Contributor: How to Remedy Low Health Literacy and Amplify SDOH Programs at Scale

Ryan Bosch, MD, FACP
Ryan Bosch, MD, FACP

Ryan Bosch, MD, FACP, is president and co-founder of Socially Determined, the social risk analytics company for organizations committed to addressing the Social Determinants of Health (SDOH), and is also a practicing physician in Reston, Virginia. In previous roles, Dr. Bosch has built healthcare IT businesses, and advised and served as CMIO for health systems. He was also director of the division of internal medicine at The George Washington University, served on the White House medical team and achieved the rank of Major as flight surgeon in the United States Air Force.

Ryan Bosch, MD, FACP, founder and president of Socially Determined, outlines steps for improving health literacy.

Earlier this month, the Biden administration announced it will commit $250 million in funding to improve COVID-19 vaccine health literacy in vulnerable and medically underserved communities. With the logistics of administering vaccines no longer an overwhelming question mark and an ample supply of doses available, vaccine hesitancy has quickly emerged as one of the biggest hurdles to overcoming the pandemic. In fact, polling from the Kaiser Family Foundation shows that 17% of Americans still want to “wait and see” before getting vaccinated, and that figure increases to 24% among Black Americans.

Vaccine hesitancy among vulnerable and medically underserved communities is especially concerning, as these populations have the greatest risk of contracting and becoming severely ill with COVID-19. For some, vaccine hesitancy is an understandable result of a lack of trust in the US health care system, brought on by past negative experiences and systemic inequities. For others, the hesitation can be attributed to low health literacy (ie, having insufficient capacity to obtain, process or understand the information needed to make decisions about healthcare).

Social and Cultural Disparities Increasingly Impact Health Outcomes

90 million Americans score low in health literacy, in the "below proficient" range.

COVID-19 has illuminated the dangerous implications of low health literacy among vulnerable and underserved communities, leading health care payers, providers and pharmaceutical organizations to begin paying more attention to the impact social and cultural disparities have on health outcomes. As a result, many are working to implement social determinants of health (SDOH) programs. Focused on improving education around the health care process and how to navigate the care journey, these programs work to establish relationships of trust to increase community understanding, buy-in and productive, collective action.

An increased emphasis on the impact social risk has on health and wellbeing is certainly welcomed and well-timed and improving health literacy can serve as a valuable social amplifier to any and all SDOH programs. Still, despite the fact that SDOH can drive up to 80% of health outcomes, a recent study from The Root Cause Coalition revealed that 52% of Americans have never heard of the term "social determinants of health" and just 21% know what it means.Fewer understand the tangible actions they can take to address their individual SDOH or the SDOH of their community as a whole.

Best Practices and 5 Tactical Steps for Improving Health Literacy

With little individual or community understanding of SDOH, the onus is on organizations to take action to improve health literacy, because ultimately this is how SDOH programs will succeed in addressing critical health disparities for the long haul. Best practices for remedying health literacy at scale include listening to individuals, as opposed to talking at them. Persuading them shouldn’t be accomplished verbally, but rather in the form of action, and by communicating information with care. Furthermore, by serving as an example in the community of individual action (within the context of a community’s needs), organizations can help the individuals they serve better determine who and what to trust.

Tactically, there are 5 sequential steps to take to improve health literacy in a meaningful way, including:

  1. Obtain: First and foremost, individuals must have the ability to access their health information. Is the necessary data available and attainable? What are the gaps to access information at both the individual and community levels?
  2. Process: Individuals must also be able to read and review any clinical information within relevant social and cultural context. Keep in mind that context will be different for every person and community. Failing to take this into account typically leads to reduced empathy and trust.
  3. Understand: Putting health risks into personal and cultural context is essential. Understanding the contours of social risk at the community level is also important, as skeptical populations may share attributes. To overcome any comprehension obstacles, community resources and relationships can be leveraged to meet the needs of a person’s education level, cultural influences, and primary language.
  4. Decide: Individuals make the final decision on their health care, so health care organizations need to determine if the populations they serve—whether it is health plan members, employees, or patients—have the capacity to make those decisions. Supporting those stakeholders and showing support from within their community is vital as decisions about care choices are being made. High health literacy populations can also be a resource for helping separate individual decisions from decisions that are best for the community.
  5. Relate: Once the capacity to obtain, process, understand, and decide has been increased, organizations need to work to develop a relationship-based care model. This can be established by tapping into trusted relationships, social norms, cultural concerns/risks, and creating a common, holistic view for optimal health and outcomes. Overall, access to health information and trusted relationships work best to guide choices for all key stakeholders and ensure better outcomes.

The Time to Act is Now

Now more than ever, our country’s health care system has a timely and profound opportunity to intervene on SDOH by improving health literacy levels via a targeted, 5-step continuum. By following this process and implementing social risk analytics solutions from companies like Socially Determined, health care payers, providers and pharmaceutical organizations can repair lagging health literacy levels and use improved health literacy as the lever to amplify the positive impact of SDOH programs at scale.