Low Literacy Can Be Hazardous To Your Health
Op-ed
BY SUSAN A. McLEAN

Imagine sitting on the examining table as your doctor explains, in detail, your diagnosis, the treatment course, your prescribed medication regimen, the lifestyle changes you now face ahead and numerous options to evaluate in order to make a decision about surgical treatment. He hands you pages and pages of documents and says, "Don't worry about remembering all this stuff…it's all written down here for you."

Such a doctor's visit would be frustrating and confusing for most people. Now imagine facing all this being unable to read or being unable to grasp even basic medical terminology.

The health of 90 million Americans is at risk due to difficulties understanding and evaluating medical information. In other words, low literacy can be hazardous to your health - fatal, even. In fact, the issue of low literacy crushes our already strained healthcare system with an additional $73 billion in costs, with annual healthcare costs for low-literacy patients quadrupling those of their literate counterparts.

The link between literacy and health is shocking- and obvious. According to the American Medical Association, literacy is a better predictor of health status than age, income, education level, employment status and race or ethnicity. Furthermore, a recent study revealed a relationship between low health literacy skills and life expectancy.

Patients with low health literacy report worse oral communication with their doctors than patients who can read. Therefore, chronically ill patients who lack basic literacy skills know significantly less about their disease than the literate sick. While the medical community has many ways of educating patients about their diseases, their efforts often neglect disparities in patients' literacy skills.

The doctor-patient relationship must take varying literacy skills into account, but that will not likely happen without increased and focused attention on the facts of low health literacy. Experts recently revealed that doctors commonly misjudge their patients' literacy levels. As a result, the health care these patients receive may well be compromised. When the doctor incorrectly assumes that a patient can follow directions, read a prescription bottle label or ask the right questions, the patient may leave the examining room without a clear understanding of what to do next. Such an easily preventable gap in communication may prove to be harmful, even fatal.

Our healthcare system must learn how to better detect and, consequently, take action around the issue of low literacy. But let us not put the entire burden on its shoulders, for low literacy is a societal problem. Low-literacy patients are often adept at hiding their handicap from authority figures and even from loved ones. They may develop elaborate strategies, frequently out of shame and embarrassment, in order to mask their deficit. When, and only when, we, as a society become more understanding, compassionate, and supportive surrounding the realities of low literacy can the urge to conceal this handicap be remedied. As a society, we must start by resisting this concealment ourselves, by bringing to light the facts and risks of low literacy.

We are not without a cure. There is an effective prescription for reducing health illiteracy along with its related societal costs.

We can do more. Our schools need to work health literacy into the curriculum. Public libraries, community organizations, senior and adult education centers, and consumer advocates can raise health literacy higher on the agenda. Most importantly, government funding for adult literacy programs, which is now grossly inadequate, must increase.

It is those of us fortunate to have the ability to read this simple prescription who must work together to act on it.

Susan A. McLean is executive director of Literacy Partners, a New York City-based nonprofit organization that provides free classes to help thousands of adults learn basic reading, writing, math and English language skills. Literacy Partners can be reached at 212-725-9200.