Shared Decision-making Increases Need for Greater Health Literacy

Another study on the relationship between health literacy and health outcomes:

“Limited health literacy is a significant problem in our patients, and why this is so important is because we have moved so far from paternalistic medicine to an approach that is all about shared decision making,” Tormey said, which increases the health literacy burden on the patient. “Most patients, if you look at studies, will say they have limited literacy, that they want to be involved, that they want to be engaged, but they have more barriers to doing so, and they interpret communication differently than patients with adequate health literacy. So we really need to be able to develop tools that can engage these patients and make them feel supported as they embark on these kind of decisions.”

Access to Health Care Doesn’t Eliminate Health Disadvantage of Poor Education

Report Cover: Health Care Necessary But Not SufficientInteresting new brief from the VCU Center on Society and Health on the relationship between education and health. Most would find it unsurprising that people with less education tend to have poorer health outcomes. But does improved access to health care remove this disparity? Or as, they put it in this brief, “[w]ill health care reform make high school dropouts as healthy as college graduates?”

It won’t. According to this report, while access to health care has a bigger impact on people with limited education than for those with more education, access to health care isn’t enough to overcome the educational disadvantages associated with poor health: “People with fewer years of education have worse health than those with more education—even when they have the same access to health care.”

The authors go on to recommend that the adverse health consequences associated with a limited education “will require other policies that target factors outside of health care.”

Catching up on Summer Reading: New Book on Health Literacy from National Academies Press

Health Literacy: Improving Health, Health Systems, and Health Policy Around the World: Workshop SummaryThis is (relatively) old news, but in case you missed it, the National Academies Press recently released an interesting new book on health literacy interventions around the world, Health Literacy: Improving Health, Health Systems, and Health Policy Around the World. The book is basically a summary of the discussions and findings that came out of a workshop held here in Washington earlier this year on international health literacy efforts.

You can read it online or download a PDF of the book for free. You can also order a hard copy directly from National Academies or through Amazon.

Michael Lytton, Blog Editor for the American Journal of Preventative Medicine, discusses this publication in a recent blog post the first installment in a short series he is planning to write on the subject of health literacy.

New Study Suggests Literacy Programs in Ghana Lead to Lower Rates of Infant Mortality

Although it supports the (apparently) widely agreed notion among those in the global development community that adult literacy programs are not effective, a new study does point to an “unintended success” of such programs: decreasing child mortality.

So says Niels-Hugo Blunch, associate professor of economics at Washington and Lee University, in his recently published a paper, “Staying Alive: Adult Literacy Programs and Child Mortality in Rural Ghana.”

Blunch says that evaluations of adult literacy programs in developing countries tends to skip over beneficial outcomes that would cast them in a more successful light. From Washington and Lee’s news release:

Blunch explained that although the adult literacy program is formally about literacy and numeracy, it is really a multiplex program that integrates other modules such as health and social issues, income generation/occupational skills and civic awareness. Approximately 28 different topics are covered across those three modules.

Under the health module, women learn about family planning, teenage pregnancy, environmental hygiene, immunization, HIV/AIDS, safe motherhood and child care, drug abuse, traditional medicine and safe drinking water.

Blunch is hoping that publication of his paper will get the attention of the global development community, including the World Bank, and result in increased attention and funding for these programs, especially in rural areas.

I also thought this was interesting:

Classes in rural Ghana are held two to three times a week for a total of about six hours per week and, in most cases, there are 20 to 30 participants per instructor. It takes about 21 months to complete the course. Yet, according to Blunch, a significant reason for the skepticism and resulting reduction in funding of these programs is the poor outcomes in Latin America and South America, where classes frequently lasted only six to eight months, were shorter, and often also not with the additional health, income generating activities and civic awareness components.

I don’t have any direct experience with adult literacy programs outside of the U.S., so I can’t speak with any kind of expertise about them, but in general, with adult literacy, it shouldn’t be a surprise that programs that are longer, with a greater intensity of instruction and an integrated learning approach would lead to better outcomes than the programs he is describing in Latin and South America.

Blunch’s paper also included a cost-benefit analysis (again, this is according to Washington and Lee’s news release—I don’t have a link to the paper itself) of program participation that showed “substantial positive net benefits in monetary terms, including the future earnings of children whose deaths have been averted, even when disregarding women learning about income-generating activities, as well as the many other positive potential outcomes of program participation.”

From the perspective of domestic adult literacy policy and advocacy, I think it’s equally important to conduct this kind of research, and to point out these “indirect” outcomes to policymakers—and in monetary terms. (I know, of course, that there has been research like this, but there needs to be more of it, and it needs to be better publicized.) Anyone who has been around an adult education program here in the U.S. has seen the positive impact that simply enrolling and participating in a program can have on the individuals who have enrolled—in terms of their health and overall well-being, the example they set for their children, etc. We sell our programs short here in the U.S. as well.