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Improve Health Literacy in Poor Communities: Start a literacy program

 
Health Literacy: An economic issue
In the US, literacy has long  been addressed as an economic issue, a pre-requisite for a productive workforce in a competitive global economy.  Some scholars argue that political campaigns to address adult low literacy have been undertaken repeatedly in the US and elsewhere to explain or distract attention from economic downturns, most recently in 1991 by  GH Bush[1], That campaign produced the the 1992 National Adult Literacy Survey. Results led academic medical researchers to discover a glacier in their backyard — the fact that few Americans understand information from  healthcare organizations, doctors, pharmacists, and health insurers. The first health literacy studies in the medical literature came out in 1993. 

Workers' low literacy as an explanation for national economic woes extended to patients' low literacy as an explanation for low quality, high costs and inequities in healthcare.  Health literacy was understood as low functional literacy (reading and numeracy) in a clinical setting. The thinking went like this: if patients could read better, they would better understand their disease and treatment instructions, and so comply. Outcomes would improve and we would avoid unnecessary expenses like ED visits,  re-testing and re-admissions. That thinking led to much needed information-improvement initiatives.
 
High demands of complex systems increase negative impact of low skills
Recent policy documents acknowledge patients' ability to understand and use information for health is determined not only by their personal skills (or lack of them) but also by the demands and complexities of the healthcare system [2] . That recognition is leading to initiatives to redesign services and remove barriers to access and participation.
 
Health Literacy: A health issue linked to individual & community context
In a new leap forward in thinking about HL, the National Academy of Medicine (formerly IOM) has released a discussion paper suggesting that a person's HL is intrinsically linked to an individual’s and a community’s socio- economic context, and is a powerful mediator of the social determinants of health [3].  This suggests health literacy is  strongly influenced  by the demands and complexities of the home and social context. It makes HL a public health issue, a pre-requisite for an equitable health system, and  key to achieving health equities. At a recent IOM workshop, experts discussed the role of the social determinants of health in health literacy and the need to move health literacy intervention into the community [4]. (Can you hear me applauding?)
 
Healthcare organizations should lead adult  & family literacy efforts
It is becoming clear that literacy is not just an economic issue, but a matter of personal and public health. There is no getting around the fact that health and literacy are inextricably linked. More literacy —  more health, and more health literacy.  In communities where low literacy is the norm, where high school graduation rates are low and schools are poorly funded —these are the same communities with high incidence of asthma, diabetes, cancers—, healthcare organizations should establish, house and  and actively support adult literacy and family literacy programs. High returns can be expected from a relatively low investment. Such a program can make good use of facilities that typically are vacant in the evenings and on weekends; and provide good marketing opportunities while building the community's capacity for health and making participants more prudent healthcare consumers. A healthcare-based  literacy program  that incorporates health education and health literacy improvement can make everything easier and more efficient for the participants and for the organization that provides their healthcare.
 
References
1.     Hourigan, M.M. (1994). Literacy as social exchange: Intersections of class, gender, and c Albany, NY: State University of NY Press.
2.     Logan, R. (2015). Health literacy research’s growth, challenges and frontiers in C. Arnott-Smith and A. Keselman (Eds.). Crucial conversations: Meeting health information needs outside of healthcare. New York: Chandos, In Press.
3.     Health Literacy: A Necessary Element for Achieving Health Equity. Robert A. Logan, Winston F. Wong, Michael Villaire; Gem Daus,Terri Ann Parnell, Earnestine Willis & Michael K. Paasche-Orlow, Full text at: http://nam.edu/perspectives-2015-health-literacy-a-necessary-element-for-achieving-health-equity/   
4.     Health Literacy: Past, Present, and Future: Workshop Summary. Joe Alper, Rapporteur .
This PDF is available from The National Academies Press at http://www.nap.edu/catalog.php?record_id=21714
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