Clueless on healthcare: here’s how we can get smarter

Michael Joyce produces multimedia at and tweets as @mlmjoyce

health literacyMedpage Today sent me a video this week that triggered a stream of consciousness about health literacy … or illiteracy.

Here’s my chain of thoughts, not a scientific approach by any means, but more of my trip down a sobering rabbit hole which ends with this question:

How much of the health information that journalists send out there actually gets through to readers and has any sort of impact?

Thought One: How bad is it?

Here are the gee whiz statistics from the US Department of Health & Human Services highlighted in the video:

  • 12% of Americans have proficient health literacy (ie. can obtain, process, and understand basic health-related information)
  • Over one-third of Americans have problems with simple tasks like following the directions on a prescription bottle
  • 1 out of 6 American have a communication ‘disorder’ or challenge to begin with

These statistics align with the conclusions of the Report of the Council of Scientific Affairs on Health Literacy published in 1999 which found, amongst other things, that about 25 percent of Americans can not fully comprehend the information on an appointment slip, and almost two-thirds can not understand a standard consent form.

In other words, the deck is stacked against basic messages being understood in the first place.

Thought Two: So where are people getting their health-related information?

According to the American Press Institute (2014 data), most Americans still tune into their local nightly news to get their general information. But each year more of us are turning to the internet. According to a 2013 study by the Pew Research Center, the majority of us have gone online looking for health information in the past year. Over one-third of Americans report they have gone online specifically to learn more about a medical condition for themselves or someone else. Almost half say the information they found online led them to consult a physician.

So there is a pipeline from our keyboards to our doctor’s office.

Source: American Press Institute, 2014

But are we surfing, just liking and sharing, or actually reading? Depends on who you read. But the numbers are impressive. A 2014 analysis by the Media Insight Project found that about 6 out of 10 Americans admit they did nothing more than scan the headlines in the past week. And that tally only includes those who admit it.

Last summer French and American researchers found that nearly 60 percent of links shared on social media had never been clicked open, prompting Washington Post reporter Caitlin Dewey to write:

“Worse, the study finds that these sort of blind peer-to-peer shares are really important in determining what news gets circulated and what just fades off the public radar. So your thoughtless retweets, and those of your friends, are actually shaping our shared political and cultural agendas.”

If there is even a smidgen of truth in that, then adding Thought One + Thought Two = trouble. Big trouble.

But, for us that’s a motivating factor.

A Final Thought: Four tangible steps journalists can take to address health illiteracy

At we have access to a living library of experienced health care journalists and providers who are part of our editorial team, as well as a list of industry-independent experts.

It’s a deep well to draw from, and it’s been instrumental in helping us develop pragmatic resources that journalists can turn to when looking for help both with interpreting health care information, as well as communicating it with more accuracy and clarity.

I’m speaking mostly about the toolkit section of our home page, which we are constantly updating and adding to. (Just this week we revised our primer explaining why surrogate markers — things like cholesterol levels and blood sugar — are often misunderstood and misused.) This toolkit has become encyclopedic and can feel daunting at first. So, I thought I would select the four sections that are most likely to be helpful in addressing the health literacy challenges mentioned above.

  1. Headlines: if it’s true that a growing number of us aren’t getting past the headlines, then that makes accurate headlines much more important than seductive ones. These 5 TIPS for writing better headlines are the best place to start.
  2. Numbers: numbers and graphs save time, and can connote ‘real science’ to many non-scientists. Appropriately used, numbers can be incredibly powerful. Inappropriately interpreted, they can mislead and misinform. Nowhere is this more apparent then when writers have to make a decision about communicating risk in relative vs absolute terms. Just clarifying this distinction for the public would have a huge impact on health literacy.
  3. Association & Causation: just because a study finds an association between two things does not mean one thing caused the other one to happen (“eating broccoli associated with fewer strokes” doesn’t mean the broccoli is somehow directly responsible for fewer strokes). Sounds straightforward enough, but every week we review medical news stories that fail to mention: association≠causation!
  4. Words Matter: There are those words that are all too easy to fall back on, but that all to easily send the wrong message. Here are 8 Words we recommend journalists avoid and consumers stay wary of.

It’s often argued that a well-informed public (that votes) is the key to a successful democracy. It’s a major motivation given by many journalists I know for doing what they do.

The health literacy parallel could go something like this: Health care journalism that is compelling, clear, and evidence-based is the key to success in enhancing health literacy.

To answer the questions I opened with:  How much health information is getting out there? More and more each day. And is it having an impact? Absolutely …. but it’s all-too-often counterproductive. Our TOOLKIT section can help make that impact more substantial and constructive.

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Comments (2)

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Sally James

July 14, 2017 at 10:48 am

Dear Michael,
I find the stat about shared links being unread the most alarming in your wonderful post here. It makes me ask – doesn’t this make the headlines alone the most potent contributor to health misunderstanding?

    Michael Joyce

    July 14, 2017 at 11:44 am

    Thanks for reaching out.
    My guess is that with the growing popularity of Twitter, Instagram, Facebook and other formats prone to click-baiting, your concern is spot-on.
    I often find myself wondering:
    Do we live in a time where believing has taken the place of knowing?