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September 1, 2014, 1:39 am

The real health reform – literacy

Aside from President Barack Obama’s health care law being upheld by the U.S. Supreme Court last week, there is an issue, which will continue to cause needless suffering, death, and costs: health literacy.

Health literacy is defined as: the degree to which individuals have the capacity to obtain, communicate, process and understand the basic health information and services needed to make appropriate health decisions.

In other words, health literacy is the ability to make good health decisions every day.

More than 90 million people in the United States — about the same number of people in France, Belgium and the Netherlands combined — have a hard time understanding and using health information.

This means that the health of 90 million people in the U.S. may be at risk because of the difficulty some patients experience in understanding and acting upon health information.

A closer look at recent statistics shows that one out of five American adults reads at the 5th-grade level or below, and the average American reads at the 8th- to 9th-grade level, yet most health care materials are written above the 10th-grade level.

According to the Center for Health Care Strategies, a disproportionate number of minorities and immigrants are estimated to have literacy problems:

• 50 percent of Hispanics

• 40 percent of Blacks

• 33 percent of Asians

In fact, more than 66 percent of U.S. adults age 60 and over have either inadequate or marginal literacy skills, and 50 percent of welfare recipients read below fifth-grade level!

So, imagine what this means in major urban cities around this country where the populations are mostly brown and Black people.

Never mind that all of these cities have world-class medical centers, hospitals, and the latest in pharmaceuticals and treatments. They mean nothing to people who are disproportionately sicker, poorer, and uneducated. How is it possible for them to benefit?

And it’s not just these poor souls who suffer. Low health literacy is an enormous cost burden on the American healthcare system — annual health care costs for individuals with low literacy skills are 4 times higher than those with higher literacy skills.

Patients with low health literacy and chronic diseases, such as diabetes, asthma, or hypertension, have less knowledge of their disease and its treatment and fewer correct self-management skills than literate patients. Patients with low literacy skills have a 50 percent increased risk of hospitalization, compared with patients who had adequate literacy skills. Only about 50 percent of all patients take medications as directed.

The research suggests that people with low literacy:

• Make more medication or treatment errors

• Are less able to comply with treatments

• Lack the skills needed to successfully negotiate the health care system

• Are at a higher risk for hospitalization than people with adequate literacy skills

In fact, just five percent of the U.S. population — those with the most complex and extensive medical conditions — accounts for almost half (49 percent) of total U.S. health care spending, and 20 percent of the population accounts for 80 percent of total spending.

In medicine, a chronic disease is a disease that is long lasting or recurrent. The most common chronic conditions are high blood pressure, diabetes, arthritis, high cholesterol, and respiratory diseases like asthma and emphysema. These are the very conditions commonly mentioned when we hear talk of “health disparities,” in reference to minorities and people of color.

In Pennsylvania, like other states, chronic diseases are the leading cause of death and disability and account for 80 percent of all health care costs. About half of all Pennsylvanians have a chronic disease, including diabetes, asthma, heart conditions, and others. God only knows how severe this is in a city like Philadelphia!

Thirty-seven percent of Philadelphia public school students who start 6th grade will drop out but before graduating, and, according to my research, 34 percent of the city is on Medicaid. For African-American males, that number jumps to 43 percent, and it’s 51 percent for young Latino men.

Poor and uneducated, what hope is there to live healthy and productive lives?

Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need. Individuals with inadequate functional health literacy often struggle with basic tasks when managing a chronic condition such as reading and comprehending prescription bottles, appointment slips, self-management instructions and educational brochures. Inadequate functional health literacy can be a barrier to controlling disease and can subsequently lead to poor health outcomes and increased health care costs.

So, while we all sit back, comfortably, and watch the dismantling and devaluing of our traditional public school system, consider this:


  • Reading abilities are typically three to five grade levels below the last year of school completed. Therefore, people with a high school diploma, typically read at a seventh- or eighth-grade reading level.
  • Every school day, more than 7,200 students fall through the cracks of America’s public high schools.
  • Three out of every 10 members of this year’s graduating class, 1.3 million students in all, will fail to graduate with a diploma. The effects of this graduation crisis fall disproportionately on the nation’s most vulnerable youths and communities.
  • A majority of non-graduates are members of historically disadvantaged minorities and other educationally underserved groups. They are more likely to attend school in large, urban districts. And they come disproportionately from communities challenged by severe poverty and economic hardship.
  • The average adult in the United States reads at an eighth-grade level yet most patient education materials are written on a high-school or college reading level!

Over the years, I have become absolutely convinced of the intersection between health and basic education, and I have witnessed countless horror stories to prove it.

Hospitalizations; Clinical Trials; Medication Errors; Unhealthy Behaviors … just to name a few.

Regardless of how the Supreme Court’s decision turns out, we have allowed our health and public education systems to degenerate, and the fact remains that all of us deserve to enjoy the ability to be healthy and to be educated. It’s not a privilege, it’s a right!

As we consider how to “reform” our public education system, we need to look at what we have become as a society.

Let me leave you with this:

“The most certain test by which we judge whether a country is really free is the amount of security enjoyed by minorities.”

— John E.E. Dalberg, Lord Acton, The History of Freedom in Antiquity, 1877


Remember, I’m not a doctor. I just sound like one. Take good care of yourself, and live the best life possible!


Glenn Ellis is a health advocacy communications specialist. He is the author of “Which Doctor?” and is a health columnist and radio commentator who lectures, and is an active media contributor nationally and internationally on health related topics. His book, “Information is the Best Medicine,” was released in January 2012. Contact him via his website: