View from the Bridge

Health Literacy for Health Equity – Both Should Be Essential Elements of Every Provider’s Mission

What if I told you that I have access to a wonder drug that could reduce hospitalizations by 32%, eliminate 14% of visits to the emergency room, lower overall healthcare costs by 11%, and more surprisingly, do so without any observable side effects?  Those results are not associated with a wonder drug but were reported in an article published in 2019 by the Journal of Medical Internet Research which reported on a “…Web-Based Health Literacy, Aligned-Incentive Intervention: Mixed Methods Study.”  I guess the more important question is why isn’t every provider organization regardless of size using such an approach?

Another report published in 2020 by the United Health Group found that older adults have more chronic conditions, utilize more services and take more medications than any other age group, and unfortunately have the lowest health literacy levels of any age group.  From studying what is, not just what could be, in the counties with the highest health literacy levels, the Medicare beneficiaries get 31% more flu shots, have 26% fewer avoidable hospitalizations, 9% fewer readmissions, 18% fewer ED visits, and 13% lower costs per beneficiaries.  There’s a clear lesson in those statistics.  If only we could raise the health literacy levels for all age groups including those who are already health-literate.

Health literacy is critical to achieve the ultimate goal of improving health equity.  For a broad definition of health literacy please refer to my earlier blog, Digital Health – Literacy Matters, which addresses many of the elements of health literacy.  Please note from the accompanying picture that equality and equity are not the same.  Regardless of how you define health equity, providers should do what they can to leverage the potential of improved health literacy to impact health equity.  Start small – act big.

The World Health Organization says it well, “Health equity is defined as the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically.”  I infer from the definition a call to action.  It points out “unfair and avoidable or remediable differences.” 

On April 22, 2022, CMS published the “CMS Framework for Health Equity 2022–2032”, a comprehensive 33-page document that defines 5 priority areas on which it will focus to help its enrollees.  Here’s the graphic they published:

Priority 4 calls out “Health Literacy” and deals with 2 important elements of it – language and culture.  Health literacy for providers requires that we educate the workforce on how to deliver culturally competent care.  You cannot effectively focus on underserved, under-resourced persons if the people who are interacting with them don’t understand the culture of the patient and their families.

Dr. LaShawn McIver, Director, CMS Office of Minority Health, eloquently stated what every provider, payer, and other healthcare organizations should commit to “…taking an integrated, action-oriented approach to advance health equity” to improve the lives of the underserved or disadvantaged.  She goes on, “We [should] strive to identify and remedy systemic barriers to equity so that every one of the people we serve has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.”

Her words and the plan (the Framework) are a call to action.  As we emerge from this most recent pandemic, we are reimagining care delivery.  In every design session where we strive to create a new and better normal, we must include processes and support policies that contemplate both those who are well resourced and those who are disadvantaged or underserved.

McKinsey & Company published an article in March 2022 that focused on an action plan in its “Health equity: A framework for the epidemiology of care.”  It pointed out that “Health equity is a virtuous cycle.”  The 4-part cycle 1) analyzes the data associated with the problem as we understand it, 2) suggests expanding the focus to ensure a more inclusive approach to define the population impacted by the problem, 3) challenges the current approach to improve inclusivity, and then 4) encourages collaboration to engage those who are most qualified to address the gaps that exist and deliver the needed care.

Don’t we all bear some degree of social responsibility to care for every member of society?  The best way to progress is to take steps to evolve your organization into a health-literate organization.  Then get your health-literate organization working on creating a health-literate community.  Explore how you can get your patients and their families to move from not understanding to understanding, to action.  Let’s embrace the social imperative that is health equity. 

To explore the topic more deeply, please reach out to the AHIMA Foundation website.  They have aggregated credible resources and tools for consumers and healthcare professionals.

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