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Lack of health literacy is often cited as one reason why patients fail to follow their doctors’ instructions. It makes sense. If you can’t understand what your doctor is talking about then not doing what you are told is a logical outcome. The problem is further compounded when you are too embarrassed to say that you don’t get it or too pressured by the physician’s time constraints to get a word in edgewise.
Lack of health literacy impacts our health broadly
Health illiteracy extends way beyond failure to follow doctors’ instructions. We may see our physician once or twice a year—or more frequently if we have an acute or chronic condition. But we, as individuals, make hundreds of decisions each day that favorably (or unfavorably) impact our health:
- Do I get out of bed and exercise or do I roll over for an extra 30 minutes of sleep?
- Should I have a second helping of Chocolate Decadence or should I exert my willpower and push away from the table?
- Buckle up? Or just forget it since I am only going two blocks away?
- Should I vote for or against the city resolution that would require earthquake retrofitting of houses built before 1950? And what about the one requiring asbestos removal?
- Should I quit smoking today? Or wait until next month?
- How many drinks will I have at the party tonite? And, should I drive home or take an Uber?
We are our most important health decision-makers. But what training do we have to take on such an immense responsibility? The answer is, in most cases, little or none.
Public health campaigns try to educate us so that we can make the right decisions on certain issues (smoking, for example), but all too often private sector media campaigns—both overt and covert—send much more powerful messages to get us to do what they want instead.
Who should be responsible for teaching health literacy?
So, who should be responsible for teaching health literacy? Our parents? Yes, but unfortunately, they may not be health literate themselves.
Health professionals…as if they don’t have enough to do already. And how often do we see them during adolescence anyway? For most teens, the answer is rarely even tough it is the time in our lives when we are forming many of our health habits?
Well then, how about the educational system? Isn’t being health literate as important as knowing your ABCs or how to add and subtract? Why not teach health in high school? Not as an elective or afterthought, but as a required course that is considered every bit as important for future success as math and American history.
And, while we are at it, why not teach health skills, such as self-directed physical activities, like weight training or yoga, that young people can use over their lifetimes instead of primarily focusing on team sports that many won’t be able to participate in once they have left school.
The High School health curriculum
According to the most recent CDC sponsored School Health Policies and Practices Study (SHPPS 2016), although the majority of middle/high schools in the study required health education, some did not, in fact, actually cover all of the 15 topic areas considered essential:
Health literacy is not only about getting trained in 15 different topics (even if one thought these were the most important 15 topics). Rather it is about understanding how all of the different decisions one makes will result in health (or lack of it). And, it is about practicing healthy living until it becomes routine.
By the way, what better place to begin practicing healthy living than in school. So it is disturbing to see that only 65.3% of schools in the SHPPS 2014 report prohibited all tobacco use during any school-related activity. And, while more than 90% of schools provide administration of medications, CPR, and first aid, “less than 66% provide prevention services, such as tobacco-use prevention, in one-on-one or small-group settings.”
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Also, 75% of high schools had either a vending machine or a school store, canteen, or snack bar where students could purchase food or beverages. It is definitely good news that, in all schools, the most common beverage sold was bottled water (34.6%) and the most common foods sold were low-fat salty snacks (25.7%), low-fat baked goods (21.7%), and low-sodium snacks (20.8%). However, what is missing from the report is a listing of the other foods being purchased, the ones that were chosen most of the time.
Unfortunately, the topic is often not given the same weight as math, science, English, and social studies. Although 94% of high schools offered students opportunities to participate in interscholastic sports, only 4% required daily physical education or its equivalent. And many times, PE classes and after school activities focus on group sports instead of the teaching the type of individual physical activities types, such as strength training and yoga that can be sustained once kids graduate and are out in the “real” world.
Elevating health education
Elevating health education to a core part of the high school curriculum would mean requiring a comprehensive program, hiring trained professionals, and providing oversight and accountability, such as including health education questions on required and/or important examinations. Health education programs should also look at health outcomes—have kids improved one or more aspects of their health as a result of taking the classes?
All of this will require money and a willingness to depart from the status quo. In these times of resource constraints (to put it mildly), the former seems unlikely. And, if you have ever been involved in change management, you know the latter is a formidable challenge. Nevertheless, I believe if we compare the costs of implementing a meaningful health education program with the costs related to health illiteracy, we would find the return on investment well worth the effort.
This post was first published July 2, 2010. It has been reviewed by the author and updated with the latest SHPPS statistics on September 4, 2017.
Patricia Salber, MD, MBA
Patricia Salber, MD, MBA is the Founder. CEO, and Editor-in-Chief of The Doctor Weighs In (TDWI). Founded in 2005 as a single-author blog, it has evolved into a multi-authored, multi-media health information site with a global audience. She has worked hard to ensure that TDWI is a trusted resource for health information on a wide variety of health topics. Moreover, Dr. Salber is widely acknowledged as an important contributor to the health information space, including having been honored by LinkedIn as one of ten Top Voices in Healthcare in both 2017 and 2018.
Dr. Salber has a long list of peer-reviewed publications as well as publications in trade and popular press. She has published two books, the latest being “Connected Health: Improving Care, Safety, and Efficiency with Wearables and IoT solutions. She has hosted podcasts and video interviews with many well-known healthcare experts and innovators. Spreading the word about health and healthcare innovation is her passion.
She attended the University of California Berkeley for her undergraduate and graduate studies and UC San Francisco for medical school, internal medicine residency, and endocrine fellowship. She also completed a Pew Fellowship in Health Policy at the affiliated Institute for Health Policy Studies. She earned an MBA with a health focus at the University of California Irvine.
She joined Kaiser Permanente (KP)where she practiced emergency medicine as a board-certified internist and emergency physician before moving into administration. She served as the first Physician Director for National Accounts at the Permanente Federation. And, also served as the lead on a dedicated Kaiser Permanente-General Motors team to help GM with its managed care strategy. GM was the largest private purchaser of healthcare in the world at that time. After leaving KP, she worked as a physician executive in a number of health plans, including serving as EVP and Chief Medical Officer at Universal American.
She consults and/or advises a wide variety of organizations including digital start-ups such as CliniOps, My Safety Nest, and Doctor Base (acquired). She currently consults with Duty First Consulting as well as Faegre, Drinker, Biddle, and Reath, LLP.
Pat serves on the Board of Trustees of MedShare, a global humanitarian organization. She chairs the organization’s Development Committee and she also chairs MedShare's Western Regional Council.
Dr. Salber is married and lives with her husband and dog in beautiful Marin County in California. She has three grown children and two granddaughters with whom she loves to travel.