Pre-Conference P18 Health Literacy by lpx20272


									First representative survey on health literacy in Switzerland

Health literate citizens: dream or reality?
The initial findings of a pioneering study expose shortcomings.

1250 respondents answering 150 questions in 30-minute telephone inter-views:
building on the original project in 2003, the Institute for Social and Preventive
Medicine (ISPM) at the University of Zurich has conducted the first-ever
representative survey on health literacy in Europe. It reveals that many citizens in
Switzerland are not able to properly exercise competencies for health. Although some
federal agencies have recently embraced the notion of health literacy, the healthcare
system and current policies are preventing health-conscious citizens from taking their
share of responsibility for their own health. The knock-on effect of this is
considerable: low health literacy costs the country some 1.5 billion Swiss francs and is
pushing the country towards a two-tier healthcare system whereby the socially
vulnerable are at a particular disadvantage.

“Patients want more say in their care, and providers want patients to take on greater
responsibility. Yet there are no incentives for this in our system, which is not yet equipped
to handle these new demands and their consequences.” This was how Jen Wang, Senior
Researcher at the Institute for Social and Preventive Medicine (ISPM) at the University of
Zurich, summed up the findings of the “Future Patient” study in August 2003.

Participation in treatment decisions                    Since then, a new concept has caught on
                                                        in Switzerland: “health literacy”. Health
                                                        literacy describes the ability of an
                                                        individual to make decisions and act in
                                                        favor of his/her health in daily life – be it
                                                        at home, at the workplace, in the

                                                        healthcare system or in society at large.
                                                        Or as Prof. Ilona Kickbusch puts it:
                                                        “Health       literacy    strengthens   self-
                                                        determination and freedom in making
          10                                            health-related decisions and improves a
          0                                             person's ability to find information about
                Desire                 Experience
                                                        health, understand that information and
 85% of respondents want to be actively involved in
 making medical decisions, but only 49% were actually
                                                        translate it into action.”
 involved by their GP to the extent desired.

Gap between preferences and the possible
Building and expanding on the Future Patient project, ISPM conducted 1250 telephone
interviews in Switzerland on the topic of health literacy in May of this year. The initial
findings are striking: 85% of respondents want to be actively involved in making medical
decisions, but only 49% were actually involved by their GP to the extent desired.
Moreover, research repeatedly shows that patients would like to have a choice of treatment
options, yet only a quarter of respondents say that their GPs always suggest therapy
alternatives. This is despite the fact that people are well aware of the difficulty of health-
related decisions: roughly 60% of respondents regard choosing a treatment or a drug as a
moderately to highly complex task.

In certain areas, of course, people may – indeed, must – make choices, such as selecting a
sickfund or a GP. Almost all of the respondents want freedom of choice which in their
opinion strengthens trust. However, just half believe they have enough information to
choose the right sickfund or the right doctor for themselves.
The media play a pivotal role in the search for information: of the five most cited sources of
health information, three belong to the media. The Internet has become the third most
important source of health information ranking just after GPs. Admittedly, the information
currently available has not necessarily contributed to greater comprehension: a mere 26%
say that the information in the media is easy to understand.
Sources of health information

  Newspapers/ Magazines
     Friends and relatives
                Radio/ TV
            Private sector
    Patient organizations
           Public service

                              0   5   10   15    20       25     30      35   40   45    50

                                            Main source   Additional source

Low health literacy costs 1.5 billion Swiss francs
Other sources also highlight the importance of health literacy. In a strategy paper
commissioned by the Swiss Federal Office of Public Health (FOPH), the Office for
Employment and Socio-Political Studies (BASS) in Bern estimates that insufficient health
literacy accounts for around 3% of health spending or 1.5 billion Swiss francs. The BASS
strategy paper concludes that insufficient health literacy has an impact on all of the
objectives of the national health insurance scheme. The principle of solidarity between the
healthy and the ill is being eroded because people with low health literacy fall ill more
often, and BASS believes this will ultimately undermine the principle of solidarity between
rich and poor.

“We are taking responsibility for our health.”
The findings from the Future Patient study released in 2003 had already brought to light
blatant discrepancies between citizens and stakeholders in the Swiss healthcare system.
Although providers are aware that tomorrow’s patient wants to take on greater
responsibility, they have little faith that he/she will actually do so.

However, the new survey shows clearly that citizens are playing an active role in their own
health. Prevention is a very high priority and the vast majority are already doing something
for their health – 86% by taking regular exercise and 86% by eating healthy. In addition,
82% of respondents say that they often treat minor problems themselves, while 68% are
very keen to engage in more self-treatment. These activities pay off, with 64% of
respondents avoiding a visit to the doctor in the last 12 months.

Are decision-makers doing their part?
In addition to capturing citizens’ preferences and skills, the survey findings also shed light
on existing shortcomings such as unfavourable structures and policies which impede high
health literacy. This raises some key questions about context: how can health literacy be
promoted? Is this the duty of the federal government, the cantons, a new agency, the
media, industry, sick-funds, or patient organizations? What’s more, the line between good
health and illness is gradually blurring. Is a person diagnosed as being at primary risk of a
heart attack still healthy, or already ill? Does health literacy also mean people becoming
aware of potential risks, independently assessing their risk and thereby being able to avoid
illness or, with the right treatment, to prevent the illness from progressing?
Who should make treatment decisions?                                            The initial findings of ISPM
                                                                                show that the patient of the
                                                                                future, predicted three years ago,
                                                                                is already a reality. The paradigm
          50                                                                    shift is well underway. Health

          40                                                                    literacy is a genuine necessity in
          30                                                                    a modern information society.
          20                                                                    The wide gap between what
          10                                                                    citizens want to do and what they
          0                                                                     are able to do is problematic,
               Ticino 1993       Switzerland    Switzerland     Switzerland     however, and should therefore be
                                   1997           2002            2006          regarded as a call to arms for
                       Patient     Patient and doctor equaly   Doctor           policymakers, industry (e.g.,
                                                                                sickfunds), and the media.

The latest findings lend new relevance to Jen Wang’s comments on the patient of the future
at the press conference in August 2003: “Citizens are willing to seek solutions and
contribute to their implementation. In order for this to happen, they will have to be better
informed and their preferences need to be taken into account in policy discussions.”

Swiss Health Literacy Survey (HLS.CH)
When it comes to their health, the Swiss would like
to take more personal responsibility. However, they
are often unable to do so – either for want of the
necessary skills or because they have no access to                            Merck Sharp & Dohme-Chibret AG
clear information. These are the initial findings of a                        Schaffhauserstr. 136
representative survey conducted by the Institute for                          8152 Glattbrugg
Social and Preventive Medicine (ISPM) at the                        
University of Zurich.
The Future Patient Project is supported by MSD                                Stefan Wild, Director External
Schweiz, a subsidiary of Merck & Co., Inc., which                             Affairs, Tel.: 079 467 15 80
has its headquarters in the USA. The Sezione                                  Alexander       Rödiger,    Manager
Sanitaria of the canton of Ticino also made a                                 Healthcare Affairs, Tel.: 079 619 98
financial contribution to data collection.                                    19

For further information, please contact:
Jen Wang, MPH
Institute for Social and Preventive Medicine
University of Zurich
Hirschengraben 84, 8001 Zurich
Telephone +41 (0)44 634 46 49

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