Advertisement

Health Literacy: The Affordable Care Act Ups the Ante

      This fall, the enrollment period for state-based health insurance began. By the end of 2014, more than 30,000,000+ new patients may be enrolled in health plans in the United States, under provisions of the Affordable Care Act (ACA). We are concerned about the lack of patient preparedness with regard to health literacy and medical science, 2 interrelated areas.

      National Action Plan to Improve Health Literacy. Available at: http://www.health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf. Accessed June 20, 2013.

      Somers SA, Mahadevan R. Health Literacy Implications of the Affordable Care Act. Available at: http://www.iom.edu/~/media/Files/Activity%20Files/PublicHealth/HealthLiteracy/Commissioned%20Papers/Health%20Literacy%20Implications%20of%20Health%20Care%20Reform.pdf. Accessed June 20, 2013.

      There has been a lack of medical science courses in US K-12 public schools from as far back as anyone can remember.

      National Health Education Standards. Available at: http://www.cdc.gov/healthyyouth/sher/standards/. Accessed June 20, 2013.

      This can be traced back to a destructive ripple effect emanating from the 1910 Flexner Report, which produced a much needed reorganization of medical education, its intended outcome, but had negative consequences as well.

      Duffy TP. The Flexner Report—100 Years Later. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178858/. Accessed June 21, 2013.

      A half century later, the Flexner Report's negative impacts were manifested by the disappearance of human medical science courses from US college general studies tracks. Today, the majority of US college students lack access to courses on medical science, contributing to the low level of health literacy.

      Patient Preparedness for the Affordable Care Act

      Health literacy was defined in the 2004 US National Academy of Sciences' Institute of Medicine Health Literacy monograph 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.”

      Nielsen-Bohlman L, Panzer AM, Kindig DA, eds. What Is Health Literacy? In: Health Literacy. A Prescription to End Confusion. Washington, DC: The National Academies Press; 2004:31-58.

      According to an American Medical Association report, poor health literacy is a stronger predictor of a person's health than age, income, employment status, education level, and race.

      Weiss BD, Health Literacy and Patient Safety. Help Patients Understand. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf. Accessed June 20, 2013.

      We have concerns with the ACA's dependency on the health literacy and medical science components of personal preparedness. First, the level of health literacy is low by any standard.

      Somers SA, Mahadevan R. Health Literacy Implications of the Affordable Care Act. Available at: http://www.iom.edu/~/media/Files/Activity%20Files/PublicHealth/HealthLiteracy/Commissioned%20Papers/Health%20Literacy%20Implications%20of%20Health%20Care%20Reform.pdf. Accessed June 20, 2013.

      Second, the scopes of official health literacy definitions need broadening.

      Nielsen-Bohlman L, Panzer AM, Kindig DA, eds. What Is Health Literacy? In: Health Literacy. A Prescription to End Confusion. Washington, DC: The National Academies Press; 2004:31-58.

      Standards should be strengthened with greater specifics based on common disease entities, for example, cancer, cardiovascular disease, and diabetes.

      Toward a K-12 Medical Science/Health Literacy Core Competency

      Sadly, it turns out that US national policy makers do not expect US high school graduates to know much about most common diseases at any time soon. They seem oblivious to the obvious link between health literacy and medical science, a carryover from the Flexner era.

      National Health Education Standards. Available at: http://www.cdc.gov/healthyyouth/sher/standards/. Accessed June 20, 2013.

      Duffy TP. The Flexner Report—100 Years Later. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178858/. Accessed June 21, 2013.

      In contrast, we think that every K-12 student should take medical science classes in preparation for their own future decision-making as ACA beneficiaries. That is incentive enough. By providing such medical science courses in local schools, we recently found that middle school students are at the right stage in their adolescent development to handle the coursework, at a time when they are less interested in “doctoring” and more interested in the science, a desirable combination. We smiled when middle school students voted ‘Medical Science best elective course of the year’.

      Yearbook, BASIS Oro Valley Upper School, Oro Valley, Arizona, 2013, p. 34.

      Summing It Up

      Our point is that kids like to learn about diseases and should be encouraged to do so in primary and secondary schools. This would be their first step in preparedness training for shared responsibility between patients and their doctors, sometime down the road. This will require lifting a century-long partial moratorium on teaching about diseases in US K-12 public schools and colleges. The Flexner Report gets the “Century Award,” but nothing lasts forever!

      Duffy TP. The Flexner Report—100 Years Later. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178858/. Accessed June 21, 2013.

      References

      1. National Action Plan to Improve Health Literacy. Available at: http://www.health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf. Accessed June 20, 2013.

      2. Somers SA, Mahadevan R. Health Literacy Implications of the Affordable Care Act. Available at: http://www.iom.edu/~/media/Files/Activity%20Files/PublicHealth/HealthLiteracy/Commissioned%20Papers/Health%20Literacy%20Implications%20of%20Health%20Care%20Reform.pdf. Accessed June 20, 2013.

      3. National Health Education Standards. Available at: http://www.cdc.gov/healthyyouth/sher/standards/. Accessed June 20, 2013.

      4. Duffy TP. The Flexner Report—100 Years Later. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178858/. Accessed June 21, 2013.

      5. Nielsen-Bohlman L, Panzer AM, Kindig DA, eds. What Is Health Literacy? In: Health Literacy. A Prescription to End Confusion. Washington, DC: The National Academies Press; 2004:31-58.

      6. Weiss BD, Health Literacy and Patient Safety. Help Patients Understand. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf. Accessed June 20, 2013.

      7. Yearbook, BASIS Oro Valley Upper School, Oro Valley, Arizona, 2013, p. 34.