One way to advance health equity is to improve health literacy, says one physician who is working to do just that—though she adds that low health literacy transcends social determinants of health such as education, income and background.
“The way I think low health literacy is linked to health inequity is that, No. 1, if it's not recognized and addressed, it leads to poor outcomes,” said Lisa Fitzpatrick, MD, MPH, MPA, an infectious disease specialist, epidemiologist and former chief medical officer for the Washington, D.C., Medicaid program.
“No. 2, people who have low health literacy that are also from under-resourced communities are already less likely to have the best outcomes,” Dr. Fitzpatrick explained. “So if we're not addressing their health literacy needs, we can exacerbate health inequity just because people don’t have access to the information they need to make a better health situation for themselves.”
Dr. Fitzpatrick is the founder and CEO of Grapevine Health, a Washington-based company that uses technology and digital media to deliver culturally appropriate and trusted health information to engage people in communities that have been historically underserved by the health care system and have had limited exposure or access to health innovations.
She discussed health literacy in an interview with the AMA and in an interview posted on the website of the In Full Health Learning and Action Community, which engages the industry and encourages digital solutions that address the needs of historically marginalized communities while ensuring that new tools don’t unintentionally embed bias.
Anyone, including physicians, investors, solution developers, funders and others interested in participating in the influence of the health solution ecosystem are invited to join the In Full Health Learning and Action Community. The AMA is the lead sponsor of In Full Health, which was sparked by the AMA’s strategic plan to embed racial justice and advance health equity.
How health literacy removes barriers
“A lot of the health-equity issues are linked to the social drivers of health, and I definitely believe health literacy is a driver of health,” said Dr. Fitzpatrick, a member of the AMA External Equity & Innovation Advisory Group. “If you have less education, you may be less likely to recognize you have a health issue, which can make you have a worse health outcome.
“If we give people the information they need and give them the comfort and the confidence to talk to doctors, improving their health literacy absolutely will improve the health outcomes because it makes them more confident, active participants in their health care,” she added.
Among other things, AMA policy on health literacy:
- Recognizes that limited patient literacy is a barrier to effective medical diagnosis and treatment.
- Encourages the development of literacy appropriate, culturally diverse health-related patient education materials for distribution in outpatient and inpatient settings.
Building street-level solutions
Dr. Fitzpatrick founded her company after seeing how patients’ needs for understandable health information were not being met.
“It's really a universal problem,” Dr. Fitzpatrick said. “Doctors need to speak in plain language to help demystify health information—because it scares people.”
After searching for solutions that “were reaching people” and finding none, she starting recording “Dr. Lisa on the Street,” a popular series of YouTube videos in which she talks with passersby about medical issues and patient-physician communication.
In one video, for example, she asks people on the street to explain what it means when physicians use jargon such as “hypertension” and “reducing sodium intake.”
The experience blossomed into Grapevine Health. Even after starting the company, the videos kept coming—including a series chronicling her participation in clinical trials for the Moderna COVID-19 vaccine.
“I was on the street talking to people about the vaccine and this Black gentleman said to me that he wouldn't trust the vaccine unless he could see Black people associate with it,” Dr. Fitzpatrick said. “I was also doing vaccine education for a group of seniors and half of them had no interest in getting vaccinated at all because they didn't trust it.”
When she asked if their attitudes would change if she participated in the vaccine’s clinical trials, the responses ranged “from utter shock and awe, to fear, to gratitude.”
The experience also served as a platform to explain how clinical trials work and to discuss how pharmacies don’t stock medications that haven’t been subject to such a test.
Dr. Fitzpatrick’s take-home message for physicians and other health professionals is to take responsibility for educating patients.
“We are trusted messengers and people are looking to us for sound, credible information,” she said. “We should be honored, really—given all the misinformation out there—that they would come to us.”
