The Silent Epidemic of Health Illiteracy

Nobody questions the fact that healthcare is a confusing profession. Doctors and nurses seem to speak in foreign tongues; medicines have names and ingredients that are not even pronounceable; more and more news comes out every day about diseases and conditions that seem to contradict each other. If doctors must devote 12 years of higher education just to get a basic understanding of how the body works, how does a patient hope to know what’s wrong with them?

In the federal government report, Healthy People 2010, which was written in 2000 and speculated on the upcoming problems facing the population, one of the objectives identified as a barrier to effective healthcare was the problem of health literacy. Health literacy goes well beyond the specific problem of an inability to read. The report defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Making appropriate health decisions is a huge task made up of thousands of tiny ones. Scheduling and keeping appointments, knowing medications and dosages, understanding complications, consenting to procedures, and reading health information are all critical components.

Healthy People 2010 reports that as much as 30% of the United States population is either health illiterate or only has a “basic” literacy, meaning that they can only comprehend the most remedial tasks. Most people who are health illiterate either have a job or are retired workers, meaning they are otherwise functional within society. The problem is especially worrisome within the elderly population, where two thirds of adults over age 60 have inadequate or marginal literacy skills, and 81% of patients age 60 and older at a public hospital could not read or understand basic materials such as prescription labels. Other groups with high levels of health illiteracy include immigrant populations, minorities, and patients with lower incomes. About half of Medicare/Medicaid patients read below the 5th-grade level.

According to the AMA, having poor health literacy is “a stronger predictor of a person’s health than age, income, employment status, education level, and race.” Patients with inadequate literacy tend to suffer from more complications from medications due to errors in dose and timing. Medical complications are also more common because patients are less likely to follow-up with conditions that require it, and in general are less compliant with physician instructions. Without clear and accurate language to describe their symptoms, patients with less health literacy are also more difficult to evaluate and diagnose, leading to longer times until appropriate treatment is initiated. The cumulative effect is that poor health literacy costs the United States over 100 billion dollars every year in extra healthcare and lost productivity.

Ultimately the issue of health literacy needs to be addressed on a national level with a well-funded initiative for patient education and awareness. However, anything professionals can do to facilitate better communication is of the utmost importance for the well-being of our patients. Everybody in the healthcare profession needs to recognize the possibility that patients may not be understanding what is expected of them. Simple changes like providing a plainly written care plan for the patient to take home after every visit can help to avoid potential errors. After an encounter, rather than asking patients if they have any questions, consider instead to ask if there is anything you can explain more clearly. We may not be able to change our patients’ behavior overnight, but we can start by changing our own.