BCMS President’s Message

Health Literacy: A Social Determinant of Health

By Rodolfo Molina, MD, 2021 BCMS President

Part 2. Recent Events and Actionable Proposals

The purpose of Part 1 of this article was to ground us with a historical perspective and a working definition of health literacy. In this Part 2, I wish to explore recent events and actionable proposals to carry us forward to improve our level of health literacy in the population.

What is San Antonio and Bexar County doing to improve the health of our population? During the COVID-19 pandemic, while being home-bound, we heard daily reports from our local leaders, Mayor Ron Nirenberg and County Judge Nelson Wolff. Aside from giving us local statistics, they repeatedly told us to wear masks, adhere to social distancing and to wash our hands frequently. Good advice the fact that it was so often repeated made it a very clear message to understand. In a letter to the editor, Abel and McQueen used the term “critical health literacy” describing the urgency for the need of every individual to make an effort of understanding facts from fiction in the “exploding market of COVID-19” information. They further stated, “While accepting to sacrifice some part of one’s own individual freedom for the sake of a collective good may be seen as a matter of humanistic social values, in the case of the COVID-19 pandemic there is little time for philosophical rationales.”4

Even before the pandemic, over ten years ago, then Mayor Julian Castro initiated the Mayors Fitness Council. Its primary focus then was to target obesity by educating the population on nutrition and providing spaces for exercise. Recently, the Council has branched out to address mental illness. The council has been working with various business owners and our school districts to promote mental health awareness and have been recognized as a model for other Texas cities.

These are two specific examples of how to improve our population health and each with specific goals in education and community involvement. These examples are an excellent beginning in a path leading towards improved public health for everyone in Bexar County, but we have much more exciting work ahead of us. Through these efforts to improve health education, we are both directly and indirectly targeting and improving health literacy in our community.

Below are some fundamental steps that should be considered by our community, healthcare providers, healthcare mentors, and our politicians. • Engaging students as early as elementary school, by teaching healthy eating habits in school and providing parents with resources to promote these habits at home • Require schools to provide healthy options for all students at school-provided lunches • Consider offering or requiring a one-semester course on basic healthy living principles including basic human anatomy, simple

medical vocabulary and preventative/primary healthcare concerns for all Texas high school students • Dedicated lecture series for our medical students on nutrition and how to counsel patients on lifestyle modification • Expanded social services to include adequate follow-up after hospital discharge for all patients, regardless of insurance status, and require insurance companies to provide this service • Require insurance companies to contact all their clients and help them with any issues they have encountered after a doctor’s visit • Non-politicized platform from the city council (local newspaper clipping, local radio, flyers, commercials, etc.) with which medical providers can provide healthy tips and /or information on resources available locally • Appropriate compensation for social work and case management teams within the medical field, and easy access to these services for the general public • Mandate limits on pharmaceutical costs on a national level regardless of insurance status, especially for common medications such as those for high blood pressure, high cholesterol, and diabetes

These thoughts and recommendations are neither meant to be allinclusive nor final in their draft, but rather a starting point with which we can begin a conversation to address the much-needed changes in how we view and interact with health and our healthcare system.

It is essential that we maintain a complete understanding and appreciation of the value that health literacy adds to the betterment of all our patients.

References 1. Taylor, R., Rieger, A,. Medicine as Social Science: Rudolf Virchow On The

Typhus Epidemic in Upper Silesia. International Journal of Health Services,

Vol. 15, No. 4, 1985. 2. Berkman, N. D., DeWalt, D. A., Pignone, M. P., Sheridan, S. L., Lohr, K. N.,

Lux, L. et al. (2004). Literacy and health outcomes: Summary. In AHRQ evidence report summaries. Agency for Healthcare Research and Quality (US). 3. Kindig, D. A., Panzer, A. M., & Nielsen-Bohlman, L. (Eds.). (2004). Health literacy: a prescription to end confusion. National Academies Press. 4. Abel T, McQueen D. Health Promotion International, daaa040, https://doi.org/10.1093/heapro/daaa040. 02 April 2020.

Rodolfo (Rudy) Molina, MD, MACR, FACP is a Practicing Rheumatologist and 2021 President of the Bexar County Medical Society.