Healthcare Inequality: Why Everyone Should Care
ooner or later, we all get sick, and we all need healthcare.
Of course, not all Americans have equal access to healthcare. Some of us can’t afford it. Some live far from quality providers. Some experience bias based on race, sex, age, or gender identity.
The result?
People suffer and die from health problems they could have avoided — if they’d gotten the care they needed.
Untreated conditions require more expensive treatments down the line. And — whether it’s the person, the hospital, health insurance, or the government — someone has to pay for it.
Low health literacy and less access to healthcare for some people means higher healthcare costs for everyone.
February is Black History Month. Research shows that historically, people of color often receive poorer healthcare than white people, for many reasons. This is known as healthcare inequality, and it’s a problem that affects us all.
We asked Dr. Seth Serxner, PhD, MPH, EdLogics Chief Health Officer, to answer some key questions about healthcare inequality — and why we all should care.
What are healthcare disparities?
Basically, it means that not everyone has equal access to healthcare or health education. Those disparities have been documented among African Americans, women, the elderly, the LGBTQ+ community, and many ethnic groups.
How do disparities in access to healthcare disproportionately affect communities of color?
Disparities in healthcare can occur because of provider bias. The providers themselves may or may not be aware they have certain biases.
This is also an issue: Currently available medical science tends to be based on clinical findings of white male study participants. Those results may or may not generalize to people of color, women — anyone who is not a white male.
Disparities in health literacy put those populations who are already experiencing disparities in service at an even greater disadvantage. Because of a lower ability to understand health information and navigate the system, they are not as well equipped to advocate for themselves or others in their care.
Why should everyone care?
Health disparities put people’s lives and health at risk. For example, women are often not treated for heart attacks with the same urgency as men, which puts women at greater risk of death.
Delayed treatment or lack of treatment for people of color can lead to later stage disease diagnosis or disease mismanagement, which in turn may lead to more serious health consequences.
In addition to the unnecessary pain and suffering, there are increased cost consequences of treating people at later disease stages. These greater costs affect the healthcare system as a whole and result in greater costs for everyone.
👉 Overall, the goal of health equity is to provide everyone the opportunity to live healthy and active lives by addressing disparities in healthcare and health literacy. 👈
Equally important are social health essentials and personal determinants of health — such as housing and access to nutritious food, having social connections, a sense of purpose, and a positive outlook.
What can everyone do about it?
Our healthcare system needs to do a better job of training medical professionals about health disparities and help them be aware of their biases.
Those that pay for healthcare, such as insurance companies and employers, need to hold providers accountable for disparities with key performance metrics.
And individuals — regardless of ethnic background or gender identity — can strive to be prepared to advocate for themselves and others by increasing their health literacy.
At the community and employer level, providing opportunities for people to increase their health literacy is key to addressing this issue.
It’s important to note that our health system is complicated and health information is complex. Translating public health and clinical information to the personal level is challenging for most people from all walks of life. Low health literacy does not necessarily mean low literacy — some very intelligent and well-read people find it difficult to navigate our health system no matter their education level. It is NOT an issue of intelligence.
No matter who you are or what you know, you can and should improve your health literacy. It could save you some pain, some money, and even your life.
Log in now. Learn more about healthcare inequality, how it affects all of us, and what we can do about it.
(This is an example of the weekly newsletters that go out to all users of The EdLogics Platform, a gamified space that improves employee engagement and health literacy. Contact us to learn how to get access for your organization.)
The Social-Validation Feedback Loop
ecently, Sean Parker, the first president of Facebook, issued some harsh criticism of social networks in an interview on Axios.
He claims they work to exploit “a vulnerability in human psychology” and that those networks will eventually “consume as much of your time and conscious attention as possible.” He claims the networks do this by creating a system to generate addictive loops that “sort of give you a little dopamine hit every once in a while, because someone liked or commented on a photo or a post or whatever.”
The “social-validation feedback loop.”
It's very powerful and used by all of the major social media sites which continue to grow and consume our time and attention.
But what if we could take those same techniques Facebook used to grow to over 2 billion active users a month and applied them to something positive, like health education?
Recently, Tom Chamberlain, PharmD, CEO and Founder of EdLogics, gave a presentation to the Global Action Summit on the gamification of health. In his presentation, Dr. Chamberlain described various types of gaming technologies, such as video games, mobile apps, virtual reality, augmented reality, and interactive learning, and how they are being used in the medical field.
Chamberlain went on to discuss the key principles of gamification, including instant rewards, milestones, status, and competition. He described how a “little dopamine hit” is generated through playing these games and through the use of gamification technologies.
Driving engagement and facilitating behavior changes are the “holy grails” of health improvement programs. If we can get individuals, employees, plan members, and/or communities more engaged in understanding and acting on their own health, we can see vast improvements in a population’s health and lowered costs. This is why applying gamification principles to health education is so exciting.
EdLogics is using the social validation feedback loop improve health literacy.
Low health literacy is associated with poor health outcomes and higher costs. It’s pretty clear that if a person does not understand their health, their health issues, the healthcare system, or their health insurance, they won’t be able to maintain or improve their health, select the right provider, adhere to treatment, and more.
These approaches are not just fun and games when it comes to health — they are using real science in an effort to drive behavior change and improve one’s life.
If you’d like more information on the EdLogics platform for your employees, health plan or as a broker/consultant, please contact us.
A version of this article was originally published 11/11/2017.
What Experts Say About Improving Health Literacy: What Works & Why
ou can’t control many of the factors that contribute to high healthcare costs: expensive drugs, the cost of providers, rising insurance premiums. So, what can you do?
Improve health literacy, the ability to understand and act on health information.
Watch health literacy expert Russell Rothman, MD, MPP of Vanderbilt University and gamification guru Brian Primack, MD, PhD, then of the University of Pittsburgh (now at University of Oregon), outline problems with existing health education programs and describe real-life solutions.
Watch the entire webinar recording below.
Here's the skinny:
Low Health Literacy Costs More, High Health Literacy Costs Less
EdLogics wants to improve low health literacy through education.
It’s not about avoiding medical care. It’s about getting the right care at the right time.
We want to empower people to make real changes in their day-to-day habits, so they can stay healthy and keep their families healthy, too.
We want to educate people to prevent sickness before it starts, to show them what to do and where to get care when they do get sick, and help them become well-informed, proactive healthcare consumers.
Ultimately, EdLogics wants to improve health outcomes, reduce the number of claims, and lower costs. For everyone.
Dr. Primack:
“In the US, 1 in 3 Americans can’t follow directions on a drug label. And I have to say, even with a medical degree, I sometimes get a prescription for one of my kids or something and I have to look at it pretty carefully with that small print and the code that it’s in. So it’s not surprising that it’s a challenge for many different people.”
Dr. Primack:
“When someone, for example, just has an ankle sprain — if they can access and follow good information that they have — then they very well might be the kind of person who will say, ‘You know, I don’t need to go the emergency room. I can wait.’
A couple days later, they’ve already improved with ice, elevation and rest — all things that are free.
Whereas another person who is having more difficulty understanding or accessing information might decide to go to the ER for the same condition, and the second they get through the ER door, already they’ve racked up very high costs. They’ve put themselves at risk for getting some kind of a hospital-acquired infection or some additional problem.
Even though this is one small example, when we start quoting issues like ‘90 million Americans have poor health literacy, and this costs an extra $150-200 a year,’ you can see how these numbers add up.”
Improving Health Literacy Makes a Difference
Knowing what to do to prevent chronic disease, how to take medications, and where to go when you’re sick — and acting on that knowledge — can have a huge impact on both personal health and the number of costly healthcare claims.
✅ Improved knowledge of health issues
✅ Improved behaviors
- Medication adherence
- Vaccines
- Childhood obesity prevention
- Diabetes self-management
- Asthma management
✅ Improved outcomes for:
- Diabetes
- Heart failure
- Obesity prevention
- Depression
Dr. Rothman:
“Even after you take into account a patient’s education level, their income, their insurance, and a host of other factors, we find that their literacy level is an independent predictor of how they do with their health.”
The Problem with Existing Health Education Programs
Of course, health education programs trying to raise people’s health literacy already exist.
But are they actually making a difference?
Pamphlets: Often don’t make it from the doctor’s office to the car.
Health websites: Too high-literacy, not personalized, and not always trustworthy.
Doctor visits: Patients may misunderstand, forget instructions, or feel too embarrassed to ask questions.
Dr. Rothman:
“And, unfortunately — and I say this as a primary care physician [laughing] — but there’s also a lot of variation in how well doctors communicate with their patients and their families. If you ask most clinicians we would, of course, tell you that we’re excellent communicators, and our patients all nod their heads and seem to understand everything that we say to them. … Some studies suggest patients only recall about 20% of what’s said to them by the time they get home.
So we like to think we’re all good communicators as clinicians, but a lot of us struggle — using a lot of jargon that might be hard for patients to understand, maybe speaking at too high of a literacy level without enough plain language, and giving people too much information to try to take in during one single visit. We often don’t assess patient understanding before they leave.”
Poorly designed games: Many focus on the wrong goal.
Dr. Primack:
“So there would be hamburgers and pieces of pizza, and you are supposed to shoot those, but the salad you are supposed to let live. You can probably imagine the next step, which was that they studied this and they found that being exposed to this game and playing this game a lot didn’t actually make people change their diet in any way.
It’s just a caution that even though sometimes gamification is really valuable, if the game is poorly designed, that’s just not a magic quick fix.”
Improving Health Literacy: What Actually Works
It’s one thing to learn more health facts. It’s another thing to change your daily habits — the one thing that has more of an effect on health than any other single factor.
- Gamification and game-based learning
- Key principles:
- Competition, leaderboards, and peer comparisons
- Teamwork, shared goals
- Leveling up, increasing challenges, improving skill and knowledge
- Interactive content for better retention than passively-consumed content
- Unique incentives, cash drawings, charitable contributions, other benefits
Dr. Primack:
“The question is: Can we take principles of gamification and game based learning — the interactivity, the unique incentives — and can we use that to leverage for positive change? And what we have found is that, especially in the area of health literacy, there is a lot that we can do.”
- Multiple formats: words, pictures, videos
- Personalization: Content is tailored to the individual user based on age, gender, health conditions, interests, and family roles like caregiving
- Motivation and sustainability: Keep people engaged for real-life behavior changes
- Community resources: Further education and support
Dr. Rothman:
“What we really need to think about more is how to link people to other social support mechanisms to help them with their health. We have lots of studies now that really demonstrate that patients who have strong social support do much better with their health. There’s actually an epidemic of loneliness going on in a lot of countries.
And even when people are with their family, they may not have social support for disease that they’re dealing with.
So it can be really helpful to help a patient or employee and their family link to community resources — maybe to disease-specific organizations if they have a certain disease, or to a community organization that provides peer support. Or we can help them gain access to exercise or healthy food. Even to help them with getting additional support from their own family.”
Effective Health Literacy Education
- Personalized and engaging
- Addresses readiness for behavior change
- Applies principles of motivation for goal setting
- Activates participants
- Sets concrete, feasible goals
- Promotes follow-up for sustained behavior change
- Provides community resources for support
4 Things to Remember:
- Health literacy is a major problem in the US.
- Improving health literacy benefits everyone.
- We need a multi-faceted approach.
- There is no quick fix — but there IS hope.
Dr. Rothman:
“Health literacy is a major problem in the United States. We have at least 90 million Americans with only basic or below basic literacy skills. Even patients with good literacy skills can struggle to navigate what’s become a very complex healthcare system when trying to take care of their health or the health of their family.
We have found that by addressing health literacy issues, we can improve care for patients with low literacy. Studies have suggested that using good forms of health communication and addressing health literacy can even improve knowledge and behavior for people with high health literacy. So improving how we educate and communicate can be of great value to everyone.”
Dr. Primack:
“There are so many challenges here. If it were easy, we wouldn’t have 90 million Americans with low health literacy. But I think that it’s important to end on a positive note and say that we really are moving the needle. There have been studies that show that using the kind of principles that we talked about today really do help and change people’s lives. I think that that is what we need to hold up as we move forward.”
A version of this article was first published 10/12/2018.