Health Literacy _amp; Health Disparities

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					 Health Literacy &
 Health Disparities

       Jann Keenan, Ed.S.
DC Convention Center, May 20, 2008
    The travesty of health
    care disparities

“It’s intolerable that a in nation as wealthy
as ours, there are people who cannot get
        the right care at the right time”
         Richard Carmona, June 14, 2003 AMA House of Delegates Meeting)
 Today’s Goals

After today’s talk you will walk away with…
 Part 1: An understanding of the impact of low
    health literacy on health outcomes
 Part 2: Next steps you can take to get a health
    literacy initiative going in your area. To get
    providers on board.
Which is the biggest predictor of a
person’s health status?

 Age
 Income
 Literacy Skills
 Job status
 Education
 Racial or ethnic group
Literacy skills— yep! How well you
can read and understand!
Greater % of ethnic groups and seniors
 The majority of those with low literacy skills in
  the United States are white, native-born

 Yet ethnic minority groups and seniors are
  disproportionately affected by low literacy.
  (the Center for Health Care Strategies)
The numbers = real people

   50% of Hispanic Americans
   40% of African Americans
   33% of Asian Americans
   66% of US adults age 60 plus
Here in the District
 Literacy skills substantially lower than those
  in the US overall                              1

 36% of DC adults have functional illiteracy
  versus 21% nationally.
 Translation: 1 in 3 in DC versus 1 in 5 in the
        (FI means trouble with bus schedules, reading maps, filling out job applications) 2

 1 DC State of the Workforce Report, 2003    2 Phase 1 of the 2204 Study by State Education Agency
One contributor from report
 Growing number of Hispanic and Ethiopian
  residents who are not proficient in English
Leap to Functional Health Literacy

 The degree to which individuals have the capacity to obtain,
   process, and understand basic health information and services
   needed to make appropriate health decisions. (IOM and Parker)
In plain English . . .
 A person ability to understand and act on health information.
We’re All at Risk . . .
 People of all ages, races, incomes and
  education levels are challenged by low health
     The accountant who can’t fill out insurance
     The provider who speaks “medicalese”
     Anyone who doesn’t know “take on an empty
      stomach” or “light snack” means
Still . . . at most risk . . .
 Economically disadvantaged
 Older adults
 Chronically ill most at risk   (Prudential study)

 Ethnic groups. African Americans and HPB,
  sleep problems, heart attack, stroke. Latinos
  and diabetes.
Widespread problem
 Low health literacy is a threat to the health
  and well-being of Americans!
 Many patients don’t understand the best way
  to take care of themselves and prevent
   When Patients Don’t
   Understand. . .

 People with limited literacy skills:
       Have poorer overall health

       Use health services more often

       Are less likely to go to screenings

       Are more likely to be hospitalized

       Seek treatment in later stages of disease
 Have less understanding of their treatment
  and less adherence to medical regimes
Significant relationship between good
health and literacy
 Adults with lower-than-average reading skills
  are less likely to get
     Screening tests such as mammograms and
      Pap smears
     Flu shots and pneumonia vaccines
     Their kids to well child visits and more . .

Surprising Stats

 2,659 patients were surveyed
   On an empty stomach--1,100 off base
   Next appointment--691 perplexed
   Upper GI tract XRay--886 in the dark
   Informed consent form--1,582 didn’t get it
Or this?
Lofty materials/not speaking to culture
 When low-income Hispanic and African
  American women got culturally appropriate
  materials/easy-reads- smoking during and
  after pregnancy went down!  (Lillington, 1995)

 SNAP (Stanford Nutrition Action Program)
  worked for people with low-literacy. More diet
 23 folks with low-literacy and heart failure had
  100% weigh in compared to 32% without
  easy-to-read materials
When materials and information are
not clear
 75 African American women being treated for
  HPB (CDC. 1990)
     54 said they had “pressure trouble” or
     32 believed they had 2 diseases
          “High-blood” a disease where the blood was too
           “hot” “rich” or “thick.
          “High-pertension” a condition where blood would
           “shoot up “ toward their head when they were
           emotionally excited and “fall back” as they calmed
For the 32 women using folk meds
 The treatment for the “high blood”
     lemon juice, vinegar, or garlic water to “cool
      and thin” their blood so it would drop t o the
      lower level in the body
 The treatment for the High-pertension
     lower stress by not eating pork, hot, or spicy
      foods, or grease
 Message to providers-listen about folk
  medicine. Have respect . . .
Low health literacy is a threat to the
well-being on the medical system

 REPORT: Low Health Literacy: Implications
  for National Health Policy
 $106-$236 per year. U of CT in Oct 2007
Adequate health literacy
 Essential to promoting good health—
  especially in preventing disease
 Instead of helping folks stay healthy . . .
We treat them when they are sick . . .
Well, sometimes
Review and take aways from Part 1
 Most materials are lofty and not culturally
  relevant.   (Grade 10 or above. Nearly 1 out of 2 US adults read at grade 8 or lower)

 Ineffective communication and low health
  literacy combine to affect patient safety and
  health outcomes.

 Everyone is at risk- yet ethnic groups,
  chronically ill, poorer, and older adults at
  most risk!
On to Part 2-
The Best Part

Turning the tide! Some Solutions!
What providers can do
 Slow down.

 Use analogies

 Use “living room” language
    Benign = not cancer
    Lateral = side
    Anaphylactic reaction = shock, throat closing
    Oral= by mouth
    Monitor = watch
    Hypertension = blood pressure
And there’s more . . .
 Limit information given at one time. Repeat and
 Show or draw pictures
 Use “teach back” or “show me”
 Be respectful, welcoming, and caring
      Consider culture “saving my last nerve” “falling out”
       “evil” on the “down low. low ”
      Ethno-medicine—herbs. Spirit moves me.
      Encourage questions.

The Outcome? A way to empower patients to
participate in their own health care
What communities can do
Transformational change through
“Community Youth Mapping”
In the selected cities, youth help
1. How many people in the community have
   problems with health literacy
2. Where the average person can go to get
   help understanding their health paperwork
3. If doctors & hospitals have support in
   creating health literate materials
4. If pharmacies have programs to help
   people understand their medicines

5. If written materials are tested in the

6. If adult literacy programs include
   health lit examples
Who can help make a change in the

 Adult end classes can add health content to
  their adult literacy classes.
 Elder organizations can help senior citizens
  understand their medicines & provide tools to
  remember when to take meds
More ways!
 Patient advocacy groups can provide tools to
  prepare for a doctor's visit
 Local advertising & marketing agencies can
  volunteer their services to test print materials
  for readability & comprehension.
Health professionals collaborate in
 Michigan Dept of Community Health (2003)
 Employed cultural competency and health
  literacy techniques
 92% of docs are Caucasian and Asian/PI
 Difficulty in effective cross cultural
 Established a “shame-free” environment
AMA.ORG for Tool Kit- 35 bucks
Free, free, & low fee for Ask Me 3
The “Ask me 3” questions

       1.   What is my main problem?

       2.   What do I need to do?
            Why is it important for me to do

Safe Use of Medicines—FREE!
Take your medicines the right way - each day!
An easy-to-read booklet from the National Institute on Aging.
This booklet offers practical tips to make sure you are taking all your medicines the right way:

• Medicine safety

• How to stay on track and get the best results from your medicines

• Questions you should ask your doctor and pharmacist
More patient centered communications

 What did the doctor say? White paper 2/07
  describes interventions to improve the ability
  of patients to understand complex medical
 Hospitals, Language, and Culture.3/07
  Report recommends strategies of 60 US
  hospitals providing health care to diverse
 Speak Up Program 3/02 with Brochures on
  surgical safety, infection, preventing med
  mistakes, patients rights.
Joint Commission & Iowa Health
 Grant proposal in review
 At the NIH
 To develop new evidence-based performance
 To provide critical information about how well
  hospitals address the health literacy needs of
To review next steps
 Doctors can improve communication by
  looking to Ask Me 3 and AMA tool kit.
 Communities can seek grants for community
  youth mapping.
 Can get freebies from the Gov’t and the Joint
  Commission and Gov’t.
 Can look at best practice & do it!
 Can encourage more funding for literacy
  programs to include health teachings
Bottom line
 Each one- Teach one
 Spread the word!

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