Poster

Fixing the Achilles’ heel of health literacy

The Institute for Healthcare Advancement is hosting the 20th Annual Virtual Health Literacy Conference on May 25-27, 2021. You can register for free and learn by attending live sessions on your device.

My contribution to the conference agenda is a poster about Constructive Health Competence (CHC), which combines health literacy with other useful skills that are likewise lacking across most of the population.

An image of the poster follows this text. The image is rather large and perhaps will be slow to open. Those who wish to read it can open it large in the browser or download it. In the conference, the poster is accompanied by my voice-over. I am inserting the script of that here.

This poster acknowledges an Achilles’ heel of health literacy. The crazy assumption that folks will understand and use the information they read.

That’s not true of many people. The average adult in our midst reads like a child in middle school. Half of all adults can’t even do that. Others read better, so long as the text isn’t health information.

That’s because health information is not written in a vernacular. It’s by and large a professional rhetoric, a technicalese that requires higher education to understand and use.

Yet health literacy is not a professional or cultivated competence. It’s just regular folks being able to understand their healthcare, in order to inform their medical choices and decisions.

We can agree that health literacy is an important skill, too important to let language get in the way. So this poster outlines a fix for the Achilles’ heel. The fix removes textual obstacles to understanding complex information, and replaces them with pleasurable sensations.

Sensations are the fodder of art and entertainment; in this case, AAA video games. Visual and behavioral sensations are catalyzed by game mechanics and aesthetics. This is the stuff of visceral experience rather than quiet study.

That’s why playing video games is constructive. A game is a multifaceted kit that lets players themselves build the knowledge and skills they need to win. And in our games, the way to win is to defeat the illness lurking within.

So, assume we disconnect health literacy from language literacy. Can we now build effective health promotion? Nay, more is wanted. We add scientific literacy, another competence that most folks lack. We provide opportunities for regular folks to understand and use biomedical and social sciences in the game. We believe they can and they will.

The project enhances these literacies with health acumen, an ability to deal with perplexing unknowns that make us afraid or angry or depressed or unable to resist. And with medical self-efficacy, the ability to get anxious clinical situations under personal control.

The poster sums it up as constructive health competence. And because CHC emerges in the magic circle of play, regular folks can get into it. They can escape from suffering into a fantasy that brings them back to their true selves. Selves that are not dominated by chronic illness.

Copyright 2021 Humaginarium LLC

Acumen

88% of American adults have reading skills equal or inferior to a child in middle school.

Literacy is the ability to read a vernacular. In the United States, about 18% of all adults are functionally illiterate. Either they can’t read at all, or their reading skills are less than basic: at best, equivalent to a competent third grader’s, 8-9 years old.

About 34% of American adults are basically literate. They can glean simple information from printed matter, but not make much use of it. At best, their reading skills are equivalent to a competent fifth grader’s, 10-11 years old.

About 36% of American adults are functionally literate. They can understand the meaning of straightforward text, but can’t parse or interpret it for implications and consequences. They have workaday reading skills, at best equivalent to a competent eighth grader’s, 13-14 years old.

All of that said, about 88% of American adults have reading skills equal or inferior to a child in middle school. Leaving only about 12% with purported “adult” literacy. Hold on, that’s actually an overstatement.

About 10% of adult Americans have adolescent literacy: reading skills equivalent to a competent tenth grader’s, 15-16 years old. Only a tiny 2% of all Americans have genuine adult literacy, the kind of reading comprehension that is mandatory for higher education and professional endeavor.

I had to give this context in order to introduce the topic of health literacy: an ability to read the vernacular of health care. The vernacular of health care is the text printed on forms, handouts and signage in clinical and pharmaceutical settings. It’s the text in books, articles and websites with health-related subject matter. Most health-related subject matter is applied or theoretical science. For example, it’s not about how to use soap (function); it’s about why soap produces better health outcomes (cognition).

The vernacular of health care varies quite a lot — from papers in the New England Journal of Medicine at the high end to printouts stapled to prescriptions at Walgreens — but all of it has this in common: it is practically unreadable and therefore useless for around 98% of American adults.

When Humaginarium announced, at its founding, that it will promote health literacy at scale, it rose to an enormous challenge that generally goes unnoticed, despite its gargantuan economic costs and impact on health disparities. We had to come up with a way to promote adult health literacy across a population that overwhelming lacks adult literacy of any kind. Now we have done that. We have invented a way that should work well for the first 87 million adults who use it; and we are preparing to build and test a prototype of this amazing innovation. That is kind of exciting.

However our research also exposed some deflating limits of health literacy. Even if and when we demonstrate and prove exquisite technology that increases the health literacy of most American adults, will their newfound literacy effectively ameliorate health disparities among them? Put another way, will mastery of the vernacular of health care actually make most people healthier, happier and more secure?

The answer is no, it will not. The best outcome we (or anybody) can expect from adult health literacy is more participative medicine. By that I mean better quality of communication between patients and their clinicians and makers of medicines. That’s a pretty good outcome, but not good enough. It is not the game changer we seek.

To finish the job we started, we also have to promote health acumen. That is the key to medical self-efficacy. Acumen is an ability not just to read, but to exercise good judgement; to make healthy choices in the absence of external direction and authority; to possess keenness and depth of perception when observing what is obvious to any inquiring mind; to discern what is going on below the skin and the palpable symptoms in a body; and to discriminate between meaningful and false signals from blood, flesh and bones.

Understood thus, health literacy is no guarantor of health acumen. It’s just a prerequisite. Because without mastery of the vernacular of health care, critical thinking that fosters acumen must be so profoundly impaired that it’s practically impossible. People cannot exercise good judgement if they are grossly ignorant of the relevant science; and biomedicine is not the stuff of middle school.

This is why I no longer say that Humaginarium promotes health literacy at scale. Instead I say that Humaginarium promotes health literacy and health acumen at scale. Not just for the 2% who already have their linguistic ducks in a row, but for the 98% whose ducks are paddling aimlessly around the pond while the sky over their heads darkens; those who foolishly hope or expect the health care industry to make healthy choices for rather than with them. To have health acumen is to believe that “I will figure this out; I will decide; and I will make my decisions stick, come hell or high water.”

Like Gandalf, Humaginarium has found a way. We found our version of Thrór’s Map and a key that opens the door in the Lonely Mountain of health care. Beyond that adamantine door, Smaug is dreaming atop a gleaming horde of stolen treasure. After a long and perilous journey, Humaginarium is coming for him.