The High Cost of Low Health Literacy

When Ruby Grayes’ husband became ill, she was terrified because she didn’t know how to administer his medication and couldn’t read the prescription labels and written materials given by her husband’s healthcare provider. She was embarrassed and struggling with guilt and depression about her low literacy skills.

Ruby isn’t alone, and for the hundreds of thousands of Hispanics in San Diego who have low literacy skills, their struggle is compounded by additional challenges: language, educational, and cultural barriers that inhibit their ability to seek and obtain proper healthcare.

These individuals — many of whom have immigrated here from Mexico — may not be familiar with how the healthcare system works in the United States or may be accustomed to rely more on family, community, or folk remedies rather than “institutional” healthcare programs. Additionally, many have had limited formal education and may have literacy challenges even in their native language.

With 27 percent of San Diego’s population being Hispanic and San Diego being the 12th largest Hispanic market in the United States, it’s critical that we look at ways to improve the health literacy for this population, which, by 2010, is expected to represent 40 percent of all San Diegans.

The High Cost of Low Health Literacy

Health literacy refers to the set of skills needed to read, understand, and act on basic healthcare information; more than 90 million adults struggle with the problem.

For individuals and families who battle low health literacy, the effects can be life threatening — literally. For example, in one instance, a 9-day-old baby died when her mother fed her undiluted formula because she couldn’t read the measuring instructions, and Hispanics are at greater risk for this type of problem. Low-income and minority populations are less likely than those with higher incomes to get the healthcare they need, according to the U.S. Department of Health and Human Services. But the effects of low health literacy are felt far beyond the individuals and families who struggle.

The annual cost of low health literacy nationwide is $73 billion, including $30 billion for the population that is functionally illiterate. A functionally illiterate person can’t read and understand instructions on prescription bottles, appointment slips, insurance forms, and health education materials.

Finding Solutions

The Health Education and Adult Literacy: Breast and Cervical Cancer project, administered by World Education, a non-profit organization supporting adult education, is a great example of health literacy being introduced as part of general literacy and adult education programs.

The project disseminated information about breast and cervical cancer, early detection and screening through adult basic education, and English for Speakers of Other Languages (ESOL) programs. The curriculum included four phases.

Phase one engaged learners in discussions about good health and preventative healthcare. Phase two introduced the topic of cancer and the concept of early detection and screening. The third phase described mammograms and Pap tests, while phase four prepared learners to take healthful action.

Following the implementation of the program, qualitative and quantitative research was done to measure whether the project increased women’s knowledge, attitudes, and behaviors in regard to mammograms and Pap tests. There were statistically significant increases in the number of learners who answered the content knowledge questions correctly after receiving the program as compared to the pre-program questionnaire.

For example, before undergoing the program, only 49 percent of respondents properly identified the statement, “A mammogram is only needed when a woman feels a lump in her breast,” as false. After the program, 80 percent of respondents answered the question correctly. Behavioral changes were also seen as more women were screened with Pap tests and mammograms.

Spanish-language Resources

While the project by World Education provides a great example of health literacy being taught in the context of ESOL and adult education, such a program is only effective with individuals who meet a certain literacy level. Very remedial readers need individual attention from a tutor who is sensitive not only to the learner’s literacy challenge but also to potential language and cultural barriers.

Time and again, I hear from people who say that even basic ESOL classes are too difficult for them, mainly because of the literacy challenges they have in their native language. Therefore, it is critical not only that health literacy materials be written at a basic literacy level but also that literacy materials be provided in Spanish. Additionally, healthcare providers must be equipped to identify if someone is challenged with literacy and/or language barriers.

Local Help for Those Struggling With Health Literacy

At the San Diego Council on Literacy, which is comprised of more than 20 literacy programs that provide one-to-one, classroom, and small-group literacy services throughout San Diego County, health literacy is addressed in two ways: First, tutors often provide assistance to individual learners as the assistance relates to health literacy. Tutors help learners with everything from reading and understanding a prescription medication label, to reading, understanding, and navigating health insurance options. Additionally, some programs within the Literacy Network have specific health literacy programs and curricula in place. Also available through the council’s Literacy Network are ESOL programs. In fact, 70 percent of the 110,000 people helped each year by the council and the network are Hispanic; many utilize the ESOL services. But the council, and the literacy community, can’t solve the problem alone.

Although there have been great strides in the healthcare community in improving health literacy among patients — the San Diego Medical Information Network Exchange (SD MINE) is one of several initiatives to address the problem — there is still a lot more work to be done. We need help from both the public and the private sectors, which must come together to address the critical issue of illiteracy … an issue that impacts more than 450,000 adults in our county.

Health literacy programs must become a priority, and the most effective programs are those that partner with literacy organizations in developing curriculum and healthcare materials. With history and expertise in addressing literacy issues, established literacy organizations can provide invaluable resources to curriculum and healthcare material development. Furthermore, in San Diego, as in many other parts of the United States that serve a large Hispanic population, we must have special sensitivity to the Hispanic community, which is such a vital part San Diego’s cultural landscape. Without such efforts, the quality of life for individuals and the community at large will suffer.

For more information, visit www.literacysandiego.org or contact Louis Murillo at 619/574-1641, ext. 103.