Chelsea Dade
What does health literacy look like in 2019? It is patient-specific? Is it doctor-centric? Is it a bit of both? I present to you just one opinion on how we can move the needle towards an equity focused vision for health literacy.
ICYMI, October is Health Literacy Month. According to the Centers for Disease Control and Prevention, health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
Historically, health literacy tends to focus on educating patients, family members, and other caregivers about health decisions. Communicate for Health Justice (CFHJ) decided to flip the script by having a healthcare professional-centric health literacy campaign titled, “Bad Terms, Be Gone!”
Whether you work in global health, youth health, LGBTQ health or the like, there is a need to address the increasing awareness around the importance of reflective terminology in medical practice. Still, there are many outdated, culturally offensive healthcare terms in use. But by increasing awareness, we can make a positive change.
Why was it important for CFHJ to recognize the health literacy flaws commonly made by healthcare professionals? Because no one else was doing it! (Stick around and you’ll notice that this is a trend at CFHJ, since we’re concerned with highlighting stark, but overlooked, inequities in healthcare, which are often made worse by inconsistent or inappropriate communication.
More than Just Plain Language
Health literacy professionals often cite the importance of plain language when speaking with their patients. But what exactly does plain language mean past linguistic simplicity? To us, it means using relevant, up to date terms to educate patients about their health. The updated definition of plain language incorporates cultural competency, and the use of reflective terms and identification. Due to America’s tendency to categorize people of color as property, healthcare research has historically referred to people within the racial identity, “Black,” as “Blacks.” However, the more appropriate term is “African Americans,” or when used correctly, “Black people.”
Social determinants of health are another term that is simply not plain, no matter how much health professionals say it. The phrase is increasingly used in healthcare organizations and hospitals. According to the Robert Wood Johnson Foundation (RWJF), social determinants of health are things like the quality of our schools, affordability and stability our housing, access to good jobs with fair pay, and the safety of our neighborhoods can keep us healthy in the first place. It all sounds good on paper, but the truth of the matter is that this term includes too much and it doesn’t cover enough.
You see, when a researcher, scholar, or healthcare professionals says they study “social determinants of health,” that can mean many things. They might study disparities between age groups, between genders, or between racial and ethnic groups. They might study the negative impacts of racism or other -isms on health outcomes, or they might not. In this way, we can have multiple “disparities” researchers who may or may not acknowledge racism and other -isms in healthcare. They might acknowledge sexism, but ignore racism’s unique impact on healthcare delivery. By using a broad-brush term like social determinants of health, people can hand-pick and rate inequalities, thus reinforcing the hierarchy that already exists in healthcare, and in our society.
This is why some researchers have moved away from this term and have begun to classify “social” determinants as “structural”. The latter term acknowledges the manner in which health disparities have historically been worse for certain groups of people, and that they continue to magnify due to failures in our systems and institutions.
Back to health literacy. Do you think that physicians who have been in practice for years, possibly decades, ascribe to these new terms? Do you think that medical students and professionals today understand the importance of keeping up to date with the new terminology? Unless each medical school in the US is consistently updating its curriculum to provide inclusive educations on patient-centeredness, cultural competency, and shared decision-making, the answer is probably no.
This is where health literacy professionals and health communication professional alike need to step in! Many of us have a different skillset than medical professionals, focused on communication, advocacy and perspective taking. If we can be another advocate to patients, we can get one step closer to a more respectful and reflexive healthcare system.
Suggested Resources
The Intersection of Health Equity and Health Literacy
https://www.nichq.org/insight/intersection-health-equity-and-health-literacy
Promoting Health Care Equity: Is Health Literacy a Missing Link?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910560/