We'll now spend a few minutes talking about the extent to which health literacy matters for health. In fact, there are domains of health related to public health risks, medical risks, and indeed health outcomes that have been associated with health literacy deficits, regardless of how they're measured. Again, using the REALM, the TOFHLA, or even the subjective measure. What do I mean by public health risks of restricted health literacy? Individuals who have those literacy deficits have been shown to have low awareness of environmental and occupational hazards. They're not conscious and sensitive to danger and warning signs. They have poor understanding of warning labels, even labels that have illustrations indicating danger and poisons. They may be associated with inappropriate use of potentially dangerous products and devices, because they don't really understand the instructions around self-protection, and particularly instructions about mixing dangerous chemicals, for instance, or even common cleaning supplies. People with restricted literacy are unable to adequately evaluate over-the-counter drugs and remedies, are more likely to use fraudulent or ineffective remedies. Individuals with literacy restrictions often lose their way in navigating the medical system. What that means is walking into a busy large medical institution, they are less likely to be able to find the diabetic clinic located on the third floor because signage is hard to follow. They're also at risk for inappropriate, either excessive or under utilization and high costs. They also are at high risk for passive citizenship. If they can't follow and understand the challenges and the risks around them, then they're less likely to be able to respond as an active and empowered citizen. There are medical risks in addition to the public health risks of restricted health literacy. The medical risks are associated with misunderstanding print instructions or directions. Physician difficulty in following patient descriptions of symptoms and illness. So people with restricted literacy ability also find themselves less likely to articulate things like symptoms and medical history. They are more likely to delay care-seeking than patients without a bad literacy. They are passive in the medical dialogue and they're passive in decision-making. They don't initiate questions. They don't ask for risks and benefits. They don't pursue alternatives. Finally, there's potential loss of autonomy because their passivity is misinterpreted as agreement. They lose their ability to establish their preferences, their expectations, and their needs. Finally, there's some evidence that restricted literacy is associated with health outcomes. There are studies that have shown that people with greater literacy deficits are more likely to be hospitalized, and are higher users of emergency care services. In terms of preventive medicine, they are less likely to receive screenings like mammography or preventive vaccines like influenza vaccine or pneumonia vaccine. They have poor ability to demonstrate medication use appropriately, and poorer overall health status and higher mortality. This is especially true among the elderly. In fact, the health outcomes are so strikingly different for patients with health literacy deficits, that the Institute of Medicine has concluded that poor health literacy partially explains racial disparities in some health outcomes. In fact, in Healthy People of 2010, the surgeon general had noted that closing the gap in health literacy is an issue of fundamental fairness and equity that is essential to the reduction of health disparities.
