I looked forward to seeing the published proceedings of a one-day roundtable on health literacy held by the Health and Medicine Division of the National Academies in November 2017. I find the topic of health literacy compelling. As a writer, I know how challenging it is to communicate clearly about anything, never mind something as difficult and important as health care. I also knew that Christopher Trudeau, a frequent contributor to this blog, had been tapped as an expert speaker for the roundtable.
The proceedings are now available, for sale as a paperback or eBook or for free download as a PDF, from the National Academies Press.My anticipation was well founded; the report is both accessible and a deep look at a surprisingly complex topic.
I say “surprisingly” because I thought I knew a fair bit about health literacy. It’s hardly a new concept for me, but the report and related materials on the NAP website introduced me to dimensions of health literacy I had overlooked.
Making the business case
The roundtable was focused on building the business case for health literacy and therefore included experts from disciplines – such as finance, law, industry and training – relevant to corporate officers in hospitals and health systems. Patients who had experienced harm related to poor communication were also included as experts. Their stories are presented in the first chapter following the proceedings’ introduction and establish both the grave consequences and wide effect of poor communication on health and daily life.
The workshop and proceedings trace a direct line from value-based purchasing and consumer-directed health-care spending to literacy. If we expect patients and their families to make smart decisions, we must ensure they understand their options and the implications of their choices. The report also connects the dots between poor communication and medical error.
Other resources are available
Intrigued by the complexity of topics discussed in the proceedings, I went looking for earlier activities of the Roundtable on Health Literacyand found an extensive library of reportsand videos. Sessions from the November 2017 roundtable are available in video,which gives even more texture to the topic through presentations, panel discussions, and audience questions. For example, Session 5, with Trudeau as a panelist, is a moderated discussion of the question: Where do we go from here?
A lens, not a topic
I’ve grown tired of the concept of seeing something “through the [fill in the blank] lens,” but find it useful to describe the awareness I gained reading this report. Before, I thought of health literacy as recognition and response to a specific problem related to language, most often patients who through lack of education or cultural difference are not able to understand the high-level lingo of health care. I now see that virtually all of health care, including the business side, can be seen through the lens of health literacy.
Whether patients and family members are able to access and understand the information they need to participate in their own care and the system in general (including, for example, choosing a hospital or purchasing health insurance), has implications for all stakeholders. The U.S. health care system is somewhat fitfully moving toward paying for value, which means transferring power to the citizens/consumers/patients who use the system. An informed citizenry is important to health care the same way it’s important to democracy.
Other resources on this topic:
Ten Attributes of Health Literate Health Care Organizations
Community-Based Health Literacy Interventions
How to Engage Patients With Written Materials
Health Literacy: Making the Case to Organizations
Improving Patient Engagement Through Clear Health Communication
Reading up on literacy for work, it seems to be a very squishy thing to define. Apparently in 18th century Sweden (I think it was Sweden. I believe it was the 18th century. I forgot to write it down) the nation boasted 100% literacy, based on the fact that every adult was able to “read a particular psalm. Not: Open the Bible and read us a verse, but Look at this page and read this specific psalm. I suspect a lot of people memorized the psalm long before they were tested on it. In some places/times you were literate if you could write your name, or read it. Or if you could add a column of figures. Sitting down and reading all the way through a book with understandinga feat many of us take for grantedwas a very high order of literacy indeed. Even printers and book binders, who you would expect would need to be literate to do their jobs, often were just as literate as they needed to be (binders, who would receive unfolded “parent sheets which they folded into signatures before they could be sewn together, would refer to the number or letter on the bottom of the first page of each signature, in order to tell what it”s place in the collated work was. Very often the first word of the next signature was printed at the bottom of the last page of the previous one. Even then, you were likely recognizing the letter shapes rather than the words themselves.)