Background and Significance

Education is recognized as the means to escape poverty (Kawachi, Adler, & Dow, 2010; UNESCO, 2005), but the benefits of education go beyond income and status. Poverty is an important factor in worse health outcomes, often the result of delays in treatment and non-compliance due to insufficient resources or lack of understanding (McMahon, Wanke, Terrin, Skinner, & Knox, 2011; Meyer, Springer, & Altice, 2011; Wapner, 2011). Delavega and Lennon-Dearing (2015) found that poverty and homelessness are associated with worse health outcomes and riskier behaviors among HIV positive women. Shame may be a factor preventing poor people from seeking care or clarification (O’Rourke, 2013), and this may lead the poor to wait too long or to fail to follow instructions.

In recent years, there has been a tremendous push for financial literacy as a way to help the poor (Kindle, 2009; Sherraden, Laux, & Kaufman, 2007), but health literacy may be equally or more important. The authors, a poverty researcher and a physician in clinical practice for over 20 years explain the consequences of health illiteracy and propose solutions in social work and medicine to address this looming problem.

Health Literacy: Challenges and Solutions

Health literacy is understood as the personal ability to understand and process health information in order to make healthcare related decisions including the implications and ramifications of such decisions (Institute of Medicine, 2004).  In a perfect world the education and socioeconomic level of the patients would be equitable and as such basic health literacy should be standard, unfortunately this is not the case and addressing this issue must be two-fold.

Efforts to improve health literacy in the population include individual and group teaching and outreach by an interdisciplinary team so the patients can develop the skills necessary to improve their own health literacy.  Education to improve reading, writing, and communication skills as well as numeracy and critical thinking is needed to ensure proper decision-making.  These skills are critical in processing and applying the usually complex data involved in health decisions for oneself or a family member.

These efforts must be paired with a deep understanding from the healthcare teams of the deficiencies present.  Beyond understanding the ability chasm, the healthcare teams must improve their own communication skills to meet the patients where they are.  It is time consuming and burdensome at times to tailor the message to different health literacy levels, but it is best way to ensure better health outcomes (Coleman et al., 2008).  Healthcare providers must also receive training in communication, patience, and compassion. Specific curricula has been shown to reduce blaming among social work students (Delavega, Kindle, Peterson, & Schwartz, 2017) and shows promise for all healthcare providers.

Health literacy education for patients, and health communication education for practitioners are both aspects of comprehensive health literacy to promote better outcomes. Health literacy is crucial to improve the lives of the poor.