A health literacy crisis looming?

April 16th, 2004 by Julie Ferguson

A few weeks ago, we featured an article that discussed the need for cultural competence in healthcare – “the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.”

More recently, The Health Show pointed us to a recent report by the Institute of Medicine (IOM) suggesting that 90 million Americans face significant health literacy issues. The IOM emphasizes taht this is not simply an issue that faces the uneducated or the poor. According to the report:

“Health literacy skills are needed for discussing care with health professionals; reading and understanding patient information sheets, consent forms, and advertising; and using medical tools such as a thermometer. Over 300 studies indicate that health-related materials cannot be understood by most of the people for whom they are intended.

Individuals are increasingly responsible for managing their own health care, the committee noted. They are assuming new roles in seeking information, measuring and monitoring their own health, and making decisions about insurance and options for care. Patients’ health often depends on their ability and willingness to carry out a set of activities needed to manage and treat their disease. This self-management is essential to successful care of chronic diseases such as diabetes, HIV, and hypertension. Patients with chronic illness who have limited health literacy are less knowledgeable about disease management and less likely to use preventive measures.

Limited health literacy is not a problem that starts and ends with patients, the committee added. Health systems are becoming increasingly complex, involving new technologies, scientific jargon, and complicated medical procedures and forms. All of these aspects of the health system can be confusing to patients.”

In the midst of this increasing complexity, throw the $3 billion in annual drug advertising that pharmaceutical companies spend on direct-to-consumer advertising into the mix. While ads previously focused on discretionary types of treatments, pharmaceutical companies are increasingly advertising complex treatments for serious health conditions.

To remedy the health literacy issue, the IOM suggests that practical health education and skills be added to the curricula from kindergarten through high school, as well as in adult education and community programs.

From a workers comp perspective, this makes the case for nurse case managers as health care advocates and educators, particularly in complex cases. However, case managers are often introduced too late in a claim after the treatment trajectory has been set. Also, their role is too often viewed as mere “cost control” when the most effective goal would be to foster recovery and return to work.

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