Home > News

THURSDAY, April 8 (HealthDayNews) -- Ninety million adult Americans, or nearly half the adult population, lack the ability to understand basic health information, severely compromising their ability to take care of themselves and their families.

These people are more likely to have poor health, higher rates of hospitalization, and greater use of emergency services, said a study issued Thursday by the Institute of Medicine (IOM).

That, in turn, translates into higher health-care costs. For instance, an additional $29 billion had to be spent in 1996 due to poor patient reading skills, according to a study reviewed for the IOM report. And another study, this one of Arizona Medicaid patients, found that costs averaged $7,500 higher for those patients who read at a third-grade level or lower, compared to patients who read above a third-grade level.

The issue of health literacy and what America can do about it was the subject of two reports issued Thursday: Health Literacy: A Prescription to End Confusion, from the Institute of Medicine, and Literacy and Health Outcomes, commissioned by the Agency for Healthcare Research and Quality at the request of the American Medical Association.

"Limited health literacy is a huge obstacle standing between millions of patients and the care physicians wish to render," Dr. John C. Nelson, president-elect of the AMA, said at a news conference. "They can't read the front page of USA Today or a bus schedule, let alone how to take multiple medications. The implications are incredible and enormous."

"The numbers are not new but are shocking nevertheless with shocking consequences," said AHRQ director Dr. Carolyn M. Clancy. "Low literacy plays an important role in health disparities."

Like "regular" illiteracy, health illiteracy involves poor reading skills and difficulty with numbers, which can translate into difficulty understanding dosages, taking prescriptions, reading food labels, and filling out informed consent forms, among other things.

But health illiteracy is also different from regular illiteracy.

"The ability to read at all is not the question. It is the ability to interpret and use for your own benefit sometimes rather complicated information and sometimes rather simple information that is deceptively difficult," said Dr. Harvey V. Fineberg, president of the Institute of Medicine. These individuals are less likely to seek preventive care, such as mammograms, Pap smears, and flu shots. They are also less likely to understand the full effects of smoking, AIDS, and asthma, he said.

There can also be an emotional component. "It's a different kind of understanding," Nelson said. "The emotionality that occurs when any medical process or procedure goes on is intense. You hear some of the words. You don't hear all of the words."

Nelson gave the example of a college-educated patient who came back to him in extreme pain because she had not understood that she needed to take the plastic wrapper off a vaginal suppository before inserting it.

"In health care, you have an emotional overlay to communication that makes clarity and understanding more problematic than otherwise," Fineberg said. "Many people can function with a limited ability to read on their jobs, and colleagues never know. When it's an emotional consequence of communication within the health-care experience, that difference really shows up."

But there also seems to be a widespread and fundamental misunderstanding of what illiteracy is and who "has" it.

"The word literacy is misleading. It makes it seem like it is a characteristic of a person," said Bill Smith, a member of the IOM committee that issued the report. "We came away believing that this is not true. It is a function of society. It's what we give to them to read and their ability to read, it's a dual responsibility. We have to stop thinking of literacy as something a person has but something society has."

As a consequence, the problem needs to be attacked from all sides. "It's kind of a pincer program," Fineberg said. "We have to attack the problem both from the ability of improving individuals' and families' capacity to use information, and from the vantage point of the provider community."

For example, doctors and other health-care providers could present information in a more user-friendly way, perhaps by drawing a diagram or by forsaking words and phrases like "hypertension," "endometriosis," and "retrograde menstrual flow" for something simpler. It could also mean talking a little slower, or asking the patient to repeat the information back.

Before more sweeping changes are made, however, both the IOM and the AHRQ reports call for additional research. "The problem is that most of this is anecdotal," Nelson said. "The purpose of this report is for research to ask what is the casual relationship."

But the incentive is there. "In health, life is at stake," Fineberg said. "Every time there's a misunderstanding there's a risk of life lost."

A separate report released Thursday found that low-income working minorities lack health insurance at a higher rate than their white counterparts. The report, from the Commonwealth Fund, found that insurance for minorities is either unavailable or unaffordable.

Three-quarters of Hispanics whose income was 200 percent less than the poverty level of $16,000 for a family of four had no insurance at some point between 1996 and 1999, the study found, while half of whites faced the same problem.

More information

Get more on the reports from the Institute of Medicine or the Agency for Healthcare Research and Quality. The American Medical Association has a health literacy kit for professionals.

(SOURCES: April 8, 2004, news conference with Harvey V. Fineberg, M.D., Ph.D., president, Institute of Medicine, Washington, D.C.; Carolyn M. Clancy, M.D., director, Agency for Healthcare Research and Quality, Rockville, Md.; John C. Nelson, M.D., M.P.H., president-elect, American Medical Association, Chicago; Bill Smith, Ed.D., committee member, Institute of Medicine, Washington, D.C.; IOM report, Health Literacy: A Prescription to End Confusion; Agency for Healthcare Research and Quality report, Literacy and Health Outcomes)

Copyright © 2004 ScoutNews, LLC. All rights reserved.