Health Literacy in the Public Health Service

As national leaders in the public health field, it is critical for officers in the Commissioned Corps of the U.S. Public Health Service (Corps) to understand the concept of health literacy and the ramifications that can result from poor health literacy. Health care professionals interact with individuals who have different levels of understanding of health. Oversimplifying information may be interpreted as derogatory to some individuals, while under simplifying may cause individuals to misunderstand crucial health information. Awareness of the concept and the problem with the lack of health literacy becomes the first step in improving challenges associated with poor health literacy.

The Institute of Medicine (IOM) defines health literacy as “The ability to find, understand and use health information and services to make appropriate health decisions and act on health information. . .” According to the National Adult Literacy Survey, 90 million adults in America are classified as having poor literacy. Health literacy is a complex issue involving multiple factors, making improvements in this area challenging.

As Corps officers, it is our job to equip ourselves with competencies and skills for working with individuals with poor health literacy. To be competent, it is important to first be aware of the factors that affect health literacy such as age, language, race/ethnicity, education level and cognitive ability, income level, and cultural considerations. Individuals with poor health literacy are at risk for a multitude of adverse health consequences, for example, misinterpretation of medical instructions or misuse of prescription drugs, which may result in frustration, injury, and/or death.

Knowing your patient, participant, or target population is also a critical competency. What is your personal learning/teaching style? Do you tend to give your patients/participants a learning tool that may be your own personal preference? Individuals with poor health literacy skills can benefit from having multiple methods of health education presented to them. For example, handing out a brochure with illustrations, written text, and then explaining the brochure will provide the patient with visual and audible learning tools. Communication is another key competency in health literacy. Do economists expect us to know the stock market as well as they do, or when we seek the expertise of translators, do they expect us to have a comprehensive knowledge of their language? If they did, their professional service would not be of use to us. In the same way, we should not expect patients to understand health the way that we do. Using analogies and ranges will help health information become more real to a patient. Here are two examples: “You can lift up to 5 pounds—about the same weight as a bag of flour” or “The chance of you getting (x) is like catching a foul ball at Fenway Park.” Developing skills associated with cultural awareness is a final competency in which Corps officers should be proficient. Take time to become aware of cultures that you are not familiar with. Sometimes habits or traditions such as dietary restrictions, non-traditional medicine, or other behaviors associated with different cultures may affect health literacy.

Corps officers serve as strong leaders in the field of public health nationally and globally. Health literacy is the currency of success for everything that is being done within the Office of the Surgeon General. As public health leaders, we need to ensure that every effort is being made to address health literacy in everything that we do. Health literacy can save lives, save money, and improve the health and well-being of millions of Americans. As Corps officers, we must promote, protect, and advance effective communication with individuals at all health literacy levels. How competent are you in health literacy? For more information, please take advantage of the following resources:

Department of Health and Human Services Health Literacy Workgroup http://intranet.hhs.gov/healthliteracy/

Improving Health Literacy: Centers for Disease Control and Prevention’s Approach http://www.cdc.gov/communication/resources/literacy.htm

Health Literacy: A Prescription to End Confusion http://darwin.nap.edu/books/0309091179/html

 

VADM Richard H. Carmona Surgeon General of the U.S. Public Health Service

Note of appreciation to LTJG Rebekah A. Sagan, Office of the Surgeon General, for preparing this article.

References used:

Institute of Medicine (2006) Health Literacy Community Youth Mapping. Retrieved      February 2006 from http://www.iom.edu/CMS/28312/30065.aspx. Kutner M., Greenberg E., Baer J. A first look at the literacy of America’s adults in the 21st      century. Washington, D.C.: National Center for Education Statistics, U.S. Department of      Education, 2003. Neilse-Bohlman L., Panzer A.M., Kindig D.A., eds. Health Literacy: A Prescription to End      Confusion. Washington, DC: National Academies Press; 2004. Baker D.W., Gazmararian J.A., Sudano J., Patterson M. The association between age and      health literacy among elderly persons. J Gerontol Series B-Psychok      Scien Soc Scien 2000; 55 (6): S368-74. Agency for Healthcare Research and Quality. Literacy and Health Outcomes (AHRQ      Publication No. 04¬E007-2). Rockville, MD: AHRQ Printing Office, 2004. Kirsch I., Jungeblut A., Jenkins L., eds. Adult literacy in America: A first look at the findings      of the National Adult Literacy Survey, 3rd edition. Vol. 201. Washington, D.C.: National      Center for Education, U.S. Department of Education, 2002. Osborne, H. (2004). Health Literacy from A to Z: Practical Ways to Communicate Your      Health Message. Massachusetts: Jones and Bartlett Publishers.

 

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