Health literacy and health care systems
Health literacy, what is it? And who does it concern?
Health literacy is the ability of one person to obtain health related information and to use this information in such a way that this person can receive and follow the best treatment possible. It would be of no surprise to hear that people with difficulties in health literacy are people also having difficulties in basic reading and writing. We will see later together why low literacy and low health literacy are not always linked. This will just remind us of how complex of a problematic health literacy is to understand and how difficult it is to implement effective policies. But I think that no one, literate or illiterate, deserves a lack of good medical advise because of its impact on one’s health.
How can health literacy and low literacy not always be linked?
I was myself surprised when I realized that depending on the country you’re looking at, these two concepts are not always proportionate in the statistics! To give you some examples, Austria ranks quite high when it comes to literacy, it is in the average of several EU countries. But is has one of the worse health literacy rates in Europe! Here, numbers in health literacy and ‘basic’ literacy are not proportionate. How and why is that possible? Well, in Austria, the numbers can be explained by how the Austrian health care system is constructed. The Austrian health care system is doctor driven. It does not leave room for patients to participate or to some extent ask questions about the medical terms used by the doctors. Austrian hospitals are not known for health promotion, and it has a negative impact on people’s lives! Imagine the feeling of not being listened to and not being able to clearly understand what your doctor is telling you; it must feel terrible!
And when looking at another country like Spain, we can see that the situation is very different than in Austria. In Spain, the literacy rate is slightly under the EU average, the majority of the population scores lower than other European populations. Overall, we can say that Spain is not as good as Austria when it comes to basic reading and writing. But when we look at the health literacy rates, we can conclude that there are far less people with inadequate health literacy in Spain than in Austria.
With these examples, we can realize that people who are considered as literate can also be considered as health illiterate depending on the health care system and policies implemented!
So, can we all sometimes be health illiterate?
I think that no matter how literate you are, there are always going to be things that you don’t fully understand when you go to the doctor. As a literate person, you maybe just don’t want to bother your doctor by asking questions that are obvious to them. But for illiterate people who have major difficulties in understanding health jargon, asking what a word means and telling your doctor that you can’t read what they wrote on the prescription can reveal a weakness that you would’ve wanted to keep rather secret to avoid any kind of judgment. This is the product of a low literate taboo which is very much present in societies. But how could we make people feel more comfortable sharing their difficulties?
I personally realized when I was positive to COVID-19 how difficult it is, even for literate people, to have a clear understanding of what is asked from you. It was difficult for me to know what I was supposed to do but I gave a call to the Covid information line which helped me figure the situation out!
But COVID-19 is something we are all concerned by for the moment. Finding information about it is not as challenging as finding information about a disease you might have which is not talked about every day on the news. So, what should you do then?
How to help people with medical jargon? Implement policies?
Of course, ideally, there should not be a taboo about low literacy and low health literacy. Having no taboo would allow people to speak openly about their difficulties with their doctor and thus obtaining the right information about what their treatment is and how to make sure that they follow it. But we can’t oblige low (health) literate to be comfortable speaking about that… This is why I think there should be anonymous hotlines which everyone could call in order to be explained in easy words what their doctor told them. There are already hotlines for low literate people, the next step is having hotlines for low health literate people! Another possible thing to implement is giving classes throughout Europe to people who need them. These classes could make people better readers and writers and teach them how to communicate with easy vocabulary which would suit several situations a person might find themselves in.
Obviously, health literacy is something that is only briefly talked about in literature which makes it rather difficult to reach low health literate people. Reaching low health literate people could make it easier for governments to implement effective policies!
Hi Marie! I really enjoyed reading your blog, as it gave me a very interesting insight into health care systems and how various they can be. I was wondering, as you write about finding information in Belgium for people impacted by Covid-19, would you happen to know if Belgium proposes hotlines for health illiterate people in general? Or perhaps classes which can be taken in order to improve one’s health illiteracy? Thank you in advance 🙂
Hello Florine! Thank you for your interesting question!
I made some research to answer your question in the best way possible. In Belgium, there is a French-speaking Belgian association movement for the right to literacy for all. This association is called Lire & Ecrire (read and write) and can easily be found on the Internet. Lire & Ecrire works with several non-profit organizations which prevent illiteracy in schools and in different associations. In this association, illiterate people can be offered classes in order to help them with different everyday life tasks. Some classes focus on health vocabulary and help people learn how to make an appointment at their doctors. The association itself recognizes that the aid is limited because not all illiterate people know about this association and they are not all aware of the help they could receive.
However, there is no hotline available for people in need of a medical vocabulary explanation.
I hope this answers your question! 😀
Great blog! You mention that people with low health literacy feel uncomfortable or weak to talk freely (without any taboo) with their doctors. Would you say that training the experts, in this case: the doctors, to approach patients in different ways could bridge that gap better?
Thank you for your comment Heidi!
Some doctors don’t always make sure that their patients understand all aspects of their treatment but I don’t think that they do that on purpose. I think that sometimes doctors just assume that people understand them and don’t bother to ask them about their health literacy level. This is why I do believe that doctors should be more aware of the reality and should be trained to handle these situations without making them awkward for the patients. Doctors should be trained with patients’ therapeutical education. This means that doctor should not only give the patient medical information but should also educate the patients on what their disease is and how to cure it.
I hope this answers your question! 😀
merci Marie. reading your blog, it seems that the availbility of abundant medical information on the internet is only used by a small group. Isn’t there also a big group of people reading all kinds of online medical texts and understanding them badly? Or making their own health choices and dealing with their doctors only for ‘second opinion’? Would you consider this as well an example of ‘low health literacy’ – what kind of attitude what this require from medical professionals?
Merci pour votre question Charles!
Indeed there is a large part of the population who uses the internet as a source for health related information. According to an article (https://www.beckershospitalreview.com/healthcare-information-technology/72-of-consumers-use-the-internet-to-find-healthcare-info-6-survey-findings.html) which summarizes 6 surveys, up to 87% of the questioned people used the internet to find medical information. They do so either to put a diagnosis on their symptoms, find what medication they should be taking or even find a new physician in their area. Using the internet for this type of information doesn’t necessarily mean that the information will be misused. However, as stated in my blog, no matter how literate one is, there is always room for misinterpretation of information. This is therefore why it is problematic for people to favor asking the internet instead of asking a ‘real’ doctor.
In my answer to Heidi’s question (which can be found above), I talk about how doctor should be trained to patient’s therapeutical education. This means that doctors should be trained not only to give information to their patients about their health issues but also educate them on what they are and what they imply. In addition to that, part of patients’ therapeutical education is doctor being aware of patients’ mistaken beliefs, help them understand why the information they found on the internet is either incorrect or simply doesn’t apply to their cases. Overall, doctors should help patients manage their health better.
To answer the question, yes I do believe that this can be an example of low health literacy as people are not able to obtain the right information and apply them to their case.
Thank you again for your comment!
Hey Marie, your blog is very nice. I think that, considering the time of pandemic we are going through and the level of illiteracy in Europe, combining the two makes your blog particularly insightful. Since you mentioned data regarding Austria and Spain and their discrepancy in terms of literacy and health literacy, I was wondering if there is any country in Europe that satisfies and averages standard levels of both literacy and health literacy?
Hey Matilde,
Thank you very much for your comment and your interesting question. It is true that sometimes we focus more on countries that don’t do so good when we should also look at countries which do well in a field, in this case (health) literacy. A country which scores rather well both in literacy and in health literacy is The Netherlands! In The Netherlands, there are approximately 99% of the population of age 15 and above who can read and write basic information they’re familiar with. And when it comes to health literacy in The Netherlands, only 1.8% of the population has an inadequate level of health literacy compared to 18.2% in Austria for example. And almost 25.2% of the dutch population has an excellent level of health literacy compared to 9.1% in Spain.
Overall, there are several countries which have pretty satisfactory numbers both in literacy and health literacy and The Netherlands is a good example.
I hope that my answer was useful!
Thank you again for reading my blog !
https://academic.oup.com/eurpub/article/25/6/1053/2467145?login=true
Hi Marie, your blog is very good and very easy to understand. I felt very identified when you mentioned that when you had covid 19 you had problems understanding medical things because when I had covid I did not understand many times what was happening to me. I think it’s a great idea to implement the phone calls to be able to ask about things we don’t know about health. About this I think: Do you think that they have not implemented these measures because the governments see it unnecessary or is it because there is a lot of taboo about this subject? thank you very much.
Hi! Thank you very much for your comment and your question. I’m glad you liked my blog!
Your question is really interesting but I think that I don’t have enough knowledge to give you a general conclusion applying to many countries.
However, to answer Florine’s question (which can be found above), I focused on Belgium to find what the government does in order to help low health literate people get the information they need. To find information about that, I called the Agence Pour une Vie de Qualité (Agency for a Quality Life) which informed me that unless the low health literate person suffers from a disability, they can’t really help them. To be honest this answer surprised me. I had to get in touch with an association which specifically takes care of low literate people to find actual help people might seek.
I personally think that because of the taboo and because of how hard it is to get in touch with low literate people, governments might think that the situation is not bad enough to implement measures (measures which could obviously be costly). From my research, I got the feeling that if you’re not disabled, you are not eligible to receive help even though you might really need it. I think that governments should be better informed of how serious low health literacy is and of how implementing measures (such as hotlines) could change some people’s life! Helping people in need (even though they might be a minority in the population) should not be seen as a waste of money nor a waste of some people’s time.
I hope this information answers at least a little part of your question.
Thanks again!
This was a really interesting blog to read! I think you make an interesting comment by saying that another possibility of making people more health literate is by offering classes throughout Europe. In your opinion, do you think this will be effective? I feel like this way would not be as effective as anonymous hotlines, as classes are not anonymous anymore, which I think would create a barrier for low health literate people – if assuming they would not want everyone to know that they are low health literates. I am curious to hear your opinion about it!
Thank you for your comment Isis!
To answer this question, I can only talk for about Belgium.
I was in contact with the association Lire & Ecrire which offers classes for low (health) literate people. According to them, the classes are very useful for people who follow them. But they say themselves that not all low (health) literate people in French-speaking Belgium follow these classes. Either because they don’t want to be categorized as unable to read or write or because they simply don’t know these classes are there. This is why I think you are right to say that classes are alone probably not effective enough.
But I personally think that the combination of hotlines and classes is the best way of helping low (health) literate people.
I hope this answers your question 😀
Thank you for taking the time to answer my question! I totally agree with you: a combination of the two options proposed by you would be the best solution. Even maybe a third option if one arises!