Health illiteracy 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 and you are too embarrassed to say so or too pressured by the physician’s time constraints to get a word in edgewise, then not doing what you are told is a logical outcome.
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 a taxi?
We are our most important health decision makers. But what training do we have to take on such an immense responsibility? 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—the time in our lives when we are forming many 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.
According to Wikipedia, many states require “a health curriculum in which students learn about anatomy, nutrition, first aid, sexuality, drug awareness, and birth control. In many cases, however, options are provided for students to ‘test out’ of this requirement or complete independent study to meet it.”
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.
According to the most recent CDC sponsored School Health Policies and Practices Study (SHPPS 2014), 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.”
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.
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.