#2 - Health Literacy: A Journey to Informed Decision-Making

Understand the world of Health Literacy -- where health information becomes a superpower. In this episode, we unravel the layers of health literacy in the US. With 9 in 10 Americans struggling with health literacy, we explore how this impacts healthcare decisions. Discover how the Healthy People Initiative shapes the landscape of health literacy and how the National Action Plan to Improve Health Literacy guides the way forward. Join us to bridge the gap, foster clear communication, and empower a healthier future for all. And most importantly, learn how you can make a difference!

Timestamps: 
(00:00) Channel Intro 
(01:45) Episode Introduction 
(04:31) Infancy of Health Literacy
(08:08) The Healthy People Initiative
(11:09) Literacy in Healthy People 2010 and 2020
(15:55) Healthy People 2030
(18:53) Today’s Definition
(20:25) Personal Health Literacy
(23:23) Organizational Health Literacy
(27:35) Objectives in Healthy People 2030
(30:43) Measures in Healthy People 2030
(35:50) Outcomes of Poor Health Literacy
(44:29) National Action Plan to Improve Health Literacy
(51:51) How Can You Help?
(57:09) Conclusion Summary 
(01:00:11) Outro

Linktree: linktr.ee/gustavofrancopod

Chapters

• 0:00 Channel Intro
• 1:45 Episode Introduction
• 4:31 Infancy of Health Literacy
• 8:08 The Healthy People Initiative
• 11:09 Literacy in Healthy People 2010 and 2020
• 15:55 Healthy People 2030
• 18:53 Today’s Definition
• 20:25 Personal Health Literacy
• 23:23 Organizational Health Literacy
• 27:35 Objectives in Healthy People 2030
• 30:43 Measures in Healthy People 2030
• 35:50 Outcomes of Poor Health Literacy
• 44:29 National Action Plan to Improve Health Literacy
• 51:51 How Can You Help?
• 57:09 Conclusion Summary
• 1:00:11 Outro

Transcript

Introduction

• Welcome to this month's episode of the Gustavo Franco Podcast, where we delve into a critical issue that affects every 9 in 10 adults in the US: health literacy. Being health literate is more than just understanding medical jargon; it's about empowering individuals to make informed decisions about their well-being. In today's episode, we'll not only uncover the layers of health literacy but also explore how understanding it can play a pivotal role in addressing the epidemic of health illiteracy that we face today.
• Health literacy is a complex topic, deserving of its dedicated episode. Consider this: How would you define someone as health literate? Is it merely knowing that eating greens is healthier than indulging in French fries? Or does it require understanding the intricate mechanisms of a widely prescribed drug like atorvastatin? While most statin users may not comprehend the drug's mechanism, it doesn't automatically label them as health illiterate. This episode aims to shed light on the intricacies of health literacy, a spectrum that defies a straightforward cutoff.
• To illustrate this, let's turn to the Sorites Paradox, a concept from the 4th century BCE. Imagine a heap of sand, say 100,000 grains. As you remove grains one by one, the heap diminishes until there's only one grain left. But when does it cease to be a heap? At 100,000 grains, it's undoubtedly a heap; at one grain, it's not. The challenge lies in defining the exact transition point. Much like this paradox, health literacy exists on a continuum. While it's easy to classify a one-week-old baby as health illiterate and a seasoned doctor as health literate, most of us fall somewhere in between, defying easy classification.
• Even government entities find measuring health literacy a daunting task due to its multifaceted nature. Our goal in this episode is to unravel the present and applicable definition of health literacy, trace its evolution through the years, explore strategies for measurement, and discuss tangible ways to enhance it. We’ll also talk about how individulas, just like yourself listening, will at the core of improving health literacy in the US, so stay tuned to learn more and help the lives of those around you!

Health Literacy before Healthy People 2010

• If you've ever tried to wrap your head around the term "health literacy," you're not alone. Defining it is a bit like trying to catch smoke in your hands—it's elusive, yet profoundly impactful. So, before we embark on this journey, let's demystify health literacy and peel back its layers. But be warned, it's a story that traverses decades, evolving alongside the healthcare landscape.
• Health literacy, as we know it today, didn't always occupy the forefront of public health discussions. In fact, the recognition of health literacy's importance and its impact on individuals' well-being was a gradual process.
• During the early 20th century, healthcare communication primarily targeted medical professionals and experts. Conversations between doctors and patients were complex, often leaving people feeling distant from their own health choices.
• With medical progress came more complex health info. Everyday folks faced a maze of prescriptions, forms, and treatment plans. Making sense of this became tough, especially for those with less education or English skills. Understanding and acting upon this information became a challenge, especially for those with limited education or English proficiency.
• It wasn't until the latter part of the 20th century that health literacy finally started to gain modest attention. Researchers and healthcare practitioners began to realize that patients who struggled to understand health information were more likely to experience adverse health outcomes. The realization sparked discussions about the need for clearer communication between healthcare providers and patients. Still, the concept of health literacy wasn't granted a formal existence until the 1970s. In 1974, it finally appeared, labeled as "health education meeting minimal standards for all school grade levels" (Ratzan, 2001). But don't be misled by this early mention. The true understanding of health literacy was still in its infancy.
• The term "health literacy" remained relatively obscure, lacking a standardized definition or effort to address the issue on a broader scale. Efforts to improve health literacy were largely localized, with some healthcare organizations and community groups taking it upon themselves to create more accessible and easier to read healthcare information.
• There wasn't much awareness about the impact of low health literacy, and no big plans to deal with it. Health literacy's significance was still a diamond in the rough, waiting to be polished and brought to the forefront of public health discourse.
• It was in the 90s that a more comprehensive understanding of health literacy began to take shape. The term health literacy became ingrained in American vocabulary and more studies were done to assess this issue. The turn of the millennium brought in the Healthy People 2010 Initiative, a pivotal moment in the realm of public health. Established in 2000, this initiative aimed to shape the nation's health objectives for the next decade. It was here that health literacy finally found its platform—a nationwide definition and a way to measure it.

The Healthy People Initiative

• So let’s talk about the Healthy People Initiative and how it came to define, measure, and tackle health literacy.
• Picture this: It's the year 1980, and a nationwide movement is gaining momentum. The Centers for Disease Control and Prevention, also known as the CDC, steps onto the stage with a visionary concept—the Healthy People Initiative. But what exactly is it, and why did it emerge?
• The Healthy People initiative is run by the US Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion (ODPHP). It came about as a robust effort to set comprehensive health objectives for the entire nation. Its mission? To improve the health of all Americans and create a roadmap for healthier lives. This initiative was more than a fleeting moment; it was a catalyst for change, a catalyst to rally communities, healthcare professionals, and policymakers towards a common goal.
• But how did the Healthy People Initiative work its magic? Every decade, the CDC set forth a new set of national health objectives, outlining clear targets and priorities. These objectives touched upon various aspects of health, ranging from disease prevention and wellness promotion to healthcare access and health equity.
• It aimed to:
  • Identify nationwide health improvement priorities.
  • Heighten public awareness and comprehension of health determinants, diseases, disabilities, and pathways to progress.
  • Provide measurable goals and objectives that resonate on national, state, and local levels.
  • Inspire cross-sector engagement, spurring policies and practices bolstered by the finest evidence and knowledge.
  • Identify pivotal research, evaluation, and data collection needs.
• By offering a framework for public health efforts, the Healthy People Initiative rallied diverse stakeholders to join forces, fostering a collaborative spirit that extended across communities, states, and the entire nation. It was a remarkable endeavor that aimed to steer the country towards better health and well-being.
• Now, here's the intriguing part: the Healthy People Initiative reveals an updated plan every ten years. This allows for adaptation, growth, and a renewed focus on evolving health challenges. With each cycle, new insights are gained, priorities are adjusted, and a fresher perspective is injected into the fabric of public health.
• But where does health literacy come into play? Well, it wasn't until the Healthy People 2010 Initiative that health literacy took its rightful place in the spotlight. In the vast sea of health objectives, the issue of health literacy emerged as a defining concern, earning its formal recognition and acknowledgment within this ambitious initiative.
• Now, here's where it gets intriguing. The definition of health literacy that found its home within Healthy People 2010 was a result of the pioneering work of Scott Ratzan and Ruth Parker. They illuminated health literacy as the degree to which individuals possess the ability to obtain, process, and understand fundamental health information and services necessary for making appropriate health decisions. It's like having the keys to unlock the mysteries of your health journey.
• But it wasn't just about individuals. Healthy People 2010 recognized that bridging health literacy gaps is pivotal in reducing health disparities. This recognition spurred the inclusion of the objective to elevate the health literacy of those with limited or marginal literacy skills. A key insight emerged—the healthcare system itself needed transformation to align with the overarching goals of Healthy People 2010, aiming to enhance both the quality and length of healthy lives while dismantling health disparities.
• This profound understanding led to the inclusion of a robust objective within Healthy People 2010's framework. Brace yourselves for this gem—it aimed to "Improve the health literacy of persons with inadequate or marginal literacy skills."1 Think of it as extending a helping hand to those who might find the healthcare information maze a bit more intricate.
• But it doesn't stop there. Healthy People 2010 envisioned a transformation not just in individuals, but in the very architecture of healthcare. It recognized that achieving its overarching goals—boosting quality, increasing years of healthy living, and banishing health disparities—would necessitate a change in the healthcare system itself.
• The Healthy People 2010 used data from the National Assessment of Health Literacy (NAAL), Department of Education, and National Center for Education Statistics (NCES) to categorize people as having proficient or below-basic health literacy, and what they found was truly monumental because groups of below basic health literacy had health disparities of 100% or more.
• Now, let's fast-forward to the evolution of Healthy People, marking the dawn of a new decade—Healthy People 2020. The definition of health literacy stood steadfast, holding its ground. It continued to emphasize the capacity to understand and act upon health information for well-informed decisions. But this time, the narrative expanded beyond to encompass the broader societal and organizational contexts.
• Imagine health literacy as a vibrant ecosystem where individuals' abilities converge with the complexity of health messages. It's a dance between understanding and the intricate web of health communication. Paasche-Orlow and Wolf pointed out that health literacy isn't just about patients; it's a phenomenon intertwined with the entire healthcare system. Parker and Ratzan echoed this sentiment, acknowledging that sectors like education, health, healthcare, businesses, and social services all play a pivotal role in fostering a health literate society.
• Healthy People 2020 painted a vivid picture, showing us the importance of organizations in enhancing patients' grasp of health information. It spotlighted the significance of patient-provider communication and the integration of quality digital tools. The quest for progress saw the Agency for Healthcare Research and Quality joining the ranks, tracking advancements through the Medical Expenditure Panel Survey.

Evolution of Health Literacy Definition with Healthy People 2030

• Now, let's dive into the enchanting process of how the health literacy definition for Healthy People 2030 found its way into the spotlight. Imagine it as a story of discovery, where ideas merged and evolved, and where our understanding of health literacy expanded beyond what we once knew.
• Alright, let's break this down. Imagine a bunch of experts sitting together, discussing how we can best understand health literacy for Healthy People 2030. The US Department of Health and Human Services (HHS) formed a team—the Definitions Committee—to do just that.
• Now, this team had an important task—to evaluate the suggestions made by the Secretary's Advisory Committee. What they wanted was a fresh way to see health literacy—one that takes into account both individual skills and the bigger picture of our healthcare world.
• So, our experts had three options to consider. Option one was to stick with the way we'd been defining health literacy for two decades, focusing on individuals. Option two was to embrace this new idea of seeing health literacy as a bigger system that involves not just us but also the information and services around us. And then there was option three—combining the best parts of the old and new ways.
• But this wasn't just a bunch of thoughts floating around. Our experts went on a journey to gather opinions from different people. They spoke to groups who know a lot about health, like Healthy People Topic Area Workgroups and the HHS Health Literacy Workgroup. They wanted to know what these groups thought about the old way of defining health literacy, the new way, and if there were other cool ideas out there.
• Imagine this journey like a puzzle hunt. They also opened up a way for anyone in the country to share their thoughts. They put out a notice, kind of like an invitation, asking for people's opinions. And wow, did people respond! Between June 4 and August 5, 2019, they got 187 comments—187 pieces of the puzzle.
• These comments were like different colors in the puzzle. Some said they liked the new way of thinking, while others liked the old way. And many said, "Hey, why not combine the two?"
• Here's the magic part—all these opinions echoed what we've been learning over the past two decades. See, health literacy isn't just about individuals, and it isn't just about big systems. It's both! It's like a dance between how well we understand health stuff and how clear the information around us is.
• So, after listening to all these voices, our experts had a lightbulb moment. They decided to create not one, but two definitions of health literacy. One definition shows how we—the people—make smart health decisions. The other shines a light on how organizations help us make those smart choices.
• So here are the new definitions given by Healthy People 2030:
  • Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
  • Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
• So there you have it, the definitions of health literacy that we now use in the present day. But let’s dive deeper into these definitions and talk about their benefits over the previous definition of health literacy, which just to remind you was “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
• First let’s focus on the Personal definition of health literacy, which once again is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
• So, what's so special about this new definition? Let's break it down. First, it focuses on the actual use of health information and services. It's not just about understanding the basics; it's about taking that understanding and putting it into action. Imagine having a map to navigate the world of health—now, imagine actually following that map and making informed decisions and actions based on it.
• Another exciting change is the shift from "appropriate decisions" to "informed decisions and actions." See, it's not enough to just make a choice; it's about making a well-informed choice and then acting on it. It's like having the power to turn knowledge into action, whether it's at your healthcare provider's office, while surfing the web at home, or even when participating in community initiatives.
• But there's more! The new definition doesn't stop at personal empowerment—it has a bigger heart. It's not just about you; it's about all of us. This definition adds a twist by saying that your personal health literacy can also contribute to public health. Yep, you heard it right! Your ability to understand health information and services doesn't just benefit you; it can impact your community, your choices, and even your role in shaping health-related policies. And this is the gem that I think can bring about tangible results and is the way that each and every single ones of you can help improve health literacy in the US. I think this can really be exploited to help communities flourish in the future and improve overall health literacy, but more on that later.
• Going back to the new definition of personal health literacy. Think about it. When you grasp the complexities of health-related decisions, it doesn't just affect your well-being—it ripples outward, affecting the choices you make for your family, your neighborhood, and even your society. It's like your personal health literacy becomes a superhero cape, allowing you to tackle health challenges not just for yourself, but for everyone around you.
• And guess what? This new definition doesn't replace the old measures of health literacy—it complements them. It's like building on the foundation we already have and taking it to the next level. It encourages existing health literacy efforts, like education standards and adult programs, while inspiring us all to go beyond understanding and venture into action.
• So, here's the takeaway: The new definition of personal health literacy is like a torch lighting up the path to a healthier, more informed future. It's about making sure you don't just hold the key to understanding health, but that you also know how to use it to unlock better lives for yourself and those around you.
• Now on to the organizational definition of health literacy! Let’s talk about how this is an improvement from the previous definition of health literacy. And to start off, remember that organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
• Now, the idea that health literacy is not just an individual's responsibility, but also a collective effort that organizations must champion.
• Picture this: a world where health information is crystal clear, where health systems are easy to navigate, and where organizations work together to ensure everyone gets a fair shot at understanding and accessing health-related knowledge. That's the dream that the new definition of organizational health literacy is bringing to life.
• So, what does this new definition tell us? Well, it's like a shining spotlight on the fact that personal health literacy doesn't exist in a vacuum. It's shaped by the environment around it—the organizations, the systems, the institutions. It's like realizing that you're not alone on this health journey; organizations are right there with you, holding your hand, guiding you toward better health decisions.
• And here's the exciting part: organizations have a responsibility to make health literacy equitable. They need to step up and make sure that health information and systems are easy to understand and accessible for everyone, no matter their background or circumstances. It's like a pledge to level the playing field, ensuring that health disparities are eliminated and health equity becomes a reality.
• But why is this so important? Well, the benefits are remarkable. Studies have shown that when organizations become "Health Literate Organizations," magical things start to happen. Health literacy interventions become like little sparks that ignite positive change. For those with limited health literacy, these interventions prove to be game-changers. Imagine simplified health care terms and procedures—suddenly, patients become empowered to take charge of their health. They embrace preventive services, stick to medication plans, and effectively manage chronic conditions.
• But that's not all! The power of organizational health literacy extends beyond the walls of a medical facility. It reaches into the heart of public health, where organizations producing health-related information also step up. They start communicating clearly, removing cultural barriers, and ensuring that vital information reaches underserved populations. It's like a symphony of health knowledge, reaching every corner of society.
• And here's the icing on the cake—the journey toward organizational health literacy isn't a lonely one. Initiatives like the HHS Health Literacy Workgroup, established in 2003, champion the importance of organizational efforts. This workgroup's mission is crystal clear: to make health information understandable and actionable, empower health consumers, and keep the health literacy science vibrant and up-to-date.
• So, why expand the health literacy definition to include organizations? Well, it's like the logical next step in HHS' ongoing quest to enhance health literacy. After all, health professionals and organizations play a vital role in helping individuals achieve positive health outcomes. It's all about realizing that without clear communication, our noble efforts to promote healthy behaviors and recommendations might fall flat.
• Now that is all for the definition of health literacy that we now use, and I hope you are able to see how it is an improvement from the previous definition of health literacy. This allows us to set a strong groundwork from which we can create objectives and measures related to health literacy, so let’s talk about that now.
• What are Healthy People 2030’s objectives when it comes to health literacy? And I just want to note that all of their objectives are measurable, which we will dive into later. When it comes to the health literacy objective, they are broken down into three categories: core objectives, developmental objectives, and research objectives. Core objectives are the tried and true ones, reflecting high-priority public health issues and backed by solid evidence. Developmental objectives are the aspirations that are still taking shape, waiting for reliable data to become core objectives. And research objectives, well, they're the ambitious dreams, representing issues with high health or economic burdens, and they're waiting for their moment in the spotlight.
• First up with the core objectives, we have a mission to increase the proportion of adults who report that their health care provider always asked them to describe how they'll follow instructions. It's like encouraging a dialogue between patients and providers, making sure that instructions aren't just handed out, but truly understood and embraced.
• Our second core objective focuses on reducing the proportion of adults who report poor patient and provider communication. It's like a call to arms against misunderstandings, frustrations, and disconnects. This objective aims to smooth out the wrinkles in communication, ensuring that listening, explanations, respect, and time are treated with the utmost care.
• And the third core objective? Well, it's all about empowerment. We're working to increase the proportion of adults who report that their health care providers always involved them in decisions about their health care as much as they wanted. It's like ensuring that every voice is heard and every opinion matters in the health journey.
• Now, let's set sail toward the developmental objectives—those aspirations that are still taking shape. Picture this: an online medical record that's not a puzzle but a straightforward story of your health. Our fourth objective aims to increase the proportion of individuals who find their online medical records easy to understand. It's like turning complex data into a simple and relatable tale.
• And let's not forget our fifth objective, a beacon of inclusivity. We're on a mission to increase the percentage of limited-English-proficient adults who report that their doctors or health providers always explain things in a way that's easy to understand. It's like breaking down language barriers and opening doors to health understanding for everyone.
• But what about the grand picture, the broader landscape? That's where our research objective comes in. We're stepping up to increase the health literacy of the entire population. It's like nurturing a garden of knowledge, planting seeds of understanding, and watching them bloom across communities.

Measuring Health Literacy

• So that’s all for the Healthy People 2030 Health Literacy objectives. But now let’s talk about how they will actually measure these objectives. And remember that there are the core, developmental, and research objectives, and they only really have data and measurements for the core objectives since the others are objectives currently under progress.
• et's dive into the first measurement that Healthy People 2030 has set its sights on. This measurement shines a light on a vital aspect of health care—how well our health care providers make sure we understand their instructions.
• Picture this: you've just left the doctor's office, and your head is swirling with new information about what to do for your health. But here's the thing—did your healthcare provider take that extra step to make sure you really got it? Did they ask you to describe how you'll follow their instructions?
• In 2017, about 26.6 percent of adults aged 18 years and over reported that their healthcare provider asked them to describe how they'll follow instructions. Now, our target? Well, we're aiming for that number to rise to 32.2 percent. But we haven’t really been trending that way because a measurement from 2019 shows that the number actually decreased to 25.6 percent.
• Now, let's talk about the method. This data comes from the Household Component of MEPS—think of it as a slice of the population pie, gathered from households that participated in the National Health Interview Survey. The data is collected through a Self-Administered Questionnaire, where adults in these households share their experiences.
• Okay cool, so now on to the second measurement, which is one that zeroes in on communication between you and your healthcare provider.
• Now, imagine this scenario: You're sitting in that doctor's office, trying to explain how you're feeling, your concerns, and what's been bothering you. But does your healthcare provider really listen? Do they make sure you understand their explanations? Do they respect your thoughts?
• That's what this second measurement is all about—making sure you're not just a patient in the room, but an active participant in your healthcare journey.
• In 2017, around 8.9 percent of adults aged 18 years and over reported having poor communication with their healthcare providers. But here's the target—we're aiming to improve that to 8.0 percent. But here, once again, we have not been trending towards that target. In 2019, a measurement showed that this number is actually at 9.0, a slight increase from the 8.9.
• And, just like before, we're gathering this data from the Household Component of MEPS. It's like taking a snapshot of households across the nation to get a clear picture of healthcare communication.
• And now, it's time to delve into our third and final measurement on this captivating health literacy journey. This one's all about how involved you are in decisions about your health care.
• Alright, picture this: You're at the doctor's office again, but this time, it's not just about being heard—it's about having a say in your own health decisions. It's about being a partner in your care journey.
• In 2017, about 52.8 percent of adults aged 18 years and over reported that their health care providers always involved them in decisions about their health care as much as they wanted. But hold on to your hats because we're aiming to amp that up to 62.7 percent. But here we have actually been trending in the right direction because in 2019, the measurement was of 57.2 percent, and increase of 4.9 percent from 2017.
• And where are we getting all this fantastic data? It's coming from the HINTS survey—a cross-sectional survey of American adults. This survey gives us insights into how folks like you interact with health information and care providers.
• So that is all for the measurements of health literacy used by Healthy People 2030, and now I want to discuss with you guys the outcome of poor health literacy. Why is this a problem that we should even bother with in the first place and is there data to back it up? Well that’s what we will dive into now.

Outcomes of Poor Health Literacy

• Let’s first talk about all of the outcomes of poor health literacy. There are 11 of them that I came up with and I’m going to list them in no particular order.

1. Misunderstanding Health Information: Individuals with poor health literacy often struggle to comprehend health information provided by healthcare professionals, medication labels, and educational materials. This can lead to misunderstanding treatment instructions, medication dosages, and potential side effects. According to the American Medical Association (AMA), nearly half of American adults struggle to understand and use health information. A study by the National Assessment of Adult Literacy confirmed that around 46% of U.S. adults have difficulty understanding basic health information.
2. Medication Errors: Poor health literacy can result in incorrect use of medications. Patients may take the wrong dosage, miss doses, or fail to adhere to prescribed regimens, leading to treatment failures, worsened health conditions, and increased hospitalizations. In a study published in the "Journal of General Internal Medicine," patients with low health literacy were more likely to have difficulty reading prescription labels and were at higher risk of medication errors. A study in the department of education showed that individuals with low health literacy are up to 3 times more likely to misunderstand prescription labels.
3. Delayed or Missed Medical Care: Difficulty understanding health information may lead to delays in seeking medical care or preventive services. Routine check-ups, screenings, and vaccinations may be missed, allowing preventable conditions to worsen. Adults with limited health literacy are more likely to delay seeking medical care and use preventive services less frequently.
4. Inadequate Chronic Disease Management: Managing chronic conditions such as diabetes, hypertension, or asthma requires ongoing self-care. Poor health literacy can hinder the ability to monitor symptoms, adhere to treatment plans, and make necessary lifestyle changes. Patients with low health literacy are at a disadvantage in managing chronic conditions, leading to poorer outcomes and higher healthcare utilization.
5. Increased Healthcare Costs: Misunderstandings about health insurance, medical bills, and coverage can result in unexpected expenses and financial stress. Patients may avoid seeking care to save money, leading to more serious health issues in the long run. Limited health literacy is associated with higher healthcare costs due to increased hospitalizations, emergency room visits, and inappropriate use of healthcare services. According to a paper published by the George Washington University, limited health literacy costs the healthcare system up to $238 billion annually.
6. Lower Adherence to Medical Recommendations: Patients with poor health literacy may struggle to follow medical advice, leading to suboptimal outcomes. This includes not only medication adherence but also lifestyle changes like diet modifications and exercise routines. Patients with low health literacy are less likely to adhere to medication regimens, leading to poorer health outcomes.
7. Health Disparities: Poor health literacy is often associated with health disparities, as marginalized and vulnerable populations may face greater challenges in accessing and understanding health information. This can contribute to existing inequalities in health outcomes. Health disparities are closely linked to health literacy levels, with vulnerable and marginalized populations facing greater challenges in accessing and understanding health information. Limited health literacy disproportionately affects minority populations and contributes to health disparities.
8. Miscommunication with Healthcare Providers: Difficulty communicating with healthcare providers can lead to misunderstandings, misdiagnoses, and inappropriate treatments. Patients may be unable to ask relevant questions or express their concerns effectively. Poor health literacy can lead to miscommunication and misunderstanding between patients and healthcare providers. Patients with low health literacy are more likely to have difficulty understanding and communicating with their healthcare providers.
9. Increased Hospitalizations: Poor health literacy is linked to higher rates of hospitalization, especially for conditions that could have been prevented or managed with timely and appropriate care. Adults with low health literacy have higher rates of hospitalization and longer hospital stays. An article published by the American Public Health Association showed people with inadequate literacy had a 52% higher risk of being admitted into a hospital compared to people with adequate literacy, even after adjustment for age, socioeconomic markers, and self-reported health.
10. Lower Overall Health Status: Individuals with poor health literacy tend to have poorer overall health outcomes, lower health-related quality of life, and reduced ability to advocate for their own health needs. Limited health literacy is associated with lower health-related quality of life and overall poorer health outcomes. A study published in the BMJ, a peer reviewed medical journal, showed that Low and medium health literacy were associated with a 75% and 24% increased risk of mortality, respectively, compared with high health literacy, after adjusting for age and sex.
11. Impact on Public Health: At a broader level, poor health literacy can strain healthcare systems, increase healthcare costs, and hinder public health efforts to prevent and manage diseases.

• So these are all the 11 outcomes of poor health literacy that I thought of and encountered. I’m sure that there are many more so try to brainstorm and think for yourself, what would the consequences be if I couldn’t make informed decisions about my own health.

National Action Plan to Improve Health Literacy

• And now on to the solutions. How do we fix these problems, and how do we improve health literacy in the US? Well, a direct plan called the National Action Plan to Improve Health Literacy was put in place after Healthy People 2010.
• In 1999, the U.S. Surgeon General's report "Healthy People 2010" highlighted health literacy as a critical factor in achieving the objectives of the Healthy People initiative, which sets national health goals and objectives for a decade.
• The report emphasized the need to address health literacy to empower individuals to make informed decisions about their health and access healthcare services effectively.
• In 2000, the U.S. Department of Health and Human Services created the Office of Disease Prevention and Health Promotion (ODPHP), which took the lead in developing and implementing the National Action Plan to Improve Health Literacy. In 2004, they convened a group of experts from various disciplines, aptly named the National Workgroup to Develop a Blueprint for Action on Health Literacy. Their mission? To craft a comprehensive plan that could tackle the challenges posed by limited health literacy head-on.
• Fast forward to the year 2010, and voila—the National Action Plan to Improve Health Literacy was born. This strategic blueprint was a game-changer, designed to empower individuals and communities by enhancing health communication and promoting clear, accessible health information. But it wasn't just about individuals; it emphasized a shared responsibility involving healthcare providers, institutions, policymakers, and educators.
• Now, let's delve into the heart of the plan—the seven overarching goals that set the stage for change:
• Goal One: Develop and Disseminate Health and Safety Information. This goal zoomed in on creating accurate, plain-language health information that anyone could understand.
• Goal Two: Promote Changes in the Healthcare System. Here, the plan aimed to transform healthcare systems, making them more responsive to individuals with varying levels of health literacy.
• Goal Three: Equip People with the Skills to be Health Literate. This goal was all about empowering individuals to navigate the complexities of healthcare confidently.
• Goal Four: Create a Supportive Environment. Communities, families, and organizations joined forces to foster an environment that champions health literacy.
• Goal Five: Strengthen Collaboration. Cross-sector collaboration became the buzzword, uniting stakeholders to propel health literacy initiatives forward.
• Goal Six: Increase Basic Research and the Development of Effective Practices. Here, the plan underscored the significance of continuous research and evaluation to refine health literacy interventions.
• Goal Seven: Promote Integrating Health Literacy into Education and Training. This goal focused on infusing health literacy principles into education and professional development programs.
• But, of course, a plan is only as good as its outcomes. The National Action Plan sparked a ripple effect. It led to innovative programs, resources, and interventions that empower individuals to navigate the intricate maze of health information. By fostering a society where health information is not just accessible, but understandable and actionable for all, it aimed to bridge the gap in health disparities and improve overall well-being.
• So, you might be wondering, "How did they take this grand plan and turn it into practical, impactful change?" Well, it all started with a robust strategy to engage various sectors, from healthcare providers and policymakers to educators and community organizations.
• Let's break it down further by exploring some of the key areas where the plan's influence was deeply felt:

1. Health Communication: The plan spurred a wave of initiatives to make health information more accessible and understandable. Organizations across the nation rolled up their sleeves to create materials using plain language, engaging visuals, and culturally relevant messaging. This shift in communication style aimed to break down barriers and empower individuals to take control of their health.
2. Education and Training: The National Action Plan's call to integrate health literacy into education and training programs didn't fall on deaf ears. Institutions and educators began infusing health literacy principles into curricula, empowering students and professionals to communicate effectively with diverse populations.
3. Healthcare System Transformation: One of the plan's ambitious goals was to reshape the healthcare system to better serve individuals with varying health literacy levels. This led to the implementation of patient-centered care models, where healthcare providers actively engage patients in decision-making, ensure clear communication, and offer support every step of the way.
4. Community Engagement: Communities rallied together to create health literacy initiatives that addressed local needs. Workshops, events, and outreach programs aimed to empower individuals to make informed health choices and navigate the complexities of the healthcare landscape.

• But perhaps one of the most remarkable outcomes was the emergence of innovative tools and resources that put the power of health literacy directly into the hands of individuals. Online platforms, interactive websites, and mobile apps sprouted up, offering reliable health information that's easy to understand. These resources became lifelines, connecting people to the knowledge they need to make informed decisions about their health.
• Now, let's touch on the impact. The application of the National Action Plan began to pave the way for a more health-literate society. Patients felt more empowered during their healthcare journeys, healthcare providers became more effective communicators, and health disparities began to shrink as access to clear information improved.
• As the years went by, the ripple effect of the National Action Plan continued to grow. The commitment to health literacy became ingrained in the fabric of healthcare, education, and public health initiatives across the nation. The plan's influence wasn't just a temporary trend; it became an integral part of the way individuals, communities, and institutions approached health and wellness.
• And there you have it—an inside look into how the United States turned the National Action Plan into a catalyst for change. It's a story of dedication, collaboration, and the unwavering belief that health literacy is a cornerstone of a healthier, more equitable future.

Program and Initiative Tackling the Problem

• But what does this all mean to you? That’s what I want to talk about now. How can you make a difference in health literacy and help those around you because we want to turn everything that we just learned into tangible actions that we can all take. So let’s jump right into it, these are some thoughts about you can improve your own health literacy and at the same time help those around you.

1. Be an Active Health Seeker: Don't be afraid to ask questions when you visit a healthcare provider. Understand your health conditions, treatments, and medications. Research reputable sources, and when in doubt, seek a second opinion. For example, when your doctor recommends that you take a new medication, ask why? Try to understand what this medication actually does and what its side effect profile is so that you can truly know if it is the best option for you. Taking charge of your health journey is the first step toward better health literacy. You don’t need to know everything, but you have to open to learning about what’s relevant to you. No one is ever going to know the mechanism of action of every drug in that exists but you can do your best to learn about those relevant to you. And encourage those around you to do the same thing, which brings me to my next point.

2. Share Your Knowledge: Spread the word about health literacy. Talk to your family, friends, and colleagues about the importance of understanding health information. Share reliable resources and encourage open conversations about health topics. If you are open to them about your healthcare journey and how you navigate your health conditions, medications, nutrition, or doctor appointments, it will encourage them to do the same. You and all of those around should be an active consumer of healthcare, not a passive listener and together, you can create a ripple effect of informed decision-making. My next point is relate to sharing knowledge.

3. Embrace Plain Language: If you're going to be sharing health information, whether online or in-person, aim for clarity and simplicity. Use plain language, avoid jargon, and break down any complex terms you may use. This simple shift can make a world of difference in helping others understand and act on important health information. I know it sounds cool to use all these fancy medical terms, at least I thought they used to be really cool, but when talking to others, you want the conversation to feel personal to them, you don’t want to just be showing off your new medical knowledge so just keep it simple and focus on what they should take away from that conversation.

• And what’s so beautiful about everything that I just mentioned is that it makes us more comfortable taking leadership over our health and not just being passive and accepting all that the doctor says. It makes talking about our health easier and so people are going to think more about their health and research more about it, leading to more informed decisions in the future.
• But there are more things that I think everyone can do once in a while to help them and their communities and a big one here is going to be to volunteer and engage.

4. Volunteer and Engage: Participate in community health events, workshops, and programs. Volunteer at local clinics, schools, or community centers to support health literacy initiatives. By giving your time, you're helping others gain the knowledge and skills they need to make informed health choices. But you’re also helping yourself. You’re going to learn a ton about these communities and what really matters for them in terms of their health. And in turn, this will all make you better at communicating. You will become better at talking to people about what truly matters to them and you’ll learn how to better phrase all the new healthcare knowledge you learn.

• And you might be asking yourself, well, where is all this health information going to come from, like how do I learn this stuff? Well, I’ll be honest with you, learning from your doctor is becoming harder and harder because they just don’t have that much time to go into too much detail. What has worked best for me is to google, read books, and watch youtube videos. If your doctor diagnoses you with a new condition, let’s say high blood pressure, go online afterwards and do some research into it. Watch youtube videos and educate yourself on what you may have so that when he suggest a type of medication for your high blood pressure, you understand which type he is suggesting and know if a different type might work better for you. But please please please, don’t fall prey to all the health scares you might see on google. I feel like if I search up why I have pain in my leg it’s probably going to spit out that I’m pregnant. So just make sure you are using reliable sources. And when it comes to books, there is one book called “Outlive,” by Doctor Peter Attia that is phenomenal. It focuses of preventative care medicine and talks about everything that is pertinent to you living a long and healthy life. Dr Attia does a wonderful job explaining aspects of health that are relevant to everyone. From the fundamentals of sleep, exercise, and nutrition to discussing more specific but extremely important health metrics such blood pressure and cholesterol, Dr. Attia backs everything with hard evidence and gives tangible takeaways. If you get a chance, I definitely recommend reading the book.

Conclusion

And there you have it, our journey through the world of health literacy in the United States. We've explored the depths of this critical concept, from its elusive yet impactful nature to its evolution over the years. Before we wrap up, let's take a moment to reflect on the key takeaways that can truly empower us to make a change.

We started by demystifying the term "health literacy." It's not just about understanding medical jargon; it's about having the capacity to obtain, process, and utilize health information to make informed decisions and take meaningful actions. And remember, health literacy isn't confined to individuals alone—it also encompasses organizations and systems that play a crucial role in shaping how health information is communicated and accessed.

In Healthy People 2030, two dimensions of health literacy take center stage: personal and organizational. Personal health literacy is about each individual's ability to understand and navigate health information for their own well-being. Organizational health literacy, on the other hand, calls on institutions to create equitable, clear, and accessible health information and services that cater to diverse populations.

But why is improving health literacy so important? It's a game-changer. Poor health literacy isn't just a challenge; it's a barrier that can lead to adverse health outcomes, disparities, and missed opportunities for better health. We explored how low health literacy is linked to reduced health knowledge, medication errors, unnecessary hospitalizations, and overall diminished quality of life. It's a challenge we can't afford to ignore.

So, what can you do to be part of the solution? You, yes you, have the power to make a meaningful impact. From being an active health seeker and embracing plain language to sharing reliable resources online and supporting health literacy organizations, your actions can create a ripple effect of knowledge and empowerment. By fostering clear communication, understanding, and accessibility, you're helping build a healthier, more informed society.

Lastly, I would like to acknowledge an article, which much of its information actually made it into this episode because it really helped me get a better grasp of health literacy. The article is called Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health. It was written by Stephanie Santana and others and was published in the journal of public health management and practice.

I hope you enjoyed this month’s episode and take some time to learn more about your health and share what you learn with those around you. Next month, we’ll begin a series about healthcare economics. My plan is to have the first episode giving a general overview of economics in our healthcare system such as what the main sectors of the market are and how much money goes into them. And after that, I plan on making more specific episodes talking about a single healthcare economic topic, such as mergers and acquisitions. Until then, have a good one and stay healthy.