SECOND OPINION:The low rate of health literacy is a big public health issue, writes JACKY JONES
POOR PEOPLE have worse health than the better off and, according to recent figures from the Central Statistics Office, a person’s life-span is directly correlated with their educational attainment. Poor people are also less able to help themselves get better because of health literacy problems and so are doubly disadvantaged.
The recent OECD report showing that Ireland has fallen from 5th to 17th place in students’ reading skills has been well covered by the print media, but the effect of lower literacy levels on health has not been analysed.
Educational attainment is the most important factor determining a person’s health in Ireland. The adult female literacy rate is one of 10 World Health Organisation (WHO) indicators used to assess women’s health and wellbeing. A mother’s level of education correlates highly with her child’s risk of dying before the age of two.
We have known for more than 30 years that health literacy, the “silent killer”, is related to general literacy including the ability to read and write, do sums, understand science, culture and technology and be able to participate in civil society. It enables us to function in the health world at a number of different levels. At the basic level, literacy skills enable us to feel comfortable in everyday health situations such as reading consent forms, health information leaflets and medicine labels, complying with treatment from health professionals, and being able to make appointments.
At the next level, known as interactive literacy, people have the social and cultural skills to participate as equals in the everyday health situations described above. They are able to extract and understand the information they need from health professionals and other sources of information including the internet. Members of self-help health groups usually have good interactive health literacy skills.
People with critical health literacy skills – the highest level – are able to judge, sift and use information from all sources and analyse conflicting data. They are able to take action on issues that affect their own health and the health of their communities, such as poverty and educational attainment.
Low rates of critical health literacy in Ireland are partly to blame for our overcrowded emergency departments, because people do not have the confidence or critical health literacy to deal with health problems in their own homes. The vast majority of illnesses are treatable at home, which is a safer place to treat disease than a hospital. We are bamboozled by conflicting health information and, therefore, reliant on experts to help us get better when all that may be required is rest and plenty of fluids.
The WHO defines health literacy as being critical to empowerment and the ability to take individual and collective action on issues determining health. In the US, low health literacy is a major cost to the healthcare system. A recent report from the American Medical Association shows that most US health professionals are not aware of health literacy and don’t know which of their patients might have literacy problems.
A 2007 Irish survey showed that 20 per cent of adults here do not understand the information they receive from health professionals; one in 10 took the wrong medication because they did not understand the instructions. This means that nearly two million prescriptions are wasted in Ireland every year, at massive cost to the HSE – not to mention the consequences for the patient.
Health literacy is a big public health issue. Poor people get sick more often than well-off people, they get more sick when they do, and they are disadvantaged in terms of helping themselves get better. Unfortunately, the HSE National Service Plan for 2011 does not say what it is going to do about this problem. Improving health literacy levels would be good for the nation’s health and would save the taxpayer a fortune.
Perhaps readers of HEALTHplus can help. VECs around the State will soon be recruiting volunteers to teach adults how to read and write. This involves doing a short training course and then spending an hour or two a week with an adult on a one-to-one basis. Adult literacy programmes are one sure way of contributing to the health of Irish people.
Dr Jacky Jones recently retired as regional manager of health promotion at the HSE