A small step towards a health literate Canada

It was late at night and Leanne (names changed) realized her 2 year old daughter, Meaghan, had a fever after she had been crying through the night. Leanne reached for the infant Tylenol but realized she wasn’t sure whether how much to give Meaghan, who was lighter than most kids her age. Leanne decided to give Meaghan the amount listed for her age even though the weight didn’t match up exactly. There was no one to call for help and no further information on the bottle to guide her. When she found out the next day that she actually should have given Meaghan medication according to her weight instead of age, she felt terrible, but also frustrated that the medication wasn’t labelled more clearly.

This is a common problem for parents and for adults in general. Studies have shown that 50% or more of parents make errors when administering liquid medications for their children and up to 78% of in general people may misinterpret warning labels on prescription bottles.

In June 2013, Health Canada announced plans to improve drug safety by making drug labels easier to understand and use. The Plain Language Labelling Initiative will eventually apply to all prescription and non-prescription drugs and will include requirements for clear language, contact information and standardized information templates to reduce medication errors.

The government is taking a step in the right direction by proposing mandatory changes to industry regulations, acknowledging the challenges that many people face when trying to use complicated and often confusing written information to manage their health. However, plain language labelling only a very small part of the overall picture of how the healthcare system needs to support people in using health information and managing their health.
Health literacy is the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course. It’s related to functional literacy, the ability to use written information for activities of daily living, but requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations.

Approximately 60% of Canadians and 88% of Canadians seniors have low health literacy. This is a huge number, and even more staggering when you consider that people with good health literacy skills often find it a challenge to process information when in pain, tired or facing a crisis. Low health literacy is linked to many adverse health outcomes, including difficulties managing medication regimens, decreased ability to manage chronic conditions and even premature death.

In the United States, a country with similar health literacy and literacy rates as our own, the Department of Health and Human Services, the Joint Commission, the Affordable Care Act and other national bodies acknowledge health literacy as a focus area ( The recent move by the Canadian government to acknowledge the challenges of using health information is noteworthy, but it’s not enough in the face of what can be done at a national level to support growth and development in this area.

The cost of low health literacy is estimated to be 3-5% of total healthcare costs—in Canada that is approximately $8 billion annually spent simply because people don’t understand their healthcare providers’ instructions. Since health literacy is disproportionately lower among seniors, this cost is likely to grow further with our aging population (explored in an earlier HealthyDebate article.

Yet Canadian healthcare professionals and policy makers aren’t often aware of health literacy or how to address it in practice. Health information produced by professional and health associations is often written at a level that is inaccessible to most of the population. Skills to address health literacy and patient and family education remain rarities in the curricula of healthcare providers and administrators. Healthcare providers and policy makers must be aware of this issue to start making changes and to work with patients and caregivers effectively to help them manage their care.

Mandatory health literacy training could offer healthcare providers strategies and tools to improve the usability of our system and engage people in managing their care. For example, teaching providers to simplify written and spoken communication and to work with patients on goals and self-management could make a huge difference in addressing our health literacy burden. Or having provincial or national resources for healthcare providers and organizations with usable tech tools to support better patient teaching and self management, such as medication tracking charts and reliable reminder apps.

There are many other examples of how we can make changes in practice to make our system easier to use and health literacy friendly—we just need to ensure our providers know how to do this, why it must be done and have the tools available in practice to effectively communicate with patients and caregivers.

The recent move by the Canadian government to simplify prescription bottles is an important gesture, but without more effort, it is doomed to fall short of fixing the problem. Clear language on a prescription bottle cannot replace effective communication and education with healthcare providers at the point of care, but healthcare providers need more assistance in knowing how to best support patients and caregivers. In an ever increasingly confusing healthcare system, we need an approach that goes beyond just words. Medication safety is just one example of how we need to bolster the multiple skills patients require to successfully manage their care and make sure our system is as easy to use as possible.

Let’s start talking about what people need to manage their health in the community and make sure that our health care providers, policy makers and institutions are equipped to deliver.

Farrah Schwartz is a manager of patient and family education at the University Hospital Network. Follow Farrah on Twitter @FarrahSchwartz

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  1. Sue Robins

    %featured%I’d love to see patients and families added to the review process of educational materials. They would serve as editors to ensure the language is appropriate, and written in a way that is understandable to them. Health professionals are often so immersed in acronyms and lingo, they cannot objectively edit their work.%featured%

    ‘Know thy audience’ is the first rule of writing…

  2. Don Gary

    Farrah….many many Docs seem to feel underpaid, overworked, abused and mistreated by health system, believe patients do not understand their health and treatment as the physician expects. If you’re a twitter follower you’ll see over the past week an overwhelming amount of comments about all the above. Doctors have an opportunity overtime to affect healthcare change….far better than the public. Comments speak about suicides of doctors and post traumatic stress. No doubt many do not cope well. The patient feel equally depressed and overwhelmed with diagnosis. They look to doctor to listen to them and explain. They look for empathy as it would appear doctors are seeking from the health system and the patients. Both are working with stress but doctor is expected to control and cope better than patient. He/she are the experts, they’ve been trained in the complexities of the human body, physically and mentally. I truly believe neither talk openly with each other….patient isn’t prepared with questions and doctor isn’t really listening. We’ve lost the time we used to spend with doctor, they are pressed by patients and health system and hospital problems. We all must try harder and be part of the healthcare solution…..let’s talk, we want to help, docs have to ask.

  3. Elke Ruthig

    Farrah…thank you for making excellent and strong arguements for generating new policy and enhancing professional accountability wrt health literacy. The development of overarching provincial and/or federal guiding standards and systems level / organizational recommendations (beyond medication labeling as a single initiative) will address low health literacy and its impact on the Canadian health care sytem. Even more importantly, focusing policy and professional practice on this issue will positively impact patients, families and caregivers; this is so key to moving this agenda forward.

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