By Penelope A. Domogo, MD
Everyday, people make decisions that would affect their health and the health of others- for better or for worse. (This is why the title of this column is such.) The state of your health and that of your family and community is affected by your decisions. These decisions are made in the house, in the workplace, in the offices of government, in school, in church, in the sari-sari store and market, in the drugstore, in the clinic or hospital, in the doctor’s office, or in the bus or jeep, in the bar or restaurant- anywhere that people go to. Making a decision means choosing between at least two options. I say at least two because many decisions would be choosing between doing something or not doing it. Like choosing to eat or not to eat? to take the medicine or not? to go to the clinic or not? to construct a sidewalk or not? to allot more budget for preventive health or not?, etc.
Deciding which action to take would largely depend on what you know about your options. For example, if you need to buy food, will you buy vegetables or hotdog? Your decision will depend on what you know about vegetables and hotdogs. If what you know is that hotdog is the same as vegetables, then perhaps you will buy hotdog, even if it is much more expensive. If you are sick, will you decide to seek western medical care or traditional oriental medicine? Whether as an individual deciding for yourself or an elected official deciding for your barangay, municipality or province or country, your decision will be determined by your level of health literacy.
Health literacy is defined as “the wide range of skills and competencies that people develop over their lifetimes to seek out, comprehend, evaluate and use health information and concepts to make informed choices, reduce health risks and increase quality of life.” (Zarcadoolas, Pleasant, and Greer, 2006). Health literacy means more than just reading the doctor’s prescription, reading the drug pamphlet and making an appointment to the doctor. It includes understanding scientific concepts including statistics and epidemiology, skills in spoken, written and online communication, knowledge of the interplay of politics, economics and culture in health, understanding how power relations affect access to and use of health information. And very important, it includes critical interpretation of mass media messages- discernment of what is advertisement and what is not. There are a lot of health messages in TV and internet and other mass media that are conflicting so one has to evaluate which information to use. Will you use, for example, what a popular movie star says on TV about drinking milk to guide your decision to drink milk or not? Can you distinguish an advertisement and a health information?
According to an Institute of Medicine (2004) report, low health literacy negatively affects the treatment outcome and safety of care delivery. These patients have a higher risk of hospitalization and longer hospital stays, are less likely to comply with treatment, are more likely to make errors with medication, and are more ill when they seek medical care.
The mismatch between a clinician’s level of communication and a patient’s ability to understand can lead to medication errors and adverse medical outcomes. The lack of health literacy affects all segments of the population, although it is disproportionate in certain demographic groups, such as the elderly, ethnic minorities, recent immigrants and persons with low general literacy. Health literacy skills are not only a problem in the public. Health care professionals (doctors, nurses, public health workers) can also have poor health literacy skills, such as a reduced ability to clearly explain health issues to patients and the public.
According to a report of the Institute of Medicine (2004), low health literacy negatively affects treatment outcome and safety of care delivery. At the individual level, people with low health literacy have a higher risk of contacting disease, have longer hospital days, less likely to comply with treatment, more likely to make errors in medication and have a harder time managing chronic diseases like high blood pressure and diabetes. “Obtaining, communicating, processing, and understanding health information and services are essential steps in making appropriate health decisions; however, research indicates that today’s health information is presented in ways that are not usable by most adults.” (Center for Disease Control, USA).
Health care professionals, like doctors, nurses and midwives, can also have poor health literacy skills such as poor ability to clearly explain health issues to patients and the public. Misunderstanding the doctor’s orders or the instructions given by the nurse can lead to grave medication errors.
The World Health Organization (WHO) states that by improving people’s access to health information and their capacity to use it effectively, health literacy is critical to empowerment. Lack of health literacy affects all segments of the population but are more prevalent in those with low general literacy, those in lower socio-economic level, in the elderly and recent immigrants. WHO thus exhorts governments and all concerned with health education to go beyond information dissemination and actively engage individuals and communities in discussion and critical analysis. These will lead not only to individual lifestyle decisions but also to collective community actions resulting in disease prevention and improvement of the quality of life for all. This is the purpose and prayer of this column.**
