The health literacy deficit

New Senate legislation would provide much-needed tools to address this continuing health problem.

Posted Jan. 28, 2008.

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Think about the complicated treatment regimens with which your patients grapple.

An American Medical Association Council on Scientific Affairs report used the example of an asthma patient. This patient needs to know how to monitor his or her condition with a peak flow meter. He or she also has to understand how to select and use inhalers, utilize rescue or other medicines, and avoid triggers that could cause an attack. And the patient should know when to go to the emergency department, a primary care physician or a subspecialist.

Of course, this list includes only a slice of such a patient's daily self-care activities. And information -- as well as the reading and computational abilities to process it -- is critical to success.

It's a skill set known as health literacy -- a term of art defined by the Institute of Medicine as the degree to which people can gather and understand the basic health information and services needed to make sound decisions. Unfortunately, about 90 million people in the United States fall short. The results can be tragic.

Numerous studies have shown that patients with poor health literacy have worse health status than do those who are more proficient. They tend to face strikingly higher mortality rates. And those with chronic diseases, such as diabetes, asthma or hypertension, have less knowledge about their diseases and treatments.

Because of this reality and its dire consequences, the AMA applauded the introduction late last year of the National Health Literacy Act of 2007. The AMA was the first national medical organization to adopt policy recognizing that limited patient literacy affects medical diagnosis and treatment.

The bipartisan measure, which was introduced by Sen. Norm Coleman (R, Minn.) and Sen. Tom Harkin (D, Iowa), represents important progress in the effort to address this critical health care issue. However, it also is clear that continued focus will be necessary if inroads are to be made against the problem.

AMA policy, first detailed in a 1999 council report, includes marching orders to move in this direction. And this bill, if enacted, would put in place many of these much-needed mechanisms.

Specifically, the AMA stresses that professional and public awareness of the health literacy issue must increase, beginning with education of medical students and physicians, and including improved physician-patient communication. The Association also urges that future research focus on optimal methods of screening patients to identify those with poor health literacy, as well as on effective health education techniques, outcomes and costs associated with poor health literacy, and the associations between poor health literacy and health status.

To this end, the Coleman-Harkin bill is designed to expand consumers' ability to obtain, process and understand essential health care information and services. Its objectives include not only improving the nation's overall health but also saving consumers and the health care system billions of dollars.

The measure would create a federal-level health literacy implementation center to gather and disseminate resources and best practices. It also would sponsor demonstration projects, coordinate research, assist other federal agencies, and set national health literacy strategies and goals.

In addition, it would establish state-based resource centers to identify and understand local health literacy challenges, coordinate public and private efforts to deliver services, and provide technical and policy assistance to state and local governments.

All told, this proposed legislation is a welcome sign of progress in efforts to raise awareness and trigger action to improve low health literacy. After all, patients need to be able to understand their medical diagnoses and treatments if they are going to fare well in the health care arena.

The senators who introduced this bill should be commended for bringing this issue to the forefront of the health policy discourse. Now, Congress should follow their lead.

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