J. Marion Sims | Press Release

Each year in the United States, more than 750 million prescriptions are written, but 240 million go unfilled as a result of people not understanding their conditions and why they need medication. People with low levels of literacy make more doctor visits, use more health services, use fewer preventive services, are hospitalized more often, require longer hospital stays.

These and other examples of the impact of low literacy on health care have been cited in several studies and were topics of discussion recently at a Health Literacy Forum sponsored by the J. Marion Sims Foundation. Some 50 members of the medical and health communities gathered to learn more about and discuss issues related to low health literacy.

The examples cited above occur regularly across the nation and in Lancaster and Chester counties. As a result, residents in both counties are less healthy than they could be and are paying more for health care than they would if they possessed higher literacy skills in general and health literacy skills in particular.

According to the most recent National Adult Literacy Survey (NALS), some 44 million Americans operate at or below the fifth grade level, and another 50 million are only marginally more literate. Added together, these figures represent one half of our country’s adult population that possess only low to marginal literacy skills.

Health literacy refers to “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” (Healthy People 2010) Adds Foundation Board of Trustees member Dr. Dexter Cook, “Without adequate literacy skills, such tasks as understanding prescription instructions, reading appointment slips, comprehending consent forms, discharge and test instructions, and educational materials present formidable, if not overwhelming, barriers to individuals in their health management.”

Dr. Duren Johnson, also a Foundation trustee and immediate past president of the South Carolina Medical Association, noted that the American Medical Association and its foundation have cited health literacy as one of the association’s top priority items. It is one of only two items cited by the Institute of Medicine of the National Academies as cutting across various lines to affect patients suffering from all types of medical conditions. Improving health literacy is described as essential for effective self-management and collaborative care.

Using the NALS survey results as a basis, it is estimated that the incidence of low literacy levels within Lancaster and Chester counties’ adult populations may be above the national averages. These rates translate into several critical health literacy issues for these counties’ adults:

Low health literacy contributes to higher use of health care and related services. When people do not understand health care instructions or live a healthy lifestyle, they are more at risk for adverse health consequences, resulting in increased use of health care services. In her studies of the effects of low health literacy, Dr. Erica Brownfield, MD, Assistant Professor of Medicine at Emory University’s Medical School, told forum participants that she has noted that low health literacy results in less use of preventive strategies, more doctor visits and more and longer hospitalizations -- independent of other social and economic indicators and health status.

Areas with low health literate populations shoulder an unnecessary economic burden. Taxpayers pay more taxes to fund services. Businesses pay more for health insurance premiums. Consumers pay more for health care. Limited governmental resources are diverted to serving the consequences of low health literacy. Hospitals and insurance companies pay more for services and thus charge more. Studies cited by Dr. Brownfield note that low health literacy costs the US some $73 billion per year and that Medicaid enrollees at the lowest grade levels have average annual costs of $12,974 per enrollee, compared with $2,969 for the overall population.

Low health literacy disproportionately affects the most vulnerable populations. People with disabilities, those living in poverty conditions, those speaking English as a secondary language, and seniors have special health literacy issues and challenges. These groups, on average, have higher rates of low health literacy than the general population.

One can be literate in all other aspects and still have low health literacy skills. To be functional implies that information and services are used so that one’s health is maintained and enhanced. However, what we know may not affect what we do to be healthy. Additionally, the health care system is complex enough that most of us have difficulty understanding it at times. Combined with emotional trauma present in very stressful or life-threatening situations, low health literacy can present serious challenges to understanding, retaining, and using information correctly.

What can be done to address these problems? The J. Marion Sims Foundation is engaged in a grant making initiative that seeks to improve adult literacy and basic skills in Lancaster County, Great Falls and Fort Lawn. Health literacy is one of the initiative’s focus areas. The work being done by the Foundation’s grantees as part of this initiative and that of other organizations deals primarily with raising individuals’ skill levels.

But health care service providers also can address health literacy. While speaking to members of the local medical community at the health literacy forum, Dr. Brownfield and other health literacy experts suggested a number of steps that such providers can take to assist citizens with low health literacy. Among them are:

· Simplify communication and stress communication techniques with low literacy individuals in professional training

· Use everyday language in explanations rather than highly technical terms

· Use pictures and/or pictographs to illustrate points and concepts

· Re-orient educational materials to fifth grade reading levels (most are written at the 10th grade level or higher)

· Use demonstration and repetition techniques in explanations

· Simplify enrollment forms, consent forms and insurance/employee benefit information

· Partner with other professionals to achieve common health literacy goals.

As advances occur in health care and technology and as America’s population grows more diverse, it will become increasingly important in the future for health practitioners and policy makers to develop basic indicators of health literacy, to identify obstacles to being a health literate society, and to identify appropriate public health literacy interventions.

(For more information on health literacy and the J. Marion Sims Foundation’s Adult Literacy and Basic Skills Initiative, contact Dr. Mary Henderson, Program Officer, J. Marion Sims Foundation, PO Box 818, Lancaster, SC 29721; (803) 286-8772.)