

  2. Promote changes in the health care system that improve health information, communication, informed decision-making, and access to health services

  3. Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in child care and education through the university level

  4. Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community

  5. Build partnerships, develop guidance, and change policies

  6. Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy

  7. Increase the dissemination and use of evidence-based health literacy practices and interventions

 

Why a Call to Action

 

Every day, people confront situations that involve life-changing decisions about their health. These decisions are made in such places as grocery and drug stores, workplaces, playgrounds, doctors’ offices, clinics and hospitals, and around the kitchen table. Only some of these decisions are made when patients and their health care providers are in a face-to-face consultation; many more are made when people are on their own and dealing with often unfamiliar and complex information. For example, they must figure out what type of health insurance they should choose; how much medicine to give a sick child, using the directions printed on a box; or how to respond to a warning about a severe public health outbreak in their area. People need information they can understand and use to make informed decisions and take actions that protect and promote their health. Yet two decades of research indicate that today’s health information is presented in a way that isn’t usable by the average adult. Nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely available in our health care facilities, retail outlets, media, and communities.
 

At the same time that health-related decisions are becoming more complex, the economic pressure of rising health care costs and the growing prevalence of chronic disease are creating a shift toward consumer-driven health care, where consumers are the primary decision maker of the health care they receive. Public policy is increasingly focused on the role of consumers (the public) in managing their own health in partnership with health care providers. To make appropriate health decisions and act on them, people must locate health information, evaluate the information for credibility and quality, and analyze risks and benefits. Underlying this shift toward consumer-driven care are assumptions about people’s knowledge and skills that contradict what we know about health literacy in the United States.
 

An Action Plan to Improve Health Literacy in Greater Englewood should engage all people in a linked, multilevel effort to create a health literate community. The goals and strategies support and will help achieve Healthy People objectives in health literacy and related areas, such as chronic diseases. Healthy People is a set of health objectives for the Nation to achieve over a decade. The objectives are informed by the best scientific knowledge and designed to measure the Nation’s health over time. 

The action plan identifies the overarching goals and highest priority strategies that we should pursue to create a health literate society. Organizations and professional groups can use the action plan as a framework, adapt the goals and strategies to their situation, and decide on specific actions to take. Professionals, public and private sector organizations, communities, and policymakers are the intended users of the plan because they are the ones who can organize and take actions and evaluate progress toward a health literate society. Every organization and professional group involved in the development and dissemination of health information and services should have specific goals, objectives, strategies, policies, guidelines, and metrics to ensure that their actions improve health literacy. Some groups may have a bigger role than others, but we all have a contribution to make.

Understanding and Defining Health Literacy

Health literacy is a complex phenomenon that involves skills, knowledge, and the expectations that health professionals have of the public’s interest in and understanding of health information and services. Health information and services are often unfamiliar, complicated, and technical, even for people with higher levels of education. People of all ages, races, incomes, and education levels—not just people with limited reading skills or people for whom English is a second language—are affected by limited health literacy. According to research from the U.S. Department of Education, only 12 percent of English-speaking adults in the United States have proficient health literacy skills. The impact of limited health literacy disproportionately affects lower socioeconomic and minority groups

The skills of individuals are an important part of health literacy, but health literacy is not only about individuals’ skills. Health literacy in the U.S. reflects what health systems and professionals do to make health information and services understandable and actionable. Professionals, the media, and public and private sector organizations often present information in ways that make it difficult to understand and act on. Publicly available health information can also be incomplete or inaccurate. Consequently, the skills of health professionals, the media, and government and private sector agencies to provide health information in a manner appropriate to their audiences are as equally important as an individual’s skills.1 The interactions between laypersons and professionals influence the health literacy of individuals and society.

Health literacy requires knowledge from many topic areas, including the body, healthy behaviors, and the workings of the health system. Health literacy is influenced by the language we speak; our ability to communicate clearly and listen carefully; and our age, socioeconomic status, cultural background, past experiences, cognitive abilities, and mental health. Each of these factors affects how we communicate, understand, and respond to health information. For example, it can be difficult for anyone, no matter the literacy skills, to remember instructions or read a medication label when feeling sick.
 

Health information comes from many different sources and is delivered through multiple channels—for example, discussions with friends and family; TV, radio, and newspapers; schools; libraries; Web sites and social media; doctors, dentists, nurses, physician assistants, pharmacists, and other health professionals; health educators; public health officials; nutrition and medicine labels; product pamphlets; and safety warnings. Many of these sources present different and possibly conflicting information, and some present biased or incomplete information. As a result, people confront a complex and potentially overwhelming set of health messages every day.

To prevent or manage disease and promote health, the people of Greater Englewood need to make sense of the health information they hear, read, and see from all of these sources. Consequently, no single group or organization can address health literacy issues on its own. Initiatives from all sectors must be linked and mutually supportive to achieve measurable improvements in health literacy across all socioeconomic levels.
All of us must work together to make sure that health information and services are provided in ways that meet the needs and interests of all people. Although many individual factors contribute to limited health literacy, eliminating barriers and improving the way health care and public health professionals, educators, and the media communicate health information offer the best opportunity to achieve a health literate Greater Englewood community.

Health Literacy and Outcomes

The link between limited health literacy and poor health has been well documented. In 2004, both AHRQ and IOM published reports with comprehensive reviews of the literature on health literacy and health outcomes. Both reports concluded that limited health literacy is negatively associated with the use of preventive services (e.g., mammograms or flu shots), management of chronic conditions (e.g., diabetes, high blood pressure, asthma, and HIV/AIDS), and self-reported health. Researchers also found an association between limited health literacy and an increase in preventable hospital visits and admissions. Additional studies have linked limited health literacy to misunderstanding instructions about prescription medication, medication errors, poor comprehension of nutrition labels, and mortality.

Limited health literacy has psychological costs. Adults with limited health literacy skills report feeling a sense of shame about their skill level. They may hide their struggles with reading or vocabulary. As a result of this and other issues, limited health literacy is often invisible to health care providers and other public health professionals.

Although limited health literacy affects most adults at some point in their lives, there are disparities in prevalence and severity. Some groups are more likely than others to have limited health literacy. Certain populations are most likely to experience limited health literacy:

  •  Adults over the age of 65 years

  •  Racial and ethnic groups other than White

  •  Recent refugees and immigrants

  •  People with less than a high school degree or GED

  •  People with incomes at or below the poverty level

  •  Non-native speakers of English

Because of the complexity of health literacy, there are no reliable and valid studies of its full impact on costs for health care services. The few published studies have focused on the costs generated by individuals identified as having “low” health literacy. For example, costs associated with medical errors may result from health literacy factors. Existing economic studies indicate that people with limited health literacy skills have higher medical costs and use an inefficient mix of services. 

 

In addition, substantial indirect costs are likely associated with limited health literacy, such as more chronic illness and disability, lost wages, and a poorer quality of life. Much more research is needed to make a definitive statement about the costs of limited health literacy.

Additionally, recent research has focused on health literacy as one of the critical factors in health disparities. The greatest opportunities for reducing health disparities are in empowering individuals and changing the health system to meet their needs. We cannot expect people to adopt the health behaviors and take the actions we champion without clear communication, supportive activities to build skills, and organizational changes to reduce the demands of our recommendations.

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Washington, DC: Author.