Last month I had the privilege of attending the Healthcare Equity Innovations Summit by the ICD Healthcare Network. It was an incredible event with great speakers. The people in the room were compassionate, kind, brilliant, and unified in their desire to bring health equity to the forefront of their future planning and execution. I found the information incredibly useful and in some instances enlightening even though we have worked in this space for years, even before we had a term to describe it. Most of us would acknowledge that severe health disparities exist and continue to exist. Poverty, lack of access, transportation, food insecurity, lack of minority participation in clinical trials, racism, and many other problems were discussed in detail. What wasn’t discussed to my great surprise was language and literacy.

I believe that if a patient doesn’t understand their healthcare instructions, there can be no equity. There are 130M people in the United States who suffer from low literacy due to language, age, vision, and their overall ability to read and use simple arithmetic. 65% are minorities.

“If a patient doesn’t understand their healthcare instructions, there can be no equity.”

And we understand that language and literacy issues are hard to address. But it is important for patients to understand their healthcare instructions to ensure that they receive the best possible care. Poor language skills and low literacy levels can be significant barriers to healthcare access. Statistically, there is one medical mishap in the United States due to communication errors every 14 minutes. Patients who struggle with understanding written or spoken information have difficulty communicating with their healthcare providers, following treatment plans, and making informed decisions about their health. It is also important to recognize that health literacy barriers can affect people from all backgrounds, not just those who are non-native speakers of the predominant language in a given area. Nearly 9 out of 10 adults struggle with health literacy. Even people with high literacy skills may have low health literacy skills in certain situations. For example, someone stressed and sick when accessing health information may have trouble remembering, understanding, and using that information which is a common occurrence during hospital discharge.

We must be aware of the issues and take steps to address them to ensure that all patients have equal access to high-quality healthcare information. Traditionally, this involves providing written materials in multiple languages, using plain language, hiring interpretation services, and making graphic information charts in some cases. But there are challenges to those approaches. Many people don’t read well enough in their native language. Presenting low literacy people with written materials doesn’t solve their barrier to understanding. Interpreters play a vital role but according to one study by NIH of over 20,000 patient encounters,” Errors in medical interpretation are common, averaging 31 per clinical encounter, and omissions were the most frequent type”. In addition, the interpreters cannot follow the patient home which leads us back to the reading skills of the patient if they have been given written materials in their native language. And while graphic charts are useful they can only relay simple instructions and rely on the hope that the person reading them understands the pictures.

New approaches continue to evolve. This is why we built SpeechMED, a voice and language application that speaks to patients in the language that they understand. Audio and video instructions are being used more often to explain healthcare to patients.

In conclusion, we have to broaden our approach to Health Equity. It certainly is about poverty, lack of access, transportation, food insecurity, lack of minority participation in clinical trials, and racism. But we cannot neglect the issues of language and literacy and expect to give everyone equitable healthcare. And It’s a time for healthcare organizations to recommit to making sure all audiences can find, understand, and use information and services to make the best health-related decisions for themselves and others.