By Penelope A. Domogo, MD
Every day, you and I make decisions that would affect our health and the health of others- for better or for worse. The state of our health and that of our family and community are affected by our 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? If pork adobo is set before you and you know you have high cholesterol, you choose to eat or not to eat it. Most often, though, you are compelled to eat it and some won’t even think twice before getting a portion. But really it is solely your decision to put it in your plate and put it in your mouth. Don’t give the excuse that it is disrespect to your host if you don’t eat it. In this age of diverse food choices, it is okay, it is wise, and it is healthy to choose your food well, even if you are a guest.
Still on the pork adobo, if you choose to eat it, you also choose how much you will eat. The adobo does not just jump to your plate or to your hand and mouth. That would be something, though. Then after that, it is your decision again to reach out your hand or your fork and get one piece or one plate. Then if it is in your plate, you still decide if you are going to eat it all or not. Just observe people during buffet. Some people fill up their plate to a mountain and then leave half of it uneaten. Isn’t that a totally irresponsible decision? Please just get what you can eat or better yet, just get the right food in the right amount and eat ALL that you put in your plate.
Every awake moment, we make decisions. We choose to walk or ride. We choose to take the medicine or not. To go to the clinic or not. To go to church or not. To talk to your neighbor or not. To construct a sidewalk or not. To allot more budget for preventive health or to expensive hospitals. Etc. etc. It would be a nice exercise for you to inventory your actions in one day and see how you make decisions. Right now I have decided to finish this column before I eat breakfast.
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 because it is easy to cook, even if it much more expensive and even if it will generate plastic waste (the packaging of hotdogs are plastic and thus toxic). If you are sick, will you decide to do rest and reflect or seek western medical care or traditional medicine or all of the above? These are all choices which you have to make. 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 from a health information?
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.
Where then do we learn health literacy? If we go to the classroom to learn to read and write and be literate, where do we go so we will learn about health? In the past, people were highly literate in health – they knew what to plant so that they will have food that will make them strong and sturdy. They knew that if they were lazy to till the land, they won’t have food. So they decided that they have to work hard. They learned from their parents and relatives and friends (in other words, community) what to do when they get pregnant, give birth, get sick and what not. Health literacy,, then, was a lot of common sense. Health literacy was a community phenomenon, involving not only food production but their language, rituals, relationships, beliefs and values. It was not a commodity in the hands of some professionals who know how to read and write and whose language they alone can understand.
We need to bring back this health literacy to its rightful place – in the field of common sense. Meaning it should be taught and practiced at home, at work, in school, in church, in office. Then we, as individuals, would make wise lifestyle decisions and also collective community actions that will result in wellness and happiness and improvement of the quality of life for all. This is the purpose and prayer of this column. May we all be well! **
