An estimated 250 million Americans braced themselves for record-breaking sub-zero temperatures as the January 2019 polar vortex bore down on the Northeast and Midwest U.S. states. Two months earlier, wildfires burned about 8.6 million acres in California. And a month before that, tens of thousands of residents in the southeastern states evacuated as hurricane Michael inched toward the Florida coastline.
Events of epic proportions such as these garner a lot of media attention. They carry a high price tag in terms of lives lost as well as economic damages. The January cold snap killed at least 21 people and cost U.S. businesses $1 billion. The 2018 California wildfires killed 89 people and destroyed 16,000 buildings. Estimates to rebuild top $19 billion. Hurricane Michael has been blamed for at least 45 deaths in the U.S. with costs expected to exceed $15 billion.
An even bigger impact
Government and health authorities have identified an epidemic that impacts more people in the U.S. than these natural disasters combined. Reduced health literacy touches nearly 9 in 10 U.S. adults and has an economic fallout on par with the nation’s costliest disasters.
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.” Anyone who buys an over-the-counter medicine, visits their dentist or wellness practitioner, reads health information online, or joins a weight loss group is making a health decision. Limited health literacy hampers their ability to understand the complexities and consequences of everyday decisions about their health and lifestyle, and they could end up making a decision that adversely impacts their future health.
According to a 2011 report prepared for the Agency for Healthcare Research and Quality (AHRQ), low health literacy is linked to an increased number of emergency room visits, increased risk of chronic disease, poorer health outcomes, and higher death rates. It’s also linked to higher healthcare costs. In 2003, the U.S. Department of Education National Assessment of Adult Literacy reported that low health literacy costs the U.S. economy between $106 billion and $238 billion annually. Factoring in inflation, that cost reaches 145 billion to 325 billion in today’s dollars.
Maybe if we treated low health literacy like a natural national disaster, we could better prepare for – and avert – much of the damage caused by reduced literacy.
Here are three ways health and wellness professionals can prepare for low health literacy and help mitigate its impact.
1. Assume everyone struggles with health literacy. As the adage goes, you can’t tell a book by its cover. And you can’t tell by looking whether someone has reduced health literacy. Anyone can struggle with it: Rich or poor, young and old, university educated or a high school dropout. While many people with low education levels have low literacy, it’s important to remember that health literacy requires more than being able to read or solve math equations. As the National Network of Libraries of Medicine states, “Health literacy requires a complex group of reading, listening, analytical, and decision-making skills, as well as the ability to apply these skills to health situations.” An individual’s disease, stress level, and social connectedness contribute to health literacy. The AHRQ produced a multi-question patient health literacy survey that could be adapted for use in other health and lifestyle settings. A small study found that a single question could help identify many individuals with reading difficulties.
2. Dig into your data. Your data can give you clues about the health literacy of individuals within your population. Are they comfortable communicating in English? How healthy are their lifestyle habits? Do they take medicines as prescribed and adhere to recommended lifestyle changes? An individual might not understand directions enough to follow them, or they may forget health information shortly after the appointment. The teach-back method can help health and wellness professionals check whether an individual understands and is able to follow advice.
An individual might understand face-to-face counsel, yet be unable to connect with digital follow-up. According to doctors Norman and Skinner, eHealth literacy requires a different skill set. “At its heart are six core skills (or literacies): traditional literacy, health literacy, information literacy, scientific literacy, media literacy, and computer literacy.” If you want individuals to sign onto a portal, take a health risk assessment, or connect with an intervention via a smartphone, make sure they are able to complete forms and assessments online. If not, then offer assistance or deliver the assessment or information in an alternative format. For example, you could administer the assessment online or over the telephone.
3. Have a plan. First responders and other emergency personnel have learned from past experience that epic disasters can result in lost lives and widespread property damage. They know that preparedness saves lives. Population health and wellness managers are on the front lines of the health literacy epidemic. Accrediting agencies such as the National Committee for Quality Assurance and the Joint Commission recognize the importance of planning for reduced health literacy and place the onus of understandability on health and wellness providers. Most U.S. states have literacy standards in place for Medicaid, but it’s important to remember that reduced health literacy impacts the majority of Americans – not just Medicaid populations. Although written for primary care practices, AHRQ’s Health Literacy Universal Precautions Toolkit has useful information that population health and wellness professionals can use to enhance their communication efforts.
Learn more about health literacy by checking out our guide.