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Health Literacy is Fundamental to Reducing Health Disparities
Written by Ardena L. Flippin, MD, MBA   
 Dr. Ardena Flippin

October is Health Literacy month and an October 3, 2007 article in JAMA (Sex Differences in the Use of Implantable Cardioverter-Defibrillators for Primary and Secondary Prevention of Sudden Cardiac Death) demonstrated how improving health literacy is fundamental to decreasing health disparities.

(From the Medical News feed: Women less likely to receive implantable cardioverter-defibrillators)

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The JAMA article demonstrated that among medicare patients, men are about two to three times more likely than women to receive an implantable cardioverter-defibrillator (ICD) for the prevention of sudden cardiac death. This is probably more descriptive of a health disparity than an example of health literacy, except that in an age of consumer-directed health care we “need to become informed consumers”, according to study author Adrian F. Hernandez (quoted in USA Today 10/3).

Health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Healthy People 2010). It is increasingly described as the “currency for improving the quality of health and health care in America” (The prevalence of Limited Health Literacy, J General Internal Medicine 2005). Health literacy is really about more than literacy levels for individuals – it is about how health care provider s communicate and about people’s understanding of health concepts, regardless of years of education or general reading ability (Institute of Medicine Committee on Health Literacy).

Although the JAMA article admits that there are limitations to their study, e.g., cumulative incidence may have been understated during periods of managed-care coverage and there was no information regarding patient preferences for ICD therapy, I find it hard to believe that ICDs were refused by women who were told that the procedure could help to avoid their sudden cardiac death. The question is - how well are health care providers communicating information to health care consumers (read women) in order for health care consumers to become more health literate and make good health care choices?

Inadequate health literacy adversely affects health care outcomes and the quality of life of 90 million Americans. Before patients can become better health care consumers, they need to know a lot more about health care itself. Healthcare providers and the general healthcare community are very focused on those who are at risk for “low” or “marginal” health literacy (minorities, less well-educated, elderly, recent immigrants, low-wage and industries with foreign-born workers). We also need to focus on the fact that many patients may be functionally literate in their homes or their work; this does not mean that they are health literate.

Poor health literacy contributes to high health care costs and people of all demographic groups require health literacy education. If information and education are made available to women as well as men health care consumers, this can increase health literacy, which can promote better consumer choices, and the ability to make better choices can decrease health disparities in a large segment of our population.


Curtis. et al., Sex Differences in the Use of Implantable Cardioverter-Defibrillators for Primary and Secondary Prevention of Sudden Cardiac Death. JAMA 2007;298(13):1564-1566.

Healthy People 2010 - a US governmental initiative for improving health.

Paasche-Orlow et al., The Prevalence of Limited Health Literacy, J Gen Intern Med 2005 February; 20(2): 175–184. 

Institute of Medicine Committee on Health Literacy

About the Author

Dr. Flippin brings a wealth of experience, starting with her long tenure as an attending physician at the Cook County Hospital Emergency Department. She is currently Corporate Compliance and HIPAA Privacy Officer at major Chicago hospital.

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