The Baltimore Times’ Health Matter series, “Illiteracy: Black America’s Public Health Enemy #1,” continues its examination of the connection between literacy, racial health disparities, and disproportionately high rates of chronic and acute illness in the African American community.
The financial costs of medical illiteracy are astronomical. It is estimated several billion dollars are spent on the treatment of preventable diseases and illnesses suffered by patients who are functionally illiterate, millions of individuals who lack the skill to read at the fifth-grade level. People who cannot accurately read prescription medicine labels and understand written hospital discharge instructions significantly increase their risk for making medical errors.
This deficit hits hardest poor, chronically ill people who self-administer their medications and rely on caregivers, who may have limited literacy as well.
Medical content is generally written to be understood by a wide audience around the eighth-grade reading level. To illustrate the differences in complexity and explanation of tasks compare these three post-outpatient surgery instructions written at the eighth-grade, fifth grade and third-grade reading levels:
Eighth Grade Reading Level
- Care Instructions After Your Surgery
- Limit Physical Activity: For the next few days, focus on resting. You can do light activities like reading but avoid anything strenuous.
- Diet and Hydration: Begin with bland foods that won’t upset your stomach. Keep yourself well-hydrated by drinking plenty of fluids throughout the day.
- Follow Medication Guidelines: If you’ve been prescribed medications, it’s crucial to take them exactly as directed to manage any discomfort.
- Wound Management: Ensure your wound stays clean and the dressing intact. Follow your healthcare provider’s instructions regarding wound care and dressing changes.
Fifth Grade Reading Level
- What to Do After Surgery
- Rest Well: It’s important to relax and not do too much. Staying in bed or sitting quietly will help you heal.
- Eat Soft, Simple Foods: Start with foods that are easy to swallow like apple sauce or yogurt. Remember to drink lots of fluids, too.
- Medicine Rules: You might have medicine to take for pain. Always take it exactly how your doctor said.
- Care for Your Bandage: Keep the area with the bandage very clean. Don’t let it get wet and change it when your doctor tells you.
Third Grade Reading Level
- Rest Time: You need to rest and get lots of sleep. Stay in bed or on the couch.
- Soft Foods: Eat soft things like pudding or mashed potatoes. Drink lots of water to keep you strong.
- Medicine Help: If you have pain, your medicine can help. Remember, only take it as directed.
- Keep Your Wound Clean: Don’t touch your bandage except to change it. Seek help changing the bandage if it gets dirty.
The Face of Illiteracy
It is nearly impossible to calculate how many people die each year because they cannot correctly read a prescription medicine label nor determine the number of patients who became ill after surgery because they could not read or understand critical home care instructions. The Literacy Project has gathered U.S. Census Bureau data to offer a compelling look at illiteracy and the magnitude of the problem:
*Currently, 45 million Americans are functionally illiterate and cannot read above a fifth-grade level
*50% of adults cannot read a book written at an eighth-grade level
*57% of students failed the California Standards Test in English
*1/3 of fourth-graders reach the proficient reading level
*25% of students in California school systems are able to perform basic reading skills
*85% of juvenile offenders have problems reading
*3 out of 5 people in American prisons can’t read
*3 out of 4 people on welfare can’t read
The series Medical Illiteracy: Black America’s Public Health Enemy #1, intends to identify ways to win the battle against health disparities by raising awareness of deep-seated challenges and attitudes to address the persistent root causes of illiteracy in the Black community. The legacy of historical, systemic barriers to Black literacy such as laws that made it illegal to teach slaves how to read, continues to this day, directly wielding a profound influence on the health outcomes of African Americans.
Jayne Hopson is a 2024 Commonwealth Health Care Performance Fellow. The special series “Illiteracy: Black America’s Public Health Enemy # 1 is funded by Association of Health Care Journalists (AHCJ) and supported by The Commonwealth Fund.
