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Low health literacy must be tackled

Establish the scale of the problem and address the solutions, says Dr Jo Ellins

Without health literacy, patients will not benefit from new opportunities for choice and involvement.

In her opening speech as Health Secretary, Patricia Hewitt wasted no time in confirming the Government's commitment to creating a patient-led NHS. Since New Labour came to power we have seen several policy initiatives designed to promote this aim, principally through expanding arrangements for patient choice and involvement.

However, what the Government has so far failed to recognise is that the success of these initiatives, and of the patient-centred agenda overall, depends on it also tackling the problem of low health literacy. Indeed, among all the talk of 'patient and public involvement' and 'choice and responsiveness', the issue of health literacy is nowhere to be seen.

What we know is that people with low health literacy face major difficulties accessing, understanding and using health information to make decisions about their care. Essentially, they struggle to make sense of the many types of information that are central to health care such as consent forms, educational materials, medication directions and verbal instructions from health professionals. What we don't know is how widespread this problem is in the UK or whether certain groups are at particular risk.

Health policymakers certainly have considerable enthusiasm for making more health information available for use by patients and the public. Along with NHS Direct and its online counterpart, there are moves towards patient-accessible medical records and easy public access to information about the quality and safety of patient care.

Yet without adequate levels of health literacy patients will be unable, or at best ill-equipped, to use such information to make informed choices about their health care. Given this, it is possible that initiatives such as Choose and Book and the Expert Patients Programme could have the undesired effect of exacerbating health inequalities or even creating new ones, rather than narrowing them as is hoped.

Compare the situation in the UK with that of North America, where health literacy is fast becoming the focus of public attention and a pressing policy concern.

In the US alone it has been estimated that low health literacy affects half the adult population, some 70 million people. In recognition of the seriousness of this problem, major programmes of action are being established at both a local and national level, including one recently launched by the National Institutes of Health and Agency for Healthcare Research and Quality.

We urgently need to focus our attention on the issue of health literacy, in order to establish both the scale of the problem and how it can be best addressed. Failure to do so will make it difficult for large numbers of patients to make genuine and informed choices about the care and services offered in the NHS.

Dr Jo Ellins, research associate

Picker Institute Europe, the heatlh care research charity (

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