The Truth About Health Literacy In India

1. MediBuddy Treading The Path To Health Literacy In India More than 2 lakh women1 around the world are diagnosed with ovarian cancer each year and 15% of them die within two months of their diagnosis. Chronic back pain can halt the way a person lives and unfortunately, it has now become the fourth highest cause of disability2 in India. Patients with H1N1 in Tamil Nadu wait till the disease becomes life-threatening3 to go to a doctor. Could these incidents have been prevented? There is a common thread to these incidents- the patient dies or has a chronic illness because they wait too long to seek medical help; unaware of the severity of their symptoms. A study of women with ovarian cancer indicates that 2/3rd of women had never heard of the disease till their own diagnosis1. In the case of lower back pain, people depend on painkillers instead of addressing the root cause, delaying doctor visits until the pain becomes crippling. In fact, almost 45% of patients waited for 7 weeks before seeking help2. Unless it is a comorbid case, late diagnosis or late treatment could be avoidable in H1N1 cases3, according to the Health Secretary of Tamil Nadu. Lack of awareness is becoming the number one reason for the increased incidence of poor health. Helping people make informed health decisions could mean the difference between life and death. Health literacy is the right armour to combat poor health choices. medibuddy.in

2. Health Literacy In India Health literacy refers to a person’s ability to access, read, understand and use information to make informed healthcare decisions and follow instructions for treatment. Here are two studies to suggest that India needs to improve health literacy rates. A study4 done in a dental OPD on 500 subjects, in Bangalore, Karnataka showed that around 60% had low levels of oral health literacy. This result suggests that poor health literacy may interfere with their ability to process and understand basic oral health information. India has the highest burden5 of tuberculosis and drug-resistant TB in the world. A study6 on disease-specific literacy on tuberculosis among the Saharia tribe in Central India concluded that nearly half of the respondents had not heard of TB. This indicated an important gap in education regarding TB. The Dangers Of Poor Health Literacy Poor levels of health literacy act as a barrier at every level of healthcare. Here is what poor health literacy leads to. Difficulty in understanding health information: Understanding clinicians advice, instructions on a medicine bottle, how to fill out patient forms or hospital consent forms, etc. is extremely necessary for good health outcomes. Language may also be a barrier to understanding health information, for eg., when instructions on medicine bottles and consent forms are in English rather than regional languages. Lack of awareness about illnesses: People wait too long to visit a doctor because they don’t understand the severity of their symptoms. This leads to the patient reaching the hospital only at the end stages of the disease. On the other hand, mild illnesses that could be taken care of at home reach emergency rooms or a hospital which takes away valuable time from a real emergency case. Lack of information about factors contributing to illness: It’s vital to understand the causes behind illnesses. For example, unsafe drinking water, improper waste management and bad sanitary practices cause ill health. Contaminated water can transmit diseases like typhoid, diarrhoea and dysentery. People are unaware that malnutrition is a serious illness and due to the lack of comprehensive sexual education in India, unsafe sex practices lead to increased prevalence of sexually transmitted diseases (STD). Missing health screenings and routine immunizations: Health Checkups can help find health problems before they start. Diagnosis at an early stage can help snip the ailment in the bud or give the patient room to manage the condition. People who are unaware of how diseases spread are unlikely to take these preventive measures. Stigma surrounding illnesses: Lack of awareness can lead to stigma and stereotyping, especially in the case of mental or critical illnesses like tuberculosis. An unhealthy community: Communities in their entirety need to be empowered to make appropriate health decisions. Ignorance about health issues impacts everyone who is part of it. For instance, if the community lacks information about safe reproduction methods, this puts mothers and babies at risk. Poor health outcomes are expected if the entire community is not health literate. medibuddy.in

3. Health Literacy for Better Health Outcomes In India Increase in health literacy has benefits such as adoption of disease prevention methods and adherence to and understanding of treatments leading to improved health. Through a mix of government initiatives, media initiatives and digital initiatives, the health literacy movement in India is gaining momentum. Heading in the right direction, here’s what government and related agencies have been doing to create awareness on health issues and health decisions. Making information on health accessible Health literacy is enabled through promoting health content. Mediums like newspapers, magazines, blogs, apps, social media and more can all be utilised to promote content related to general well-being as well as disease-specific guidelines. A small drop of awareness can have an ocean of an impact. As far back as 2002, Doordarshan attempted to bust myths about health problems like malaria, HIV and more in India. Receiving several awards including Gates Malaria Award, Kalyani7 has become the longest running health campaign on Indian television. MedWatch8, an app launched by the Indian Air Force, has features like basic first aid, health information, BMI calculator, helplines and more. Tackling Sanitation Issues With the help of the media, the government is trying to play an integral part in ending India’s sanitation woes, which would then reduce the incidence of diarrhoea and malnutrition in the country. On a larger scale, Swachh Bharat has gotten accolades from Bill Gates9 and also the the UNICEF on what the West calls The Greatest Toilet-Building Spree in Human History10. However, the real challenge would be to educate and inform people about the benefits of using a toilet. As of January 2018 60 mn rural households and 4.2 mn urban households have a toilet. 11 states,1,846 cities and 314,824 villages have declared themselves open-defecation-free.11 A government-sponsored ad featured Indian celebrity, Akshay Kumar, talking about the benefits of using a sanitary napkin for women. This ad, though not disease-specific, shows the importance of sanitation during menstruation. Mobilising Community Health An individual’s ability to perceive and seek care can depend on their community’s level of health literacy. Making India 100% health literate is a goal that requires community-based tools to be sustainable. The government-run ASHA (Accredited Social Health Activists)12 program promotes healthcare in rural communities where health activists from within the community are responsible for creating awareness on health and its social determinants, mobilising the community towards health planning. Preventive health takes the forefront as the government tackles malnutrition and stunting of children with POSHAN Abhiyaan13. This scheme helps a family have multiple touchpoints with the healthcare system starting from a woman’s pregnancy. Community engagement can be a tool to combat nutrition issues through POSHAN Abhiyaan. medibuddy.in

4. The concept of a “mitra” (friend) to enable patients to understand healthcare information is becoming popular in public health schemes. These mitras help patients demystify what the doctor has said about their ailment and treatment plan, reducing the errors sprouting from a communication gap. For example, Health coordinators, also called Arogya Mitras, under the Atal Amrit Abhiyan14 scheme guide beneficiaries by counselling the patient about the surgery, facilitate consultation with doctors and do much more. NGOs play a critical role in community-based health literacy. Here are two success stories. Problem: In the Channapatna community of Ramnagar district of Karnataka, an alarming 40% of people screened suffered from diabetes and hypertension owing to lack of awareness. Solved Through Health Literacy: The local women were trained to be Health Navigators15 by an NGO They were armed with handheld devices for screening, covering 50,000 people over a three year period. Problem: Araku valley in Andhra Pradesh had a high maternal and neonatal mortality rate. Visiting a medical facility or a doctor was never practised there. Solved Through Health Literacy: Maternal Health literacy led to a transformation in behaviour. Zero maternal deaths have been reported in the past 2 years.16 Through initiatives by a leading NGO, tribal women in the valley are having safer deliveries and taking care of their prenatal and antenatal health as well. Health Alerts And Labels Related To Health Patient safety can be also improved by timely, contextual health information. The warning labels on cigarette packets in India are saving lives. According to a report17, there is extensive evidence to show that health warning labels on smoked tobacco prevent relapse in former smokers and deter youngsters from experimenting with smoking. Medicine labelling is vital to a layman as it provides instructions and important information like expiry date. This lowers medication-related errors. Health alerts during disease outbreaks and health messages about vaccinations, critical illnesses, common communicable diseases, etc., put up at Primary Health Care centres, arm a person with knowledge and reduce poor health outcomes. The scenario towards health literacy is changing, but is it too slow? The initiatives and measures taken by the government show that health is on the mind of the nation. However, the lack of data on health literacy makes it difficult to know the extent of the problem. Health information must be understood and used by all Indians. Increased efforts towards health literacy will help individuals in maintaining, protecting and promoting their health by making appropriate health choices; leading to a to a truly Healthy India. References: 1. Times Now News 2. India Times 3. Times Of India 4. D’Cruz A and Aradhya M, 2013, Health literacy among Indian adults seeking dental care, ncbi.nlm.nih.gov (20/11/2018) 5. The Bureau Investigates 6. Muniyandi M, Rao V G, Bhat J, Yadav R, Sharma R K, Bhondeley M K. Health literacy on tuberculosis amongst vulnerable segment of population: special reference to Saharia tribe in central India . Indian J Med Res 2015;141:640-7 7. Usha Bhasin, Kalyani Episode 1, Jan 9 2015 8. Apps.mgov.gov.in 9. India Today 10. Independent 11. India Spend 12. National Health Mission 13. POSHAN Abhiyaan 14. Atal Amrit Abhiyan 15. The Better India 16. The News Minute 17. Global Tobacco Control medibuddy.in