The Fault in Our Logic: How Health Literacy Shapes Our Experience of Healthcare 

When I started writing for clients who practice functional medicine approaches, it became apparent quickly that there was a fine line between promoting whole-body wellness and a well-rounded lifestyle and just ripping people off. Let's look at two examples.

Medical Weight Loss

Medical weight loss can be highly beneficial if medically supervised and complemented with diet and exercise. While we're still learning about the effects of coming off of drugs like Ozempic, the marketing my clients do for medical weight loss programs is rarely misleading.

They're honest about the efficacy of Ozempic and about the work the consumer will need to put in beyond the drug. Of course, there are plenty of conversations to be had about Ozempic itself and how practices often use compounded versions of the drug, which are safe but not FDA-approved for weight loss, but those are for another day. The marketing is not misleading. 

Bioidentical Hormone Therapy

Let's consider bioidentical hormone replacement or BHRT. The marketing you often read around this is that BHRT is a "more natural" alternative to traditional hormone replacement. This is bullshit. No research shows patients benefit more from bioidentical hormones than conventional hormones. While bioidentical hormones are made to more closely resemble the structure of actual hormones, both HRT and BHRT are effective, meaning they resemble traditional hormones enough to get the job done.

This upsets BHRT's fundamental claim: its more natural composition makes it more effective and safe. BHRT is made in a lab - just like any other synthetic hormone. So, the marketing around this is entirely misleading. The idea that bioidentical hormones are better for your "whole-body wellness" is just a lie to get more money. 

Exploring Health Literacy and Our Lack of It

The average human doesn't have the health literacy to know or research any of this. We're busy and want answers, not uncertainties("bioidentical hormones might be better for you, but we have no conclusive evidence to prove it" is not as compelling from a marketing standpoint). We also tend to put a lot of faith in people with credentials. 

While we'll get into how pervasive a lack of health literacy is and how broadly it affects us, from people refusing to take vaccines to lack of access to affordable contraceptives, this example I've given you is a microcosm of how lethal the combination of good marketing, shady ethics, and a hunger to be seen as a whole person by a healthcare provider can be. 

So, let's look at how problematic our lack of health literacy is on a broader scale, who it affects, and how we can work to improve health literacy.

“Health literacy is a privilege, but just like healthcare, it shouldn't be.”

What is Health Literacy?

Health literacy is our ability to obtain and understand accurate health information that empowers us to make informed decisions about our personal health. Sounds simple, right? You probably know it's not. There are two main reasons for this: scientific information is extremely complex. As such, scientific discovery is pursued by a small percentage of the population who publish highly complex research about their findings, which is regulated by review boards. These review boards often do a good job of combating misinformatin before it spreads, but not always.

Remember when Andrew Wakefield published a paper in the Lancet(a very high impact journal) using his completely fabricated data showing that vaccines cause autism? It was debunked almost as soon as it was published, but it's a prime example of how obsene mistakes can slip through the cracks. Because information that informs our health starts up in academia, it trickles down to us through sources that may or may not be trustworhty - it's up to us to decide.

That's where health literacy becomes not so simple. 

The other thing that makes it complicated is that we often get health information from organizations, like our doctor's office or a hospital. Health literacy relies on the organizations we trust having the knowledge and capacity to deliver health information effectively. It also relies on us trusting those organizations in the first place. 

So, to put it in a nutshell, health literacy requires critical thinking skills and a certain degree of trust in an organization or person with more knowledge than we probably do. Considering that these two ideas are at odds, it's no surprise we often find people who go to either extreme of trusting too much or questioning absolutely everything, like whether the Earth is round.

I'd say this is part of the complexity of being human. We have to be able to think for ourselves so that we can know what group or organization to place our trust in. Humans survive together, and they don't survive blindly. 

Who's Affected By a Lack of Health Literacy?

A lack of health literacy can impact individuals across all age groups and socio-economic backgrounds. People with limited health literacy may struggle to understand medical instructions, navigate the healthcare system, or make informed health-related decisions. This can lead to poorer health outcomes and increased healthcare costs for both individuals and society.

From interpreting prescription labels to grasping complex health information, those with low health literacy face barriers that hinder their ability to take control of their well-being. By addressing the root causes of low health literacy, we can empower individuals to make more informed choices about their health and access the resources they need for better outcomes.

Health literacy really does affect people across all socioeconomic barriers, just in different ways.

Take our first example of bioidentical hormone replacement. 

A lack of health literacy could lead to someone with disposable income going into debt because they believed the claim that bioidentical hormone replacement could prevent a specific type of cancer.

On the other hand, a lack of health literacy routinely leads to unplanned pregnancies in minority populations, higher rates of STD transmission, and a lack of awareness about how to lead a healthy life in those who don't have access to routine care due to economic barriers and belong to populations that historically don't trust healthcare providers. 

Different situations, different societal implications, same root cause. 

Health Literacy and Misinformation

To be health literate is to understand health information accurately. And, in my opinion, it's to have the confidence to ask questions. It's to have the ability to think critically. And it's an understanding that science is always changing. These core foundations of health literacy require a great degree of critical thinking skills, and we often see these completely fall apart in the face of social media and rampant misinformation. 

Cultivating Critical Thinking Abilities

Enhancing critical thinking abilities is essential in the age of information overload, especially when it comes to health-related content. Individuals with strong critical thinking skills can analyze health information effectively, identify biases or inaccuracies, and make decisions based on evidence rather than misinformation.

By fostering critical thinking skills as part of health literacy education, individuals can become more discerning consumers of health information and services. This empowers them to navigate the complex landscape of healthcare and make choices that support their well-being.

Social Media and Health Literacy 

Social media has become a significant platform for health information, but it also amplifies misinformation that can negatively impact people's health decisions. Individuals may encounter inaccurate information that promotes unhealthy practices or misrepresents medical facts, leading to confusion and potential harm. Perhaps more confusing, people are very good at representing themselves as authoritative sources of information.

There are, sadly, more than a few doctors spreading misinformation on social media. When someone has been to medical school, it suddenly becomes harder to question if they know what they're talking about. After all, if you can't trust this doctor, can you trust other doctors? Again, critical thinking skills are vital here. 

 By developing the ability to distinguish between reliable sources and misleading content, we can make more informed choices about our health and well-being. I'll say this - I don't think staying away from health information online is necessarily the answer, although your doctor might. Find the information you're looking for! But don't forget to evaluate the source it's coming from. Who follows them, and who do they follow? Have they ever caused drama or controversy, and how did they handle it? What are their views on topics that matter to you? How do they speak about "hot-button" issues?

Moral Outrage and Fear

Misinformation can evoke strong emotions like moral outrage or fear, leading individuals to make health decisions based on instinct rather than facts. This can seriously affect personal and public health, as emotional choices may not align with evidence-based practices. 

Moral outrage can be particularly dangerous, driving us to stop thinking critically about our choices and assume feelings of self-righteousness. We believe we must be right and look down on anyone who holds the "other" opinion, even as we know they're doing the same to us. The us vs. them mindset is a vital part of moral outrage, and we saw this at a peak during the pandemic, with online fights over mask-wearing and vaccination.

I'll be the first to admit that I was not honest with myself about how quickly I trusted the vaccine. I, as a rule of thumb, trust all vaccines. I was one of the first to get vaccinated in December of 2020 as a health professional. While I don't regret that, I was not taking part in the nuanced conversations around the lack of transparency from the CDC, for example. Both sides to an argument can refuse nuance.

 Is it any wonder why? Admitting that it was weird how the CDC kept saying, "These are our recommendations," and then quickly pivoting would have given anyone with a different opinion than me ground to stand on. I was just... too tired to argue with anyone. 

If you ever find yourself in a similar situation - too tired to argue or tired of hearing the same old arguments - that's okay! Experiencing moral outrage or being firmly rooted on one side of what feels like a very polarized argument doesn't have to be something you externalize. If you feel like you could be doing more research or simply inspecting the nuance of the situation more, you can do that yourself. Just because we live in a world where everyone tells everyone else everything doesn't mean you have to go through this process of examining your beliefs out loud.

In short, addressing moral outrage and fear requires a combination of emotional intelligence and health literacy to navigate complex health information with a clear mind. By promoting emotional resilience and equipping individuals with the tools to manage their responses to health-related content, we can mitigate the impact of misinformation on decision-making.

How We Combat Misinformation with Increased Health Literacy

Research shows that we're likely to spread misinformation for a few reasons. Namely, we want to protect our loved ones, feel like we have information others don't, are trying to make sense of something, or want to feel connected to others. None of these are inherently bad, which is why combatting misinformation requires a lot of empathy. 

Listening, empathizing, refraining from public shaming(like calling out someone online), and using inclusive language can help combat misinformation. While it can also help to provide people with unbiased, credible sources, logic may not always work in the face of misinformation. That's where empathy comes in. Most people want to feel heard. If you're struggling to combat misinformation personally with someone you love, check out this toolkit provided by the Office of the Surgeon General.

We also see providers and organizations address misinformation on social media platforms. I can't believe I'm saying this, but that doctor on TikTok(pick one) can help undo the damage widespread misinformation can cause by combatting false claims. By providing accurate health information, debunking myths, and guiding followers toward reliable sources for further clarification, providers can meet patients where they're at and play a role in their health literacy journey. 

How Lack of Health Literacy Becomes a Public Health Crisis

The lack of health literacy is not just a personal challenge; it can escalate into a public health crisis when widespread misinformation and misconceptions shape community behaviors and health outcomes. From vaccine hesitancy to ineffective self-treatment practices, low health literacy can contribute to spreading diseases and hinder public health efforts.

Addressing health literacy as a public health priority involves implementing strategies that foster health equity, promoting accurate health information, and empowering individuals to make informed choices. By recognizing the impact of low health literacy on the broader community, we can begin to work towards creating a healthier and more resilient society. Let me be clear: there is no easy solution to this.

 Policy changes, programmatic offerings, and consumer education materials that work are just a part of creating a society with better health literacy.  Additionally, making healthcare accessible and affordable to everyone, as well as inclusive of all people, is a necessity.

The Right to Health Literacy

Health literacy is a privilege, but just like healthcare, it shouldn't be. If the most at-risk populations were health literate, we'd have a chance of significantly improving infectious disease outbreaks in sub-Saharan Africa. Lack of health literacy costs the US healthcare system $236 billion annually. We can't wait to see a return on investment regarding health literacy solutions. We have to act to make health literacy accessible to everyone.

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