The Healthy People initiative provides science-based 10-year national objectives for improving the health of all Americans. The program is founded on the idea that setting objectives and tracking progress can engage people and motivate action (Healthy People Press Release, 2010).
Health communications: People and platforms
One of the goals of Healthy People 2020 is to:
Use health communication strategies and health information technology (IT) to improve population health outcomes and health care quality, and to achieve health equity.
Expanding definitions of health literacy
If you’ve investigated the issue of health literacy before, you’ve probably come across this definition:
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
-Healthy People 2010
As noted on the Healthy People Web site, health information and health care access issues have become more, not less, complex. A wide-range of competencies are implicated by this definition. Individuals who have proficient health literacy must have the ability to:
- Read and identify credible health information
- Understand numbers in the context of their health care (numeracy)
- Make appointments
- Fill out forms
- Gather health records and ask appropriate questions of physicians
- Advocate for appropriate care
- Navigate complex insurance programs, Medicare/Medicaid, and other financial assistance programs
- Use technology to access information and services
All of these many competencies may be required at times when individuals feel particularly vulnerable and even well-educated people can find some of these competencies very daunting.
Poor health literacy has serious human and economic consequences.
Disparities in access to health information, services, and technology can result in lower usage rates of preventive services, less knowledge of chronic disease management, higher rates of hospitalization, and poorer reported health status.
(Berkman, DeWalt, Pignone, et al., 2004)
As reported by the American Medical Association (AMA), poor health literacy is “a stronger predictor of a person’s health than age, income, employment status, education level, and race” (AMA, 1999).
The 3As of health information
Because 9 out of 10 Americans struggle with health literacy issues, any health communication effort must consider how health information is framed and delivered to achieve the 2020 objectives. Healthy People 2020 reiterates the “3As” identified by National Action Plan to Improve Health Literacy (2010), stating that health information must be:
Information must also be targeted and tailored. Thus, an objective of Healthy People 2020 is to provide personalized self-management tools and resources for health. Additionally, the initiative recognizes the important role of social support networks in promoting health care and health equity.
Creating effective patient-centered medical teams
Health literacy and the effectiveness of patient-HCP partnerships are intimately connected. Effective communications require the ability to create shared understanding. Therefore, health literacy efforts are not just aimed at individuals trying to navigate the health care system but at health care providers as well since they must be able to assess patients’ medical histories and the important, and personal, quality of life issues that can impact treatment decisions. While it’s true that doctors can only recommend health care strategies and treatments, for patients with poor health literacy, these recommendations may be viewed as prescriptive or ignored. In either case, the element of choice is removed or significantly diminished.
Health literacy efforts, therefore, must target at least:
- K12 education
- Adult education
- Medical education
- Continuing medical education
Further, education efforts should be continuous and community-centered.
Strategies, programs, and health innovations
It’s beyond the scope of this article to discuss the many programs that are currently underway to promote health literacy, though I’ll try to highlight some innovative ones in future posts.
An emerging issue that’s particularly worth noting is raised on the Healthy People 2020 Web site:
Social media and emerging technologies promise to blur the line between expert and peer health information. Monitoring and assessing the impact of these new media, including mobile health, on public health will be challenging.
You can help address this challenge on many levels:
- By helping a friend or relative find and evaluate online health information and develop questions for his/her doctor
- By becoming familiar with how you can use social networks for social good
- By increasing awareness of health literacy issues using your personal learning network/social networks
- By sharing credible health information and good health resources with others using your personal learning network/social networks
- As a teacher or parent, by considering some of the suggestions identified here
- By volunteering
- By taking the STEPP approach defined in the National Action Plan to Improve Health Literacy (2010)
- By taking part of the myHealthyPeople Application Developer Challenge (or more generally, becoming involved in a challenge at Challenge.gov)
- By using plain language, if you are creating health information materials as part of an education or training program (some considerations for designing online materials are described here)
- By playing an active role in your own health care and speaking up about your needs and desires for a positive partnership with your doctor
Please share any other approaches you feel have been successful or lessons you’ve learned when tackling health literacy challenges. Although this posting has been about an initiative in the US, it’s useful and important to share approaches and best practices in communities outside the US so we can learn from each other.
Some additional health literacy resources
You can access my health literacy resources here (they’re continually being updated) or join this Diigo Group to share resources. This Symbaloo webmix of mlearning and mhealth resources may also be of interest. You can also follow @GoHealthyPeople on Twitter, subscribe to their YouTube channel, and find them on LinkedIn.
American Medical Association. (1999). Report on the Council of Scientific Affairs, Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs. Journal of the American Medical Association, 281(6), 552-7.
Berkman N.D., DeWalt D.A., Pignone M.P., et al. Literacy and health outcomes: Summary [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2004 Jan. 8 p. (AHRQ publication; no. 04-E007-1); (Evidence report/technology assessment; no. 87). Available from: http://www.ahrq.gov/clinic/epcsums/litsum.htm
US Department of Health and Human Services. (2010).HHS announces the Nation’s New Health Promotion and Disease Prevention Agenda [Press Release]. DC: OASH Press Office. Retrieved from http://www.hhs.gov/news/press/2010pres/12/20101202a.html
US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (June 2010). National Action Plan to Improve Health Literacy. US Department of Health and Human Services. Retrieved from http://www.health.gov/communication/HLActionPlan/