Alicia Sands Lurry, 404/616-6389, firstname.lastname@example.org
ATLANTA ≠ Ruth M. Parker, MD, associate professor of medicine at the Emory University School of Medicine and general internist at Grady Memorial Hospital, recalls the account of a mother whose 2-year-old was diagnosed with an ear infection and prescribed an antibiotic. The mother was instructed to administer her daughterís medication twice a day, yet after reading the label on the bottle and deciding it did not provide instruction on how to take the antibiotic, the mother filled a teaspoon and poured the medication into her daughterís ear.
This true story is one to which Dr. Parker points as a glaring example of the devastating impact of poor health literacy on Americans. According to Dr. Parker, about one out of every three adults in America has problems with health literacy. The effect? A 1998 preliminary analysis by the National Academy on an Aging Society, estimated that low health literacy might cost the health care system in the range of $30 billion to $73 billion annually. Dr. Parker outlines these and other health literacy concerns in a paper in the July/August 2003 issue of Health Affairs written by Dr. Parker and co-authors, Scott C. Ratzan, vice president, Government Affairs, Europe, at Johnson and Johnson, based in Belgium; and Nicole Lurie, senior natural scientist and the Paul OíNeill Alcoa Professor at RAND, a nonprofit institution aimed at improving policy and decision making, in Arlington, Va.
The paper, geared toward policy makers, focuses on how health literacy is important for improving the quality of care in America. By definition, health literacy is the degree to which people have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Dr. Parker writes that health literacy is "at the intersection of health and education." She also states that health literacy has many dimensions, including what it means to be able to read, understand and communicate important medical and health information during different phases of life. Health literacy is a major factor in quality of care, cost containment, safety and patientsí involvement in health care decisions.
"Health literacy is about what people really understand and what they need to do to take care of themselves," says Dr. Parker, who was appointed to the Institute of Medicineís Committee on Health Literacy in 2002 to study problems related to poor health literacy. "As physicians, we spend a great deal of time in both learning and creating information, through medical science and research. Yet we donít spend enough time checking to see whether people understand the information we convey to them in clinic visits and other patient encounters. As a physician, if you donít check to see what people understand, you donít know how theyíre going to act on it. Thatís why health literacy is directly related to quality of care, and which lack of health literacy is a source of medical errors."
In the paper, Dr. Parker notes that the elderly are particularly vulnerable. She writes that technological progress in health care will deepen disparities over time and that the problem will be greater for sicker, older, and more vulnerable groups. As health and health care becomes more technologically sophisticated, patients with low literacy are not able to function as "informed consumers," and are most likely to be left behind.
She says the focus on the elderly is intentional. Many are chronically ill and take various medications, and the choices Medicare beneficiaries face have become increasingly complex.
"General literacy problems are more common among the elderly, and the elderly are also more likely to have chronic illnesses," Dr. Parker says. "Many elderly lack the basic health literacy skills to read and understand all the prescription bottles and labels theyíre required to take."
According to the National Adult Literacy Survey (NALS) in 1993, 44 million Americans ≠ about 25 percent of the adult population ≠ have functional literacy skills that prevent them from performing everyday tasks. Many of these people, for example, cannot reliably enter background information on a Social Security application. Another 50 million adults have limited functional literacy skills, and have difficulty using a bus schedule. Dr. Parker observes that these are the same individuals who use the health care system.
"Health literacy is a common problem, but we donít want to blame the victim," she says. "Health care is an incredibly complicated system these days. As doctors, we need to help patients feel more empowered to say they donít understand when they donít, and we need to make sure the people who work in medical systems like our own realize how many people struggle to understand what they need to do to take care of themselves."
Dr. Parker and her co-authors also offer a blueprint for change to improve quality. She writes that one goal for health policy should be to ensure a health literate America, with support from the federal government and policy makers to help fund research for interventions. She says that health literacy must be addressed across generations.
"I think thereís a great need to engage the education world, in making basic health information more a part of standard education in our school system," she says. "As a society, itís up to all of us to try to build healthier communities. Weíve got to look at this issue from all levels and recognize itís a problem and start figuring out what we can do about it."
Dr. Parker, a renowned health literacy expert, has focused extensively on healthcare issues of underserved populations. Most notably, she has chaired the Expert Panel on Health Literacy, Council of Scientific Affairs, for the American Medical Association that authored a frequently cited JAMA white paper on health literacy. She co-authored the National Library of Medicine Complete Bibliographies of Medicine on Health Literacy, and is chair of the Steering Committee for the AMA Foundation Signature Program: Partnership in Health ≠ Improving the Patient-Physician Relationship Through Health Literacy. She has received numerous grants for health literacy research, from organizations including the Robert Wood Johnson Foundation, Prudential Center for Health Services Research, and Pfizer, Inc.