The Impact of Consumers’ Health Literacy on Public Health

The disturbingly low rates of health literacy in the United States translate into increased health risks across society as a whole, and vulnerable populations, in particular. The public health and economic implications of these trends are discussed, and suggestions for improving literacy are provided. If implemented, these suggestions have potential for enhancing public health and quality of life. ********** Despite technological advances and twice as much per capita spending on health care as other nations, health outcomes in the United States are among the worst in the industrialized world (United Nations Human Development Report 2007). Low health literacy contributes to the bleak reality of public health for society as a whole and vulnerable populations in particular: high rates of infant mortality; chronic diseases that can be offset by preventive practices (healthy diets, physical activity, avoidance of tobacco); and cancer mortality that could be reduced by early detection and screening. As chronic illnesses have replaced infectious diseases as the leading causes of death, prevention of disease has taken the forefront in public health (Satcher 2007). Prevention strategies are organized along three levels, each affected by health literacy. Concomitantly, there has been a shift from sole emphasis on individual consumer behavior to encompass an ecological approach, considering the social and environmental determinants of health. This, too, has implications for health literacy. The first level of prevention, known as primary prevention, refers to inhibiting the development of disease before it occurs. Entire populations are targeted with universal strategies designed to prevent problems from developing in the first place. For example, primary prevention of cardiovascular disease targets healthy eating and exercise behaviors. Emphasis is placed on the interaction between the individual consumer, social networks, and environmental contexts. Low health literacy affects the ability of the consumer to identify and select healthy foods, read labels, and comprehend health education materials. On a community level, low health literacy interferes with community participation, engagement, and empowerment. Health literacy affords the knowledge and skills required for effective community mobilization and political advocacy needed to demand healthy school lunches, safe neighborhoods, and fitness opportunities. Secondary prevention, also called "screening," refers to measures that detect disease before it is symptomatic. It is selective prevention and aimed at specific groups who may be at risk. Examples include early detection of cancer via mammograms, Pap smears, and colonoscopies. Individuals with limited health literacy are less likely to recognize the life-saving benefits of early detection. Therefore, cancer is detected at later stages, adversely impacting morbidity and mortality. Tertiary prevention efforts focus on consumers already affected by disease and attempt to reduce resultant disability and restore functionality. This is targeted prevention that is aimed at people who have already demonstrated serious problems. Efforts are made to restore health and quality of life. Consumers with low health literacy levels experience difficulty accessing and receiving appropriate care. Many lack skills necessary for making appointments, arranging transportation, completing paperwork, communicating symptoms, comprehending instructions, and reading prescription labels (Kiefer 2001). In an era of medical cost containment, levels of health literacy have significant economic and public health ramifications. Health care has become "consumer-centric," relying on consumers to navigate the health system, evaluate treatment options, and negotiate among multiple provider settings. Moreover, in the Medicare program, beneficiaries are confronted with decisions that demand them to analyze differences among health coverage options, prescription drug plans, and quality of care among a range of providers and hospitals. …