Health Literacy, Health Care Reform

In recent years, the term health literacy has been discussed more frequently, especially in conversations about the importance of communicating with our patients. We hear and use this term often, but do we fully comprehend its meaning and implications?

Health literacy, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,”¹ is being increasingly recognized for its importance to health and health outcomes.² We, as health care professionals, have embraced health outcomes as the gold standard for measuring the care we provide; I find it odd that in the debates I have heard regarding health care reform legislation, the loudest arguments have not included the importance of outcomes or of health literacy.

The focus on health literacy is, for the most part, an extension of the focus on issues related to culture and language and their impact on racial and ethnic health disparities. For the past decade (at least), concerns about our capacity to be culturally competent have been a key element in the discussion about health care equity and access. We have often struggled to communicate with our patients who have limited English proficiency. We know that understanding is more likely to deteriorate when the provider speaks English but the patient speaks English as a second language. Too frequently, the outcome of such encounters is a missed opportunity to reduce the inequities of health care and improve the health status of our patient.

But people’s comprehension difficulties go beyond linguistic competency. A minor oversight in our endeavor to reduce disparities caused by linguistic discrepancy is that even patients whose primary language is English can be at risk for poor health outcomes.

For years, we have been instructed that patient information must be written at a grade 7 or 8 reading level. What became evident through work by Chew and colleagues³ is that people who can read at the sixth-grade level or less have limited health literacy. That the person can read the words provides some comfort, but it doesn’t guarantee that the words are understood.

Using another person to interpret (even in the same language) is not the answer, either. The listener/interpretor must know the meaning of the words and the context in which they are being used to convey the information accurately.⁴ Moreover, the interpreter must be able to explain the implications of what is being said on both sides of the conversation.

For years, Joint Commission standards⁵ have included the principle that every patient has the right to effective communication; somewhat less directly, this includes health literacy. There are also requirements for providing patient education—that information be conveyed to patients at the right time and place, in a way they can understand, remember, and act on correctly.⁶

Do our elected officials and the public understand the inner workings of the health care system? And do they appreciate the difficulties involved in educating them about the system? Do the average “Harry and Louise” comprehend the impact this new health care reform bill will have on the health care system as they know it?

I don’t ask these questions to be condescending, but to express my concern that opposition to the overhaul is based on a misunderstanding of what is going to happen as a result. And those with limited health literacy are especially challenged to understand the dialogue about health care reform and its potential impact.

Historically, our focus has been on providing quality care, lowering costs, and eliminating access disparities; yet unless we concurrently work on improving health literacy, all our efforts to address the rest will be for naught.

What has become glaringly obvious is that health literacy is fundamental to health reform in this country. The recent workshop sponsored by the Institute of Medicine⁷ was a call to all of us to attend to the issues and complexities of health literacy. We need to move forward to develop and improve tools to measure health literacy—and mitigate the disparities that result from people’s inability to understand exactly what we are saying and what it means.

How often have you been in a situation in which you realized a patient had not understood your explanation of their condition or treatment options, or could not repeat back your instructions? What strategies or advice can you offer to provide more effective patient education and improve health literacy? I would welcome hearing from you at [email protected].

In recent years, the term health literacy has been discussed more frequently, especially in conversations about the importance of communicating with our patients. We hear and use this term often, but do we fully comprehend its meaning and implications?

Health literacy, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,”¹ is being increasingly recognized for its importance to health and health outcomes.² We, as health care professionals, have embraced health outcomes as the gold standard for measuring the care we provide; I find it odd that in the debates I have heard regarding health care reform legislation, the loudest arguments have not included the importance of outcomes or of health literacy.

The focus on health literacy is, for the most part, an extension of the focus on issues related to culture and language and their impact on racial and ethnic health disparities. For the past decade (at least), concerns about our capacity to be culturally competent have been a key element in the discussion about health care equity and access. We have often struggled to communicate with our patients who have limited English proficiency. We know that understanding is more likely to deteriorate when the provider speaks English but the patient speaks English as a second language. Too frequently, the outcome of such encounters is a missed opportunity to reduce the inequities of health care and improve the health status of our patient.

But people’s comprehension difficulties go beyond linguistic competency. A minor oversight in our endeavor to reduce disparities caused by linguistic discrepancy is that even patients whose primary language is English can be at risk for poor health outcomes.

For years, we have been instructed that patient information must be written at a grade 7 or 8 reading level. What became evident through work by Chew and colleagues³ is that people who can read at the sixth-grade level or less have limited health literacy. That the person can read the words provides some comfort, but it doesn’t guarantee that the words are understood.

Using another person to interpret (even in the same language) is not the answer, either. The listener/interpretor must know the meaning of the words and the context in which they are being used to convey the information accurately.⁴ Moreover, the interpreter must be able to explain the implications of what is being said on both sides of the conversation.

For years, Joint Commission standards⁵ have included the principle that every patient has the right to effective communication; somewhat less directly, this includes health literacy. There are also requirements for providing patient education—that information be conveyed to patients at the right time and place, in a way they can understand, remember, and act on correctly.⁶

Do our elected officials and the public understand the inner workings of the health care system? And do they appreciate the difficulties involved in educating them about the system? Do the average “Harry and Louise” comprehend the impact this new health care reform bill will have on the health care system as they know it?

I don’t ask these questions to be condescending, but to express my concern that opposition to the overhaul is based on a misunderstanding of what is going to happen as a result. And those with limited health literacy are especially challenged to understand the dialogue about health care reform and its potential impact.

Historically, our focus has been on providing quality care, lowering costs, and eliminating access disparities; yet unless we concurrently work on improving health literacy, all our efforts to address the rest will be for naught.

What has become glaringly obvious is that health literacy is fundamental to health reform in this country. The recent workshop sponsored by the Institute of Medicine⁷ was a call to all of us to attend to the issues and complexities of health literacy. We need to move forward to develop and improve tools to measure health literacy—and mitigate the disparities that result from people’s inability to understand exactly what we are saying and what it means.

How often have you been in a situation in which you realized a patient had not understood your explanation of their condition or treatment options, or could not repeat back your instructions? What strategies or advice can you offer to provide more effective patient education and improve health literacy? I would welcome hearing from you at [email protected].

In recent years, the term health literacy has been discussed more frequently, especially in conversations about the importance of communicating with our patients. We hear and use this term often, but do we fully comprehend its meaning and implications?

Health literacy, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,”¹ is being increasingly recognized for its importance to health and health outcomes.² We, as health care professionals, have embraced health outcomes as the gold standard for measuring the care we provide; I find it odd that in the debates I have heard regarding health care reform legislation, the loudest arguments have not included the importance of outcomes or of health literacy.

The focus on health literacy is, for the most part, an extension of the focus on issues related to culture and language and their impact on racial and ethnic health disparities. For the past decade (at least), concerns about our capacity to be culturally competent have been a key element in the discussion about health care equity and access. We have often struggled to communicate with our patients who have limited English proficiency. We know that understanding is more likely to deteriorate when the provider speaks English but the patient speaks English as a second language. Too frequently, the outcome of such encounters is a missed opportunity to reduce the inequities of health care and improve the health status of our patient.

But people’s comprehension difficulties go beyond linguistic competency. A minor oversight in our endeavor to reduce disparities caused by linguistic discrepancy is that even patients whose primary language is English can be at risk for poor health outcomes.

For years, we have been instructed that patient information must be written at a grade 7 or 8 reading level. What became evident through work by Chew and colleagues³ is that people who can read at the sixth-grade level or less have limited health literacy. That the person can read the words provides some comfort, but it doesn’t guarantee that the words are understood.

Using another person to interpret (even in the same language) is not the answer, either. The listener/interpretor must know the meaning of the words and the context in which they are being used to convey the information accurately.⁴ Moreover, the interpreter must be able to explain the implications of what is being said on both sides of the conversation.

For years, Joint Commission standards⁵ have included the principle that every patient has the right to effective communication; somewhat less directly, this includes health literacy. There are also requirements for providing patient education—that information be conveyed to patients at the right time and place, in a way they can understand, remember, and act on correctly.⁶

Do our elected officials and the public understand the inner workings of the health care system? And do they appreciate the difficulties involved in educating them about the system? Do the average “Harry and Louise” comprehend the impact this new health care reform bill will have on the health care system as they know it?

I don’t ask these questions to be condescending, but to express my concern that opposition to the overhaul is based on a misunderstanding of what is going to happen as a result. And those with limited health literacy are especially challenged to understand the dialogue about health care reform and its potential impact.

Historically, our focus has been on providing quality care, lowering costs, and eliminating access disparities; yet unless we concurrently work on improving health literacy, all our efforts to address the rest will be for naught.

What has become glaringly obvious is that health literacy is fundamental to health reform in this country. The recent workshop sponsored by the Institute of Medicine⁷ was a call to all of us to attend to the issues and complexities of health literacy. We need to move forward to develop and improve tools to measure health literacy—and mitigate the disparities that result from people’s inability to understand exactly what we are saying and what it means.

How often have you been in a situation in which you realized a patient had not understood your explanation of their condition or treatment options, or could not repeat back your instructions? What strategies or advice can you offer to provide more effective patient education and improve health literacy? I would welcome hearing from you at [email protected].