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In April 2004, the Agency for Healthcare Research and Quality (AHRQ) released a report on the condition of health literacy in the United States, reporting that 90 million adults have “limited health literacy.” In an Associated Press article, Dr. Carolyn Clancy, the director of this federal government agency, called this number “a shocking figure.” However, to those of us who work in the field of adult literacy, this number isn’t shocking at all. According to the National Adult Literacy Survey of 1993, which doesn’t reflect the huge increase in immigration reported in the 2000 Census, twenty-two percent of adults in the U.S. are functionally illiterate, meaning that their reading, writing, and English language skills are below fifth-grade level. Considering the scientific and technological complexities involved, it’s no wonder this percentage nearly doubles when health is the issue.
In its report, the AHRQ defines “health literacy” as “a constellation of skills that constitute the ability to perform basic reading and numerical tasks for functioning in the health care environment and acting on health care information.” A deficit in these skills plagues many in the Roanoke Valley. In fact, the National Adult Literacy Survey classifies one in four as functionally illiterate in the city of Roanoke, which is higher than the national average.
As the Basic Literacy Program Coordinator for Literacy Volunteers of Roanoke Valley, I meet people who come to us for help for a wide variety of reasons. For these adults, there’s usually some trigger that pushes them passed the social stigma, shame, and fear and gives them the courage to come forward for help. Often it’s something at home or work – a child asks for help with homework or the boss brings a new form to fill out – these events might be dramatic or just the final straw. One event that I recall hits the heart of the importance of literacy in general and health literacy specifically.
At intake, we assess new learner’s current skills and discuss specific goals for improvement. Sometimes it’s hard for learners to articulate their goals. “I want to learn to read” is the typical response. One day a young man came into our office for an intake. He was a fairly clean cut, younger than most who come in, but he had a tough edge, a sort of hard-knock wisdom in his eyes beyond his years. Like most of our learners, he was hard-working, holding down a labor intensive job for a major heating and air conditioning firm. He liked his job, although in order to advance there, he knew his reading and writing skills needed to improve. His current position satisfied him though, giving him a decent paycheck and medical benefits for himself and his six-month old baby girl. He and his girlfriend had just moved in together. Life was pretty good. No, it wasn’t the job that brought him.
Because we need to understand a learner’s motivation to help our tutors work with them to meet specific goals, I pressed him for information, and although my recollection of our conversation here may not be exact, the memory speaks a truth to me. “So why are you here? It sounds like you’re doing fine. Why do you need to read and write better?”
People often look down or away when they talk to me, but he looked at me straight, and I noticed those hard knocks gathering into a mist of fought-off tears. “Last week, my little girl got sick,” he began in the remorseful tone of a criminal confessing his crime. “She was so sick. My girlfriend was at work. I felt her and her skin was so hot. She was coughing, and it was like she couldn’t breathe. I got scared and took her to the doctor – you know, the immediate clinic.”
First, I looked down, noticing a freshly inked tattoo on his forearm, a heart and a name, and then I looked away. “Yes, what happened?”
“Well, I got her there, but I hadn’t been before, so the lady hands me this clipboard. I looked at it and just about panicked. I just stood there looking at it. Everybody there was looking at me. My little girl was crying. The lady must’ve noticed because the nurse came out and asked if I needed some help.”
My eyes returned to his and asked, “So everything was fine then? She’s okay?”
“Oh yea, she’s fine. Oh, she’s real good now.” Realizing the gravity of his manner, he sat up a bit and lightened. “It’s me, you know, I’m not okay. I mean, what kind of father am I if I can’t take my baby to the doctor?”
Of course, this young man was not a bad father. Like too many in the United States, he just lacked the necessary literacy skills to successfully deal with the healthcare system. Beyond humiliation in this case, no one needlessly suffered. However, the AHRQ report concludes: “Low literacy is associated with several adverse health outcomes, including low health knowledge, increased incidence of chronic illness, poorer intermediate disease markers, and less than optimal use of preventive health services.”
Obviously, we, as a community, need to do something about this problem. The medical community can take steps to make interventions that accommodate low literacy levels. In fact, the report suggests that such interventions have had success. For example, “Pregnant smokers and ex-smokers who received a specifically designed intervention with materials written at a third grade reading level were more likely to achieve abstinence during pregnancy and 6 weeks postpartum than those that received standard materials.”
Community-based literacy organizations, like Literacy Volunteers of Roanoke Valley, have played a significant role in combating this problem in the past. We need to make people aware that improved literacy in general is improved health literacy, family literacy, workplace literacy, etc. We strive to serve adults, free of charge, though volunteer efforts, focusing on the immediate needs, like healthcare, of people who lack the skills they need to be fully functional in life. While literacy organizations around the country seek support from their entire communities, we need to make the case to the medical community, both corporate entities and practitioners, that our help is available and necessary to the people they serve. We’d like doctors, nurses, and other healthcare providers to refer their patients who need help. In return, literacy organizations need both volunteer and financial support to advance our mission. The health of individuals and our community is at stake.
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