August 4, 2003

Improving health literacy is Parker's main test

Alicia Sands Lurry

Ruth Parker 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 daughter’s medication twice a day, yet after reading the label on the bottle she filled a teaspoon and poured the medication into her daughter’s ear.

Parker points to this story as a glaring example of the devastating impact of poor health literacy. According to Parker, associate professor of medicine and general internist at Grady Hospital, about one in every three adults in the United States 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 between $30 billion and $73 billion annually. Parker outlines these and other health literacy concerns in a paper she cowrote for the July/August 2003 issue of Health Affairs.

The paper, geared toward policy makers, focuses on how health literacy is important for improving the quality of care in this country. 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.

Parker wrote that health literacy is “at the intersection of health and education,” adding that it has many dimensions, including the ability 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 patients’ involvement in health care decisions.

“Health literacy is about what people really understand and what they need to do to take care of themselves,” said Parker, who was appointed to the Institute of Medicine’s Committee on Health Literacy in 2002 to study problems related to poor health literacy.

“As physicians, we spend a great deal of time both learning and creating information through medical science and research,” she continued. “Yet we don’t spend enough time checking to see whether people understand the information we convey to them in clinic visits and other patient encounters.”

In the paper, Parker notes that the elderly are particularly vulnerable. Progress in health care technology will deepen disparities over time, and the problem will be greater for sicker, older and more vulnerable groups. Patients with low literacy are not able to function as “informed consumers” and are most likely to be left behind.

Parker said the focus on the elderly is intentional. “General literacy problems are more common among the elderly, and the elderly are also more likely to have chronic illnesses,” she said. “Many elderly lack the basic health literacy skills to read and understand all the prescription bottles and labels they’re 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, making it difficult to understand a bus schedule, for example. Parker said these are the same individuals who use the health care system.

Health literacy is a common problem, but we don’t want to blame the victim,” she said. “Health care is an incredibly complicated system these days. As doctors, we need to help patients feel more empowered to say they don’t understand, and we need to make sure the people who work in medical systems realize how many people struggle to understand what they need to do to take care of themselves.”

Parker and her two co-authors also offer a blueprint for change to improve quality. 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. Parker said that health literacy must be addressed across generations.

“I think there’s a great need to engage the education world, in making basic health information more a part of standard education in our school system,” she said. “As a society, it’s up to all of us to try to build healthier communities. We’ve got to look at this issue from all levels and recognize it’s a problem and start figuring out what we can do about it.”