Researcher Strengthens Health, Literacy Link
Why Johnny Is Sick
December 10, 2002
If Johnny can't read, then his health is likely to suffer, too, someday.
Such are the stark findings of Dr. Dean Schillinger, University of California, San Francisco, associate professor of medicine at San Francisco General Hospital, whose research is drawing a clearer connection between health literacy and the chances of beating, or at least successfully controlling, chronic illness. He recently delivered the first lecture in a series on health literacy at NIH. His talk, titled "Babel Babble: What Is the Doctor Saying? What Is the Patient Hearing?", was sponsored by NIDCD.
A person's health-literacy skill is his or her ability to read and understand health information and to make decisions based on that information, whether it's following the directions on a bottle of Tylenol or learning on a health web site how to keep one's cholesterol in check. And one strong measure of a person's health literacy is his or her ability to read in general. If someone struggles to read a sign or bus schedule, for example, how can she or he be expected to read and accurately interpret directions for taking a prescription medication?
Schillinger pointed out that literacy is not a matter of "are you or aren't you able to read?" There are degrees. According to the 1993 National Adult Literacy Survey, 10 to 22 percent of Americans are at the lowest level of literacy, meaning that they are unable to read a medicine bottle or poison warning. Another 18 to 26 percent are considered functionally illiterate, meaning that they have trouble filling out forms for a job application. The survey also found that, on average, the reading level in the United States is somewhere between the eighth and ninth grades, while the average reading level of Medicaid recipients is significantly lower at the fifth grade.
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Dr. Dean Schillinger of UCSF |
Low literacy is a symptom of a number of underlying factors, according to Schillinger. And it is not a lifelong constant. One surprising finding is that older adults who may have had fine reading, writing and thinking skills in younger days may have difficulty as they age with reading and understanding information. Vision problems, poverty, learning disabilities, immigration and minority status, and poor education also can contribute to low literacy. Two-thirds of people ages 65 and older have poor literacy skills, while 25 percent of immigrants have poor literacy.
Low health literacy can be tied to three big negatives in the health care arena, said Schillinger. First, health care costs are generally higher for patients with low literacy. A 1992 study at the University of Arizona, Tucson, found that health care costs for patients enrolled in Medicare who were identified with low health-literacy skills were more than four times as high as costs for patients with high literacy roughly $13,000 per year compared to $3,000 per year. Second, a patient's own health assessment is usually gloomier if he or she is challenged by low literacy. In a study conducted in Atlanta and in Torrance, Calif., patients who had low health literacy were more likely to report their health as poor compared with patients who had adequate literacy.
And third, patients with low health literacy tend to be less successful in managing chronic disease.
In a study on the effects of health literacy on blood-sugar control in Type II diabetics, Schillinger and his colleagues at San Francisco General found that patients with high literacy were more likely to have lower long-term blood-sugar concentrations what all diabetics should strive for while those with low literacy were more likely to have higher levels of glucose in the blood, or worse blood-sugar control. Complications associated with diabetes also increased as literacy decreased. Patients with low literacy developed retinopathy more than twice as often as people with high literacy did, despite the fact that patients with known vision problems were excluded from the study. Retinopathy is a condition that damages the eye's retina, the sensory membrane that lines the eye, and can cause blindness.
Low literacy also may contribute to health disparities. Women, minorities and older people were much more likely than others in the study to experience problems, the researchers found, with women
twice as likely, and seniors five times as likely, to have poor blood-sugar control.
Schillinger says low literacy may contribute to health disparities. |
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