Health Literacy: A Silent Crisis

There has never been a better time for the industry to help solve the low health literacy problem.
Sep 01, 2003

The complex US health system ultimately boils down to something simple: two people-patient and physician-exchanging information. And no matter how much science and technology have transformed medicine, from iron lungs and invasive surgery to genomics and prevention, the patient-physician relationship is still the crux of healthcare delivery.

Health information plays an essential role in enabling and sustaining that relationship. As health information providers, pharmaceutical companies have a responsibility to ensure that the information we distribute enhances the patient-doctor relationship. When both doctors and patients are informed and conversant about disease symptoms and treatment options, the result is better health outcomes.

Patrick Kelly is president of Pfizer U.S. Pharmaceuticals.
The Problem Too often, however, the patient-physician relationship breaks down. Tens of millions of Americans, held back by confusion and embarrassment, remain silent rather than ask their doctors crucial questions. They can get intimidated, confused and suffer unnecessary health problems because they lack the skills necessary to understand dosing requirements, dietary restrictions, and possible drug interactions. When health information is offered, people cannot understand or act upon it. When that happens, low health literacy may be at fault.

Health literacy is defined as the ability to read, understand, and act on health information, and it becomes more important as patients are asked to take a more active and role in their own healthcare.

Low health literacy can affect people of any age, income, race, or background, and it puts an estimated 90 million Americans at potential risk for not acting on health information. It also costs the nation as much as $73 billion yearly in medical and treatment errors and countless lost work hours.

According to the Center for Healthcare Strategies, only half of all patients-informed as well as uninformed-take medications as directed by their doctors. Add low health literacy to the mix and you have the makings of a national health crisis. Patients with low health literacy and chronic diseases, such as diabetes, asthma, and hypertension, have less knowledge about their diseases and their treatments and fewer self-management skills than literate patients. As a result, they may be more likely to neglect preventive care and could end up needing far more radical treatments. In fact, patients with low health literacy skills have a 50 percent increased risk of hospitalization compared with patients with adequate literacy skills.

A Simple Cure? Just as health literacy's impact is enormous, it also is eminently avoidable. Products' greatest value is expressed when delivered with the information that makes their use possible and productive. Clear health communications are critical and begin with an understanding of consumers' reading skills.

The average American reads at an eighth- to ninth-grade level, and one out of five reads at the fifth-grade level or below. Yet, most healthcare materials are written at a tenth-grade level. Cultural relevance and sensitivity also play a role as the diversity of the US populations requires that appropriate messages and images be tailored to meet diverse values, traditions, and beliefs.

Imagine the results if we were able to reach 110 million people with vital and, even more important, understandable health information that could affect their health. According to the National Adult Literacy Survey, this is the number of people who would be able to understand health information if it were written at a sixth-grade level.

To reach those people, Pfizer has made a concerted commitment to create accessible and comprehensible health information. The company worked with leading health literacy experts to create the following guidelines for developing all health information for consumers:

  • Explain its purpose and limit the content.
  • Involve the reader.
  • Make it easy to read.
  • Make it look easy to read.
  • Select visuals that clarify and motivate.

During the last two years, Pfizer revised and rewrote hundreds, even thousands, of pages of health materials to comply with those principles. No new consumer-oriented printed materials are produced unless they meet those principles.

Although the process has taken considerable time and resources, it has been worth it. Millions of consumers who read those materials can better communicate with their physicians, which helps get them diagnosed and treated earlier and more effectively, because they understand the importance of taking medicines as directed. That is truly a win-win solution for the public and the pharmaceutical industry.

Practical Partnership Solutions Other health information providers have picked up on the promise that comes with making disease and product information easier to understand. The National Medical

Association has produced and distributed a cultural competency primer for its member physicians, and the National Health Council conducted high-level sessions in 2002 that trained more than 80 health communications professionals representing 25 health organizations. Recently, California launched California Literacy, a statewide health literacy initiative developed in conjunction with the California Medical Association.

It is no surprise that some of the most promising efforts are those that involve the cooperation of health information providers in the private and public sectors.

Among other projects, Pfizer has been working with the American Medical Association Foundation to raise awareness of patients' low health literacy problem with physicians and to develop tools that will improve physicians' communication with patients. The company also supports the Florida Health Literacy Study to build the health literacy research base, to provide training on health literacy issues, and to raise awareness of health literacy among patients to determine the most effective interventions for improving health outcomes.

Most recently, Pfizer broadened its collective and individual efforts as a catalyst in the creation of a coalition that launched in May 2003. The Partnership for Clear Health Communication includes organizations large and small, public and private, and is dedicated to promoting awareness of, and solutions to, the problem of low health literacy and its effect on health outcomes.

The partnership's dedication goes beyond ensuring appropriate health materials to helping patients talk to physicians and strives to make those conversations between doctors and patients more meaningful. It recently launched "Ask Me 3," a public education campaign that encourages patients of all educational backgrounds to ask-and doctors to answer-three important questions during every examination:

  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do this?

How many more people will be getting and staying on their treatment as a result of this initiative? No one knows that yet. But it's fair to say that by engaging 110 million more people-those at the highest risk for an undiagnosed health problem-we will make a significant dent in one of the most persistent public health issues of our time.

One Reader at a Time Addressing the health literacy crisis begins with the understanding that health information is everyone's right and improving clear health communication is everyone's responsibility.

Acceptance of that responsibility comes with the knowledge that the more people who understand their condition and their doctor's directions, the greater the possibility that people who need medicines are getting and taking them. Reaching more patients with more accessible and vital information about life-saving and life-improving medicines is good policy. It is also good business.

The more we can help improve patient health by empowering patients to talk with their healthcare provider and understand their instructions for better health, the more the pharmaceutical industry can be a part of the solution. And there has never been a more important time to demonstrate that we, as an industry, are part of the solution, not the problem.

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