I started a group on LinkedIn called Health Communication, Social Marketing and Social Scientists. Recently there has been a long discussion over health literacy.
When discussion among health communicators over health literacy becomes a debate over individual responsibility versus social responsibility, you know there is a problem. Maybe it’s just that the United States hasn’t and won’t ever get beyond its Puritan roots. Or maybe there is a true misunderstanding of the terminology and the research. So let’s start with definitions.
Healthy People 2010 defines 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.”
The term health literacy can be confusing because it is not just about reading. In fact, it is about an extremely complicated skill set. Conversational competence, that is, the ability to listen effectively, articulate health concerns and explain symptoms accurately is part of health literacy. Health literacy encompasses decision making and analytical abilities. Tasks that are required of people using the healthcare system include evaluation, analysis and interpretation. Locating information and being able to assess its quality is essential. Being able to do mathematical calculations and to judge risk are also part of health literacy.
Therefore, people who are highly educated and functioning well in our society, people who are “reading literate” may be “health illiterate.” What this means for our society has been illustrated in study after study. A recent review of the literature confirms that those with poor health literacy are more likely to have poor health outcomes. Poor health literacy is an economic drain on our society with studies focusing on chronic conditions such as asthma, diabetes, heart disease and cancer (Report on the Council of Scientific Affairs, Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association, JAMA, Feb 10, 1999; Merriman, Betty, CA: A Cancer Journal for Physicians, May/June 2002; Schillinger, Dean, JAMA, July 24/31, 2002; Norton, A. Reuters Health, July 19, 2011).
Colleagues decrying individuals who choose to leave high school without graduating as the source of the health literacy problem in the United States are missing the point. Colleagues who state that because there is so much free information “out there” it is the individual’s responsibility to understand it and use it effectively, also do not understand what health literacy is.