It's no secret that there are problems in the U.S. health care
system. Costs are high. Rates of chronic diseases are high. There's
a provider shortage. The immigrant and minority population is
rapidly increasing, as care disparities continue to prevail. But
the biggest problem is our inability to communicate within the
health care system.
Speaking at the Center
for Health Literacy's conference, Plain Talk in Complex
Times, Chris Gibbons, the associate director of the Johns Hopkins Urban Health
Institute discussed what he calls a coming health care
communications crisis. I think he's on to something.
What's Driving the Communications Problem?
A full 40 percent of Americans-115 million people-cannot
understand health information. Poor health literacy impacts the
health care system in myriad ways-but at the top of the list is
patient trust, engagement, satisfaction, and adherence. If patients
don't understand what we're saying, they are much less likely to
trust us and to do what they need to do to comply with their health
And it's not that people are uneducated or illiterate. It's that
we've not done a very good job of explaining critical health care
information to them, and that can be dangerous. Check out this
video from the American Medical Association to see real people talk
about health literacy.
AMA Health Literacy Video
With the Affordable
Care Act set to introduce 30 million more people into the
health care system in 2014, we've got a serious issue on the
horizon with a short timeframe to fix it. According to Gibbons, the
annual cost of low health literacy is between $106 billion and $238
billion. Meanwhile, a
the report, Low Health Literacy: Implications for National Health
Policy, people with low health literacy more often use
emergency services, are less likely to properly control chronic
disease, and use preventative services and treatments, such as
childhood immunizations and mammograms less often. In turn, this
impacts readmissions and reimbursements, waiting times, and
downstream, health disparities. Individuals with low health
literacy have increased use of emergency services, are less likely
to be able to control chronic diseases such as diabetes, and have
lower use of preventive procedures, such as early childhood
immunizations and mammograms.
Moreover, in 2007, 55 million people (20 percent of the U.S.
population) spoke a language other than English at home. What are
they speaking? 62 percent are speaking Spanish, Spanish Creole, and
Ladino. Indo-European languages, including most languages of Europe
and languages of India are spoken in 19 percent of homes in the
United States. Asian and Pacific languages are spoken by 15 percent
of the populations. And all other languages account for the other 4
What's more, 50 percent of people who don't speak English at
home said they did not speak English very well. This number is even
higher among older people. For instance, 65 percent of Spanish
speakers older than 65 reported that they were unable to speak-or
understand-English very well.
Bottom line: The number of people with poor English
fluency is increasing, and it's not just happening in states with
large immigrant populations, such as New York, Texas, Florida, and
California. It's happening in your city, in your state, and
in your facility. For more on language barriers and their effects
on patient care, check out this
post from, Gretel Galo, a materials coordinator at MMG.
So what can we do?
Right now, we still have a one-time, paper-based, word-dense
style of communicating. But Gibbons says the future is in
technology. Information that is available electronically, that you
can take anywhere, and that can be accessed by any device is the
way of the future. Video- and graphic-based information that is
culturally appropriate is also key.
Here are some tips for helping readers understand health
information courtesy of McGee & Evers Consulting's Quick
Checklist for Plain Language:
- Write in an active voice
- Use words that are common and familiar to the intended
- Use acronyms, abbreviations, technical terms, and legal terms
only in the readerneedsto know them, and they should be explained
if they are used
- Paragraphs should be on one topic and should be brief, with
simple and straightforward sentences
- Terms should be used consistently
- Instructions should be brief, step by step, and placed where
the reader needs them
- The writing should be cohesive, making connections among ideas
to help readers understand and absorb new information