One real failure in the discussion over health policy is that it takes place largely among educated elites. So while I may not think patients have the training and judgment to always assume a leading role in their health decisions and others do, we're too often thinking of folks basically like us. Here's who we're not thinking about:
In a 2004 report, the Institute of Medicine defined health literacy as the ability to obtain and understand basic health information and services needed to make informed decisions. Low health literacy, the institute noted, affects an estimated 90 million Americans, who struggle to understand what a doctor has told them or to comply with treatment recommendations as essential as taking the proper dose of medication. A 1999 report by the American Medical Association found that consent forms and other medical forms are typically written at the graduate school level, although the average American adult reads at the eighth-grade level.[...]
A comprehensive national assessment of adult literacy conducted in 2003 by the U.S. Department of Education found that 43 percent of adults have basic or below-basic reading skills -- they read at roughly a fifth-grade level or lower -- and 5 percent are not literate in English, in some cases because it is not their first language.
So forget, for a moment, whether individuals have the interest or time to take charge of their treatment regimens. If 43 percent of Americans are reading at a fifth-grade level of lower, how many even have the capability? And how much damage will be done -- as in the article's example of a women who sought to save face and accidentally consented to a hysterectomy -- if we don't take these educational inequities seriously?
