Written By Aleena Joseph on July 25, 2023

A couple of weeks ago, I took my 80-year-old grandpa, or Appacha, to his doctor’s appointment. This, a seemingly mundane task, caused an epiphany about the increasing disparity between his literacy and the way medicine is communicated. See, Appacha’s primary language is Malayalam, native to the Indian state of Kerala. In spite of living in the United States for more than 30 years, English hasn’t become entirely natural to him, making it hard for him to entirely understand even some of the most basic conversations. By the appointment's end, both my grandfather and his doctor were left feeling misunderstood, confused, and frustrated. This situation, however, is not uncommon among elderly immigrants. In fact, Front Public Health states, “75% of immigrants have difficulties related to information about health care and the field of health promotion”, meaning that a large majority of the US population is struggling with this issue (Medina et al., 2020). The current state of healthcare has left room for a large percentage of immigrants, particularly seen in the elderly, to have difficulty understanding their diagnosis and other personal medical information provided to them. 

The Issue

Most medical documents are unreadable to even the average healthcare consumer. As a matter of fact, according to the American Family Physician Association, most healthcare documents are written at a 10th-grade or higher reading level, which is appalling given that the average United States citizen reads at a 6th-grade level (Schmidt, 2022). If the everyday American doesn’t have the ability to understand their medical files, how are immigrant citizens, especially those whose first language isn’t English, like my grandfather, expected to comprehend theirs? The Center for Immigration Studies helps confirm this difficulty, claiming that “41% of immigrants read below the lowest level of functional literacy” (Richwine, 2017). The burden is even greater for elderly populations who tend to have more chronic and co-morbid conditions, resulting in high frustration levels associated with their health (Safeer et al., 2005). Furthermore, immigrant populations tend to maintain confusion in regard to health conditions, meaning often these individuals simply cannot comprehend the state of their own health, restricting them from agreeing to necessary procedures or accepting proper treatments, leaving them vulnerable to worsening their condition. 

Literacy and Public Health

It is well known that the goal of the public health industry has always been to “promote and protect the health of people and the communities where they live, learn, work and play”. While it may be easy to put the blame for the lack of understanding of health on the consumer, we must recognize that it is inherently wrong to not simplify the difficulty they are posed with. Having a huge majority of the population require assistance in understanding their health means it is the responsibility of those creating and verbalizing conditions to explain them until a reasonable expectation of clarity is achieved. If our leaders in public health cannot fix the issue of literacy, we, as a society, are robbing citizens of their basic rights to make autonomous decisions. 

How can we reduce this literacy gap?

Simply put, we must make healthcare more accessible to the average consumer. Just as major clothing brands cater to their specific audiences, we must take medical knowledge and make it comprehensive catering to people of all backgrounds and literacy. Doing this will allow communication from healthcare providers to become far easier to distribute, and enable patients to truly understand their conditions and make educated decisions about their own health. But, how can we achieve this great feat?

The first step comes down to medical providers and the way they convey information to their patients. Using basic, everyday terms and maintaining patience is a great start to solving this issue, but we must also remember that backgrounds and catering to them is the best solution (Tanner et al., 2006). This means, if a patient’s first language is not English, redirect them to another physician or medical personnel who speaks their primary language and can communicate using terms that may be more familiar to them. Furthermore, always give patients the room to verbalize any confusion or concerns they may be struggling with, especially if it relates to diagnosis or treatment options. Once providers adopt this behavior, confusion associated with patient health will be reduced significantly. 

This solution goes beyond providers, however. Our world’s healthcare education system must also put in curricula to make simplifying conditions a common practice, not only for the sake of elderly immigrant patients, like my grandfather but also for the average American such as myself. This educational program will stimulate better decisions among all communities, in spite of literacy levels. 

Conclusion

The public health industry and thus, healthcare systems require major reform to communicate conditions such that all peoples, in spite of background, are able to understand the state of their own health. Individuals, such as my grandfather, deserve the right to make informed decisions about their well-being, and it is our responsibility to provide them with the means to do so. 

Citations 

• Medina, P., Maia, A. C., & Costa, A. (2020). Health Literacy and Migrant Communities in Primary Health Care. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.798222

• Richwine, J. (2017, June 21). Immigrant Literacy - Self-Assessment vs. Reality. Center for Immigration Studies. Retrieved April 3, 2023, from https://cis.org/Immigrant-Literacy-Self-Assessment-vs-Reality 

• Safeer, R. S., & Keenan, J. (2005). Health literacy: the gap between physicians and patients. American family physician, 72(3), 463–468.

• Schmidt, E. (2022, March 16). Reading the numbers: 130 million American adults have low literacy skills. APM Research Lab. https://www.apmresearchlab.org/10x-adult-literacy 

• Tanner, C. E., Eckstrom, E., Desai, S. S., Joseph, C. L., Ririe, M. R., & Bowen, J. L. (2006). Uncovering Frustrations: A Qualitative Needs Assessment of Academic General Internists as Geriatric Care Providers and Teachers. Journal of General Internal Medicine, 21(1), 51-55. https://doi.org/10.1111/j.1525-1497.2005.0281.x