Health Literacy: The Missing Link in Public Health?

Andrew Pleasant, PhD, Senior Director for Health Literacy and Research at Canyon Ranch Institute, affirmed that “health literacy is the tool that can help people, and help health systems help people, to live a life of health and wellness and lower costs — regardless of socioeconomic status or other social determinants of health.” It can help people use the skills they have instead of being daunted. But, he added, though we talk about the power of health literacy correlated to health outcome and health status, we haven’t yet changed the world as much as we’d like. The health of the world continues to decline and the cost of health continues to rise. Our healthcare system absolutely requires proficiency, but 88% of us are below proficiency level.

Pleasant defined the task of public health as standing in front of millions of people and persuading everyone to move 5 steps to the left. Persuasion is one of 4 options available to public health. The others are regulation, technology development, and education. But, if you lose sight of the individual in the midst of the public context, it’s hard to create behavior change.

He gave several examples of public health campaigns that, seen through a logic model, failed. The logic model illuminated the points at which the campaigns went wrong. Perhaps the most powerful example was the anthrax scare in the United States. Information was widely available and thus easy to find, but there was low public understanding due to complex government information sources. The public failed to evaluate the risk accurately, and assumed everyone was at risk. There was little communication or feedback between those giving information and those receiving it, and the result was that information was misused counter to public health benefits; in fact, antibiotic usage increased in every state in the nation.