A recent round-table held by the Institute of Medicine focused on Health Literacy and Primary/Secondary healthcare prevention found that;
“The health system can be a cornerstone with interventions that promote healthful behaviors with the provision of health information addressing common risk factors for chronic disease such as diet, physical inactivity and blood pressure control and interventions that help patients (and the public) understand how to manage their existing disease and its effects through early detection and appropriate treatment.”
The report makes a series of strong and compelling recommendations for private and public entities to coordinate efforts targeted at developing, implementing and evaluating interventions to improve the health literacy of at risk populations. They conclude such interventions could lead to significant improvements in health outcomes and cost savings.
And then reality intercedes.
The United States healthcare system has adopted a “Fast Food” model of healthcare delivery where metrics of how quickly care is delivered and how many ‘units’ are sold is paramount. Nationally, we have “super-sized” healthcare by marketing the newest technology or medication as a panacea to ailments. Instead of demand driving the delivery of healthcare, marketing has created a healthcare demand. Advertising for medications, equipment and procedures are touted as “educational”, although often mislead the consumer to create demand for certain products or services.
Healthcare consumers have come to accept the quantity of care delivered, technically complex care and the rapidity of care delivery to equate with quality of care. (How many signs have you seen displaying emergency room wait time?) Increasingly individuals are becoming passive participants in their healthcare. Technology and fragmentation of care have made the consumer much like the individual going through the drive thru at a fast food restaurant, rapid delivery of care with minimal human interaction.
Concurrent with this shifting of the healthcare landscape, the political landscape has forced decreasing funding of public health initiatives. This decreased funding has resulted in fewer interventions targeted at public health education and decreasing availability of public health services.
The Institute of Medicine report demonstrates that improved health literacy in the areas of chronic disease prevention and management can result in improved healthcare outcomes and savings. For the recommendations they make to be implemented requires a retooling of our entire healthcare delivery model. For improved health literacy to become a priority would require that we see outcomes, not units sold, as the goal of our healthcare delivery system. Such a dramatic change will require altering consumer demand, reworking professional priorities and creating the political will.
National Research Council. Promoting Health Literacy to Encourage Prevention and Wellness: Workshop Summary. Washington, DC: The National Academies Press, 2011. http://www.nap.edu/catalog.php?record_id=13186
Ed is an ARNP and the chair of the special interest group for health literacy with the Florida Nurses Association. He currently manages a blog called “Florida Nursing Perspectives.”