When people were traveling on the Oregon Trail, they had to rely on their own instincts, and sometimes help from others, to find their way through the dangerous and wide-open spaces of the American West. Similarly, it can be hard for people to navigate the healthcare system, especially if they have trouble understanding the language or reading.
The current conversation around health equity is usually centered on race, gender, and socioeconomic status, which are certainly important factors in the healthcare disparity puzzle. But it is an absolute travesty that language and literacy are continually overlooked because they are not always visible or easy to spot behind issues like access, poverty, and lack of insurance. This isn’t just a minor oversight, it’s a gaping hole in the healthcare system that erodes patient trust and confidence.
When we zoom in on the individual patient, we find that people with limited English proficiencies, who live in care deserts, and/or with difficulties reading, not to mention their families, suffer the most from preventable medical complications. They struggle with understanding medical terminology, confusion over how and when to follow medication instructions, and challenges communicating with and understanding healthcare providers.
For immigrants and those new to the U.S., language disparities are the biggest challenge they face. Unfortunately, our healthcare system expects patients to not only read, but read well in English. But this assumption is dangerous when you think about the following:
- 21% of adults in the US are illiterate
- 54% of adults have literacy below 6th grade level and cost the economy $2.2T/year
- 48% of non-native English speakers are illiterate in English
- 35% of adults with low literacy skills are white
- Children whose families have limited English proficiencies are twice as likely to experience medical errors.
Everything is paper-based because that’s how the healthcare system can mark the checkbox that they complied with their legal obligation. These patients are abandoned in the healthcare equivalent of the Oregon Trail, careening towards an uncertain destination without the proper resources to make informed decisions about their health.
As cars, maps, roads, GPS and other tools have emerged to make traveling safer and effortless, we can use the same principles to tackle language and literacy disparities in healthcare.
The first is more research needs to be funded that looks at the current state of health literacy. While there is a lot of data on health disparities and health equity, not much of that research focuses on language and literacy as factors in these disparities. The last nationwide health literacy assessment was conducted in 2003. Without recent data and evidence to support the importance of language and literacy, it is difficult to prioritize and address these issues.
The second is to recognize that language and literacy are skill deficiencies and can be addressed from the micro-individual level. The language the patient is most comfortable understanding should be captured in the intake form and highlighted in the patient’s profile. But health centers should not make the assumption that patients with limited literacy or language skills will receive support from family members or friends. Some patients might not have a support system or may be uncomfortable sharing their health information with others. Providers and healthcare staff need to make efforts to build trust.
Finally, technology can be used to augment language and literacy disparities. Using digital tools that will read patient information in multiple languages, like what SpeechMED offers, provides continuity in the care spectrum so that no patient is left behind. By prioritizing language and literacy, we can work towards a more equitable healthcare system where all patients have the information and resources they need to make self-driving decisions about their health.