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.”

Health Literacy Problem “Poses a Challenge for the Success of the Affordable Care Act”

According to the National Journal, the Congressional advisory committee on Medicare (MedPAC), is concerned that poor health literacy discourages patient involvement in treatment decisions and substantially increases the cost of Medicare.

The article also reminds us why health literacy should be of particular concern to President Obama in the coming months:

The health literacy problem also poses a challenge for the success of the Affordable Care Act. Once the exchanges open on Oct. 1, the millions of new patients added to the system in the coming years are expected to have high rates of health illiteracy, as many of them may not have had health insurance before.

As noted in the article, improving health literacy “is a stated priority for HHS Secretary Kathleen Sebelius.”

Study: Diabetes Patients Who Don’t Understand Basic Health Information Significantly Less Likely To Adhere To Prescribed Treatment

Something new today to add to the list of health problems associated with low literacy: in a recent study conducted by the Kaiser Permanente Division of Research and the University of Washington School of Medicine, a big majority (72%) of the 1,366 study participants turned out to have limited health literacy and significantly poorer adherence to newly prescribed antidepressants compared to other patients.

According to Kaiser Permanente, depression occurs twice as frequently among adults with diabetes compared to adults without diabetes.

Although poor adherence to antidepressant medications has been a known issue with some diabetes patients, what’s new here is the evidence that diabetes patients with limited health literacy were much less likely to refill their antidepressant medications in a timely fashion than patients without such limitations.

Dr. Amy Bauer of the University of Washington School of Medicine, notes that “patients with limited health literacy may require more intensive counseling and clearer explanations about use of antidepressant medications and closer follow-up.” Considering the high number of participants in this study who were found to have low health literacy, I suspect that most doctors should, in fact, be prepared to deal with this issue.

But as a matter of public policy, we could also address this by working on improving the literacy skills of adults in this country to begin with, which would lessen the need for such interventions. Does anyone think it’s likely our health care system can really support the cost of more intensive counseling and closer followup what is likely millions of patients with low literacy/health literacy?

This study isn’t the first report to draw a connection between literacy/health literacy and public health (see link above). Shouldn’t improving adult literacy in the U.S. be a major component of our overall strategy to improve public health and lower health care costs in this country?

Grandparents and Adult Education

In many low income communities, grandparents raising children are a critically under appreciated issue. Legislation like this that supports grandparent caregivers makes sense, but as the author points out, it’s just a small piece of the kind of investment needed.

This is another gap issue that those of us involved in adult education policy need to think about as our work becomes increasingly focused on those in the workforce. Some grandparent caregivers in low-income communities have limited literacy skills, and I think it’s safe to assume that a reasonably significant proportion of them are not in the workforce, or going back to it anytime soon, if ever. But wouldn’t parenting classes and mental health programs for this population be more successful if we also increased their literacy skills? Does integrating adult education into parenting classes for those individuals makes sense? If the answer is yes, then what is our strategy for increasing adult education resources for these individuals?