Building the Literacy Infrastructure in Health Literacy

By Dennis Archambault

The connection between health and literacy has been validated in various ways through social research in the past decade. Today, however, when you hear the term “health literacy” spoken by advocates, it’s an informational process to help people navigate the new health insurance system. It may even be an effort to help the newly-insured Medicaid population who may have led an entire adult life without a relationship with the health care system, much less practicing health behavior

With around 50 percent of the adult population having limited literacy and quantitative skills, according to a review of medical and public health literature conducted by Rima E. Rudd, a Harvard professor who has written and lectured widely on health literacy, and colleagues Barbara A. Moeykens, and Tayla C. Colton

“Educational attainment and health educational attainment has become the most convenient and commonly used indicator of socioeconomic status, and the association between years of schooling and health is well established…suggesting that education is the most judicious socioeconomic measure for use in epidemiological studies.” Education, the writers summarize, “influences work and economic conditions, socio-psychological resources, and a healthy lifestyle.”

“Literacy influences the ability to access information and navigates in literate environments, has an impact on cognitive and linguistic abilities, and affects self-efficacy.” In a clinical environment, one’s oral communication skills and reading ability may prevent them from communicating effectively with their caregiver, understanding their discharge orders, and being proactive in thinking their health concern. “Patient’s literacy directly influences their access to crucial information about their rights and their health care, whether it involves following instructions for care, taking medicine, comprehending disease-related information, or learning about disease prevention and health promotion.”

The relative urgency of health care communication – in reaction to disease and injury – precludes addressing the underlying problem of illiteracy.  The tactical answer is adjusting the reading and visual style of information presentation, not dealing with the long-term issue of social illiteracy. But as we grapple with helping thousands of newly-insured Healthy Michigan clients navigate the system, we need to deal with the deeper issue – bridging traditional literacy programs to include “functional health literacy.”

Educators can take this on as a kind of applied literacy challenge. By improving language and quantitative skills, they can “increase health literacy, promote healthy lifestyle choices, and support health-promoting community actions.” Likewise, health educators can employ essential literacy skills-building in their counseling of low-literacy clients.

The Harvard University School of Public Health is doing some interesting work integrating literacy into adult education.

As more of our complex social problems require cross-disciplinary collaboration, health literacy also could benefit from the interaction between educators, literacy volunteers, and health professionals. Health literacy is more than basic behavioral navigation.

Dennis Archambault is director of Public Affairs for the Detroit Wayne County Health Authority