Health literacy enhances a population’s self-care capacity and helps to reduce health inequalities. Low health literacy (LHL) is associated mostly with mature patients with chronic health conditions, who have limited education, not necessarily from a lower income group, and those who cherish superstitions and stigma inside their preset narrow mind that prevents them from gathering some relevant information about health or health system access, diseases, and drugs from their surroundings, with a few exceptional cases. Also, being generally literate does not automatically make one to be health literate. LHL is not uncommon among patients with a high level of education or with well-off patients.
The cost of illiteracy to the global economy is estimated at US$1.19 trillion but LHL alone costs the US economy more or less US$200 billion every year. Only 12 per cent Americans have adequate health literacy and according to the US Centers for Disease Control and Prevention (CDC), improving health literacy could prevent nearly one million hospital visits and save over US$25 billion a year. LHL influences a lot of patients’ treatment guideline compliance or more directly medication adherence leads to poorer health outcomes, higher healthcare expenditures, increased hospitalisations, and even higher mortality rates in patients with chronic diseases. Individuals with poor health literacy often incur higher medical costs. Medication non-adherence contributes around 60 per cent of the US$500 billion total avoidable costs attributed to suboptimal medicine use globally each year.
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Evidence shows that LHL is significantly associated with economic ramifications at the individual, employer, and healthcare system levels. But it is common to both developed and under-developed countries around the world and socio-economic conditions are not at all the sole factor of LHL. Surprisingly, close to 40 per cent of the US and UK adults have LHL, which is around 60 per cent in Canada, Australia, UAE’s adult population, and the European older population. Even China, home of the world’s greatest scientists and inventors issued “Health China 2030” in 2016, where the rate of national health literacy is aimed to increase to 30 per cent by 2030. The GDP per capita of these countries ranges from US$11,800 to US$62,200, based on Trading Economics 2022 data.
Many studies reveal that patients from high-income countries are not adequately adherent to medications as they are prescribed. Forgetfulness, confusion about the duration required for medication use, and mistrust about the overall efficacy of medication are among the reasons for non-adherence to diabetes management protocols in Middle Eastern countries. After World War II, Taiwan faced severe poverty which is now the eighth largest economy in Asia and the home of T2DM patients with 82 per cent health literacy.
Canada is the topmost educated country with a GDP close to two trillion and a GDP per capita of more than US$44,000. A recent survey granted by the Royal University Hospital Foundation in two urban tertiary care hospitals in Saskatoon shows that around 50 per cent of the patients admitted to the general internal medicine unit had LHL. Moreover, patients with LHL, but with high education, had a higher probability of emergency department re-visits.
A cross-sectional study of 259 school leaders in Hong Kong carried out during the COVID-19 pandemic between April 2021 and February 2022 shows that more than 50 per cent of participants had LHL and their LHL was strongly associated with a negative attitude about vaccination, low information, confusion about COVID-19-related information and secondary symptoms of burnouts.
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In the US, a cohort study by Vanderbilt Center for Health Services Research (Nashville, Tennessee) of over 46,000 hospitalised patients showed that hypertension was more common in people with LHL. Also, the authors of the Hamburg Diabetes Prevention Survey, a population-based cross-sectional study in Germany concluded that LHL is an important factor in the three conditions of metabolic syndrome — obesity, diabetes, and hypertension.
Finally, it can be said that LHL is associated with patient non-compliance, but it warrants further studies to judge whether it is the top reason for the same or not, as many studies conducted in developed countries reveal a high prevalence of cost-related patient non-adherence. Nevertheless, it can be said beyond reason health literacy provides a benefit in addressing the health needs of even the most disadvantaged and marginalised communities.
To improve adherence, patients need to clearly and appropriately understand health information related to their specific illness or disease. This understanding may be essential to helping patients generate the motivation, beliefs, and appropriate health behaviours needed to improve overall adherence behaviours. LHL is a curse, and it has to be minimised. All healthcare providers, stakeholders, and even government and community authorities should work on it.
References available on request.
Abdul Kader Mohiuddin is a registered pharmacist with the Bangladesh Pharmacy Council and an alumni at the Faculty of Pharmacy at Dhaka University.
This article appears in Omnia Health magazine. Read the full issue online today.
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