Reducing Preventable Harm: COVID-19, Health Literacy, and Health Disparities in Vulnerable Populations
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We Can Do Better to Provide Accessible COVID-19 Information
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Teresa Wagner
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- Should this solution be national, regional, local or a combination with an intentional structure and designated channel?
- How would you propose we ensure public health crises information undergoes health literacy transformation prior to being disseminated?
Lightning Talk Highlights
Health Disparities in COVID-19
When we look at health disparities in COVID-19, we know that 22% of US counties are disproportionately black, 52% of our nation's COVID-19 cases have occurred in those communities, and 58% of the COVID-19 deaths have occurred in those communities. The size of the county, or whether it was urban or rural, has not played a role. In fact, social conditions such as structural racism and other factors have elevated the risk for COVID-19 diagnosis and deaths in black communities.
Health Literacy Is a Social Determinant of Health
I would like to propose that health literacy has also played a role as it is a social determinant of health. We've been bombarded with complex words that even a person with a high education can't understand. Abstract statements like underlying conditions flatten the curve and trajectory models. Zarocostas proposes that we've had a global epidemic of hard to understand information. It's had devastating consequences to public health, wellbeing, and economies across the world.
As you can see in the realm of health and healthcare of the five social determinants of health categories, access to healthcare, access to primary care and health literacy all fall in that category. We know that these communities also tend to have low access to healthcare and low access to primary care.
Health Literacy and COVID-19
In an op-ed in the Atlanta Medical Association Journal, Iris Feinberg states, "There's a huge gap between how health messages are communicated in COVID-19 and what health consumers can understand those messages to make good health decisions." Health literacy in COVID-19 has been identified as a silent killer that vital signs and oxygen saturation measures do not help. In fact, over 66 million people cannot read or understand most of the health materials about COVID-19.
When we talk about health literacy and COVID-19, we know that the average American reads at the eighth grade level and 20% read at the fifth grade level or below. Further, 40% of elderly adults read at the fifth grade level or below and 50% of African Americans and Hispanics read at the fifth grade level or below. (Graphic shows that most health materials are written at the 10th grade level.)
We Can Do Better to Provide Accessible COVID-19 Information
To stop the spread of the disease, we need to provide COVID-19 information that all Americans can understand, regardless of their social determinants and literacy level. 33 million U.S. adults do not have internet access. They use radio and TV five times more than print. Most of the information about COVID-19 has been available in print on the internet.
We need to be developing TV and radio PSAs that are concise and in plain language for people to understand. Carefully written documents are important, but having them available on the internet is useless for adults with low health literacy.
We need to have plans in place to help people get health information when it's needed most. Even before reading Feinberg's op-ed, I was thinking that in Texas, our community health workers need to be out there on the front lines, delivering this information to these disparate and underserved populations.
We need to have community-wide partnerships and collaborations with people who these communities trust to deliver information and to deliver it in a way they can understand. Before emergencies strike, we need to be prepared with trusted sources of accurate information, such as community organizations, adult education programs, and healthcare providers; we must be prepared to serve these hard-to-reach populations.
Results from an Informal Community Health Worker Preparedness Survey
By being deployed to the front lines, Texas’s 4,000+ community health workers can serve as a big part of that plan. They're already a part of the healthcare team and they're from the communities that they serve. They know the culture, or they're part of the culture, and they're well networked and trusted.
When I informally surveyed community health workers about their preparedness to handle COVID-19, I found that most were:
- not at all prepared,
- only slightly prepared, or
- moderately prepared.
Many community health workers used social media to release information, but only 81% of the U.S. population have smartphones, which decreases as income and education decreases. According to community health workers, most people in their communities needed to know basic facts about COVID-19. They also needed to understand safety precautions such as hand-washing and social distancing.
These communities get their information from friends, family, and the internet. That's an important note because if friends and family are giving inaccurate information, then those communities will continue to be uninformed. Community health workers identified key difficulties in distributing information. Often, they found themselves inundated with too much information. Worse, much of that information was contradictory. As a result, health workers couldn’t be sure which information was valid or clearly understand how it affected their communities. Most significantly, they lacked trusted resources to help them prepare.
Proposed Solution—Emergency Management Health Literacy Model
I'd like to propose an emergency management health literacy model. We need to have prepared communicators, such as community health workers, who are armed with clear communication and who can be deployed in public health emergencies, such as COVID-19. That way all Americans—regardless of social determinants or health literacy levels—can understand how to stop the spread of a communicable disease. Having these measures in place would go far in reducing disparate and preventable harm. Here's my contact information. Thank you for attending today.
Join the Discussion!
- Should this solution be national, regional, local or a combination with an intentional structure and designated channel?
- How would you propose we ensure public health crises information undergoes health literacy transformation prior to being disseminated?
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