EDITORIAL

Volume 6,Number 2 
April-June 2001

Vol. 6, Num. 2: Contents | Editorial | Up Front | Abstracts

Editorial
Scott C. Ratzan

While there has been much talk by the new administration about education and health there has been little discussion of how to strategically approach such challenges across departments.  We would like to propose health literacy as a unique opportunity for the Department of Health and Human Services and the Department of Education to join with the private and voluntary sector to cooperate for maximal impact.

Two of the most important issues for Americans are better education and better health care.  If one links both--quality health services and educational imperatives--there will be a great return on investment.  There is still little awareness of the impact that low levels of literacy have on the health of America: the economic cost to the nation's health bill has been estimated to be over $73 billion annually because of low health literacy.

This is not a marginal issue.  According to the National Adult Literacy Survey over 90 million Americans have low or marginal literacy.  For example, they have difficulty reading the front page of a newspaper or a bus schedule and--in consequence, as other studies have shown-- they also have difficulties comprehending health care instructions.  The following situation was presented to a sample of low literate Americans: "Look at the directions on the prescription bottle: Take this medicine one hour before you eat or two hours after you eat.  You are planning to eat lunch at noon. What time would you take your medicine?"  Over half did not answer correctly.

On the initial level, health literacy addresses this ability to apply general literacy skills to the health care setting.  But in the crowded context of health care, that is not sufficient.  Each day there are new developments in the science of health, followed by recommendations on prevention, treatment and medication.  The health care system is becoming ever more complex in terms of eligibility, co-financing, and treatment options.  This translates into a need for individuals to have special knowledge and skills to promote their own health and that of their families, to navigate the health care system and to understand the language of health care providers.  Patients are often embarrassed to indicate that they have not understood their condition, its causes, and the treatment that goes with it.

As the federal government is the largest purchaser of health services through Medicare and Medicaid, the citizens eligible for these plans could gain immediately from efforts to advance health literacy.  These two programs could champion health literacy and provide incentives to hospitals, health plans (or insurers), educational institutions, and professional groups to increase both general literacy and health literacy.  Take for example adult education where the most popular courses are health related.  Language classes for immigrant populations with a health focus could be offered between a health plan, service providers, and the adult education system.

Indeed health literacy could be a key component of a patient's bill of rights in order to empower people to effectively use health care.  Another area on the Congressional docket is the "new" prescription drug benefit.  Such programs can integrate health literacy for recipients as well as improve the clarity of the information offered to them, which would be an obvious complement. Other additional measures include requirements that all federal public health programs include health literacy as a factor for grant-making along with the gender and minority focus that is already firmly established.

The private sector could also contribute through better communication in advertising, packaging, and labeling as could physicians and pharmacists by increasing their effort in explaining medication regimes.  Schools should be rewarded for instigating health education and health science programs involving parents and the community at large. Since women are often prinicpal decision-makers in health and education, programs that addresss their health literacy needs would reach far beyond health sector quality and cost savings, but also benefit family and community health.

Too frequently there is no systematic and committed response to problems that do not fall clearly within the responsibillity of one sector or one professional group.  We would like to encourage linking two major issues--education and health-- in a productive manner.  Economists tell us that a healthy population is a key resource for modern societies.  We know that health knowledge (and healthy behavior) can save lives.  A health literate population will not only enjoy a better quality of life, it will also help contain health care costs.  With so much to gain, let us start by addressing the $73 billion in excess costs through a nationwide, systematic, and well evaluated health literacy initiative.
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Scott C. Ratzan MD, MPA is author of the Mad Cow Crisis: Health and the Public Good (1998, NYU Press).  He is editor of the Journal of Health Communication and on the faculty of Yale University School of Epidemiology and Public Health, George Washington University and Tufts University School of Medicine.