Reading may save your life

Suppose you put $100 in a savings account that earns 10% interest each year. After five years how much will you have?

That was a question posed in a multiple-choice quiz (completed by 150,000 people in 144 countries) by Standard & Poor’s, a rating agency. The answers proffered were ‘less than $150’, ‘exactly $150’ and ‘more than $150’. The intention was to test whether respondents understood compound interest, in addition to basic mathematics. According to The Economist’s data team, the results were not that impressive with just one-third of respondents answering three out of five similar multiple-choice questions correctly.

The main thrust of this scenario is that it has been shown that it can be difficult to drum in financial know-how at a young age. Instead, it is gained through experience. Let’s think about that. Financial know-how which, without question, aids in financial literacy is gained through experience.

Health literacy is defined as ‘the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions’. Now how do we suppose that people gain ‘health know-how’ which would, presumably, drive health literacy? I mean, if we rely on experience as one of the main drivers of literacy, you’d have to get sick in order to accumulate ‘health know-how’ wouldn’t you? You’d have to have experience with seeing doctors and taking therapies and wading through complicated private insurance plans that are massively confusing and looking up health information on the internet, etc. And since nobody knows when they’re going to get sick, the first time they do, they’re literally health illiterate. I mean aside from the annual physical and the odd needle here or x-ray there, people largely are in the dark about healthcare.

People who are better informed have better outcomes

Go ahead and ask people the questions in Figure 1 and see what kind of answers you get. Some might argue that these questions are not that easy. Maybe. Maybe not. Some would argue that these questions aren’t a standardised or even-close-to-widely-accepted measure of health literacy. Very true. But that’s not the point. The point is this: healthcare cannot be lumped into the basket of ‘other literacies’ because it’s fundamentally different from ‘other literacies’. It’s different because the idea that we can develop literacy by amassing know-how is difficult in healthcare. It’s different because compound interest of $100 after five years at 10% is always the same answer and cancer, diabetes and cardiovascular disease are not. It’s different because we have been trained to defer our property rights to clinicians and let them tell us what is right, important and required with respect to our own health.

Figure 1. Sample health literacy questions

Why is all this important? Because research shows that people who are better informed about their health status are more likely to have better outcomes. In fact, let me be far more precise: differences in health literacy levels have been consistently associated with increased hospitalisations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. And it’s important because in today’s day and age of ‘information at my fingertips’, there are an increasing number of people who self-diagnose and self-treat based on information they’ve found online.

And because some estimates suggest that upwards of 40% of all the online health information is wrong, incomplete or purposefully deceitful. And because private health insurance plans are becoming increasingly complex as insurers look to shift spiralling costs to patients through the use of co-pays, pre-existing condition clauses and annual or lifetime caps on drug spending, which (you guessed it) require a high degree of literacy in order to ensure that the right plan is being selected. And because we hope and need ‘generational’ health literacy to take hold. We need older adults to start teaching younger people about the importance of being health literate.

Teach health earlier in school. Teach it more often. Incentivise patients. Incentivise providers. Enact laws around health literacy. Change the way search engines display search results on health queries so that paid results don’t jump to the top of the page. While it may be hard to quantify the effect of health literacy in terms of life expectancy, it is not hard to agree that we need to do things differently. Plain and simple.