If, as former U.N. Secretary General Kofi Annan has said, "literacy is a bridge from misery to hope," then health literacy is a bridge from illness to wellness. However, the acceleration of medical innovation can leave the common patient increasingly illiterate— drowning in a tsunami of complex medical terms and systems.
That this is an impediment not only to high-quality medical care, but also to the patient's general well-being was recognized by Health & Human Services, whose 2010 report, "National Action Plan to Improve Health Literacy," pointed to research showing that 9 out of 10 adults have difficulty using the "everyday" health information that is routinely available in health care facilities, retail outlets, media and communities. As a result, it stated that they are more likely to skip necessary medical tests, to end up in the emergency room more often, and to "have a hard time managing chronic diseases."
The National Action Plan defined 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." It asserted that the impact of health illiteracy falls disproportionately on lower socioeconomic and minority groups. It proposed seven health literacy goals:
- Develop and disseminate health and safety information that is accurate, accessible and actionable.
- Promote changes in the health care system that improve health information, communication, informed decision making and access to health services.
- Incorporate accurate, standards-based and developmentally appropriate health and science information and curricula in child care and education through the university level.
- Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community.
- Build partnerships, develop guidance and change policies.
- Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy.
- Increase the dissemination and use of evidence-based health literacy practices and interventions.
"Health literacy is a powerful shield against medical errors," wrote Rajan Madhok, chairman of the advisory board for the Patient Safety Alliance, and Nikhil Datar, M.D., founder of the Patient Safety Alliance. They noted that although medicine is supposed to do no harm, it does, as infamously documented in To Err Is Human: Building a Safer Health System.
The problem, as they see it, is that despite "[m]any initiatives [having] been launched globally to establish the extent of the problem, identify its root causes, campaign for legislative change with regard to medical devices and professional performance, and to raise patient awareness," that shield against error has not been built.
Madhok and Datar exhort their own national health care system, India's, to promote safe medical care by:
- creating systems for recording, learning and reporting on the quality of medical services and adverse events;
- implementing evidence-based patient safety interventions (hand hygiene, the surgical checklist, etc.);
- empowering patients to question and work with clinicians;
- building capacity by educating students in the World Health Organization curriculum on patient safety and by training all clinicians through distance learning.
They note that the poor state of health literacy in India is exacerbated by the variety of regional languages and the use of English as the country's lingua franca. However, many people, especially those educated through the medium of their local language, still don't have sufficient knowledge to comprehend basic medical terms, which are usually in English.
Unsafe care and poor literacy, they say, need to be addressed on practically a war footing if India (for one) is to reduce health inequalities and ensure affordable health care to all. But they recognize that in a developing world where endemic corruption keeps voters illiterate and ignorant, and where a lack of transparent governance adds enormously to human misery, health literacy is treated as an orphan, with decision-makers seemingly unaware of how serious the problem is, to put it delicately. "Studious inactivity" seems to be their common response.
What to Do?
We agree with Madhok and Datar that "[h]ealth literacy is a powerful shield against medical errors"; but in our opinion, it is a forlorn hope that the shield will ever be built into the mind of the masses. Given the acceleration of medical innovation and the existing and growing complexity of care, functional health literacy can only be— and indeed is— built into the increasingly smart brains of our medical devices and apps.
But there's something we might call "studious inattention," which afflicts even the most advanced health care systems. For example, nowhere does the U.S. National Action Plan suggest encouraging and supporting efforts to make technology more people-literate. It suggests merely that we should "[e]nsure that instructions and risk and benefit information about medical devices for use by consumers are written in plain language and consumer-tested for usability." An appendix, "What You Can Do to Improve Health Literacy," addresses individuals and families, communities, and educators; it says nothing to device manufacturers and medical app developers.
It's not that advanced "smart" devices and apps did not exist in 2010, when the National Action Plan was published. Felasfa Wodajo, M.D., noted in a blog post in early 2011 that "a physician was on stage with Apple CEO Steve Jobs in 2009 demonstrating an early version of AirStrip, an iPhone application that provided real-time monitoring of fetal heart rate tracings," and that as of March 2010, there were "over 6,000 apps classified as health-related across the various app stores, although only 30 percent [were] directed to clinicians" (implying that 70 percent were directed to patients, perhaps?).
The point is, governments and health administrators seem to be missing a boat that is taking the private sector— even non–health care segments of the private sector— to a solution to the health literacy problem.
David Ellis is a futurist, author, consultant and publisher of Health Futures Digest, a monthly online discursive digest of news and commentary on long-range, leading-edge technological innovations and their consequences and implications for health care policy and practice. He is also a regular contributor to H&HN Daily and a member of Speakers Express.
Ramana (S.S.V.) Yashaswi, M.D., M.S., is a consultant at the 100-bed Yashaswi Hospital in Guntur, India. He is an orthopedic surgeon specializing in trauma and joint replacement. He is also a professor of orthopedics at Guntur Medical College and director of the Walk Foundation, which provides prosthetic limbs to the poor, free of charge.