Health Literacy: The Key to Results in Health Care
A few months ago, while out walking, a woman stopped me and asked why I was walking such a great distance. Sensing my puzzlement, she said she’d seen me earlier about a mile away. I told her I had recently learned that I was approaching pre-diabetes and I started exercising regularly because it could help me prevent diabetes. She said, “My doctor told me I have that too. Now what does that mean? Do I have diabetes?” I asked why she hadn’t asked her doctor, and she said he told her but she didn’t understand everything he was saying. She didn’t ask him to explain because “a lot of people were waiting” and she didn’t want to bother him. This story is an all too common illustration of how our health care system is failing to meet the most basic needs of its consumers-patient education and health literacy. It took me less than a minute to explain pre-diabetes to her in a way she understood.
Health literacy in the United States is abysmally low, and the connection between health literacy and health outcomes is a strong one. People with limited health literacy are more likely to skip preventative exams, have chronic conditions, and have higher rates of hospitalizations. We know that more is better- the more health literate our patients are, the better their health outcomes will be.
Some might argue that today’s health systems environment leaves no time for these doctor-patient interactions. I believe health care is all about these interactions, whether a clinical visit, hospitalization and discharge, engagement with an insurance company or the pharmacy, or even within the systems we build to support health care delivery, like medical education. If health care is about helping patients, why are they often made to feel as if they are a bother? Even in today’s culture of health care transformation, with new apps and health care-delivery models born almost daily, it seems patient-articulated needs are often an afterthought.
I suspect there are millions of people like the woman I met on the street who, because of our failure to incorporate their needs and voices, are instead turning to Google, Siri, Alexa, and the grapevine to find the health information they crave. What a depressing reflection on our health care system. If people don’t understand what we’re saying and doing to and for them, we will never achieve the patient engagement needed to improve health outcomes and reduce the 17% of our GDP spent on health care.
More importantly, as much as we banter about consumer engagement, patient-centered care, patient activation, or whatever moniker of the month, we are woefully inadequate in meeting the needs of consumers and ensuring they have the understanding needed to engage in a way that improves their health outcomes. Think about your own organization. How do you consider the health literacy needs of patients and health care consumers? Have you made time to speak directly to any of them? If so, how many and how did your organization incorporate the information you learned? What steps are you taking to ensure patient understanding is a priority and integrated within program operations? Every organization can play a role in improving health literacy.
While the approaches to incorporating health literacy-focused priorities will vary, the collective result will lead to a less intimidated and more engaged populace of health care consumers. It is this group, and many like the lady on the street, who will help us finally improve outcomes and reduce health care costs, two dreams we’ve been circuitously chasing for decades on end.
Dr. Lisa Fitzpatrick, an infectious diseases physician and CDC-trained medical epidemiologist, is Medical Director for the DC Department of Health Care Finance. She is also a professorial lecturer for the George Washington University Milken Institute School of Public Health in the Department of Epidemiology and Biostatistics. Dr. Fitzpatrick began her public health career at the Centers for Disease Control and Prevention (CDC) where she held several leadership positions, including as a U.S. diplomat in the Caribbean region. She earned a BA/MD at the University of Missouri-Kansas City, a Master’s in public health from the University of California-Berkeley School of Public Health, and Master’s in public administration from the Harvard Kennedy School of Government. She is also a co-founder of the Community Wellness Collective, a local non-profit organization that provides health education and exercise programs for underserved residents of Washington, DC.