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Health literacy can save many patients and hospitals from dying!

Dr. R.Kumar

President Society for Promotion of Ethical and Affordable health Care

Health literacy (HL) is the capacity to obtain, process and understand healthcare  information and services needed to make appropriate decisions in the area of wellness as well as patient- care. HL is one of many factors that lead to the acquisition of knowledge, positive attitudes, self-efficacy, positive health behaviors, and better survival. This gives a sense of control and confidence to individuals to gain access to and understand aspects of health promotion for themselves, their families and their communities. It further helps in mobilizing communities to address the social, economic and environmental determinants of health. Low HL on the other hand, has been found to be associated with lesser use of preventive services, and excessive use of emergency services, with high costs and dismal outcomes. Besides increased hospitalizations, patients with poor HL have high incidence of adverse drug reactions and nearly two-fold higher risk of death. In addition low HL is associated with failure to seek timely medical help, lower rate of vaccination in children, increased burden of sexually transmitted diseases in youth, inability to interpret and follow through with prescribed medications in the elderly and consequently higher morbidity.

HL is critical to empowerment of communities against emerging threats such as from the pandemic influenza, climate change and non-communicable diseases. Similarly, patients suffering from acute conditions like acute coronary syndrome or severe infections– those with lower HL are more likely to die than those empowered with HL, studies have revealed. The theme of this year’s World Health Day  is Universal health coverage (UHC), which includes preventive care, medical treatment and palliative care. Can UHC succeed without HL?

Indian scenario

In India at least nine out of ten adults suffer from low HL. It is reported that even in US and UK more than 50% people have low HL and the cost of ignorance is about $ 200 billion in US alone. People with low HL harbor myths about food and exercise, lack knowledge about symptoms of diseases or have misinformation about the body functions or use of medicines from different pathies. Lack of HL coupled with expanding population also poses a threat to our nation’s economic stability as patient- care expenditures are on the rise. India also has an unusually high rate of general illiteracy and stark poverty, both of which contribute to low rates of HL. Unhealthy life style caused due to low HL, leads to repeated hospital visits and this is one of the several causes that hospitals like PGI are moribund. Similarly rushing  patients  to such hospitals, when declared as ‘unlikely to survive’ by  referring doctors, is in fact ’Choking the hospitals with dying patients’. This is a myth that with advanced medicine, surgery, devices and technology an institute like PGI ensure survival, even to the terminally ill.  Unrealistic expectations and attendant violence against doctors are also part of the low HL. Thus lack of HL can be the underlying cause of many deaths due to ignorance as well as killing burden on tertiary hospitals. Can the nation afford death of its premier institutes with overload of dying patients?

Universal Health Literacy (UHL) may be better option

UHL is more comprehensive understanding, which aims to influence not only individual lifestyle decisions, but also raises community awareness of the determinants of health, and encourages individual and community actions, which may lead to modification of these determinants. It goes beyond a narrow concept of reading pamphlets or school health education and addresses the environmental, political and social factors that determine promotion as well as maintenance of good health for all. The skills under UHL include:  reading, writing, listening, speaking, numeracy, and critical analysis, as well as communication and interaction skills in the area of health, healthcare, health administration and patient education. It also includes study of working conditions (e.g., exposure to common pollutants and dangerous substances, such as lead, asbestos, mercury), as well as physical demands (e.g., carrying heavy loads), besides availability of basic needs like adequate and clean water, proper breathing and enough oxygen, appropriate foods, right exercises, exposure to sunshine, peace of mind etc. 

Health literacy also involves a range of abilities, including the following:

  • Navigating the health care system (includes filling out forms, finding appropriate doctors).
  • Describing symptoms and sharing personal health information
  • Knowledge: how the body works, types of disease and causes.
  • Connecting lifestyle (smoking, drinking, diet and exercise) with health.
  • Weighing risks and benefits of medical tests and procedures.
  • Health insurance literacy to avail  health care services
  • To get a second opinion in case treatment is invasive or expensive
  • To gather all the information; where questions tend to answer themselves.
  • To be your own advocate. No one knows you better than you.
  •  Partner with your doctor.
  • To be familiar with normal values viz correct doses. Blood sugar levels, cholesterol levels and nutrition labels etc.


March to healthy and developed India

HL is an area where the focus is missing. It cannot be stressed enough that there is a need for health policies and strategies that address the issue of HL. HL can be used as a tool for empowerment of people by their own participation not just by interventions by doctors. Better government policies can be, thus, drafted for further improvement in health services. The school and college curriculum must include ‘body literacy’ from the primary classes onwards to sow the seeds of HL in the young vulnerable minds, so that they grow into healthy adults. Reducing the availability of junk foods, ban on advertisement of unhealthy foods, highlighting perils of obesity and excessive use of mobile phones, sensitizing the media to preach HL are essential. A health-literate India would be a richer and more productive country and if we want to become a developed country, this is one of the first hurdles we need to cross.

 The Tribune 4th April 2019

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