Ethical Context of Health Literacy Essay

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Discussion: Cultural, Ethical Context of Health Literacy

The Patient Protection and Affordable Care Act of 2010, Title V, defines health literacy as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions (CDC, 2011).

Does this definition take into account cultural beliefs or remedies to which some individuals are accustomed? Or does the health literacy definition refer to only biomedical care or treatment options that also fall within biomedical standards? To what extent ethical principles of public health practices are considered.Ethical Context of Health Literacy Essay

The human papillomavirus vaccine has been shown to be effective in the prevention of cervical cancer among young women. Yet, among some populations here in the U.S., young women are not seeking the protection of the vaccine. The reasons have little to do with access to the vaccine and a lot more to do with the attitudes, beliefs, and behaviors (i.e., culture) associated with the HPV vaccine

For this Discussion, you examine the public issues you might encounter in health literacy and cultural awareness.Ethical Context of Health Literacy Essay

To prepare for this Discussion, suppose that you are a health practitioner in the health field working with the HPV vaccine.

Post a response to the following:

Identify one issue within the concepts of health literacy and cultural awareness. Also, explain the differences between health literacy and cultural awareness. (Demonstrate how these might lead you to a different type of awareness.) Discuss how cultural differences in beliefs and attitudes may influence your work with different communities in relation to HPV vaccines. Discuss to what extent ethical principles of public health practices are considered. Expand on your insights utilizing the Learning Resources.

Health LiteracyRay Marks*School of Health Sciences & Professional Studies Sciences, York College, City University of New York,New York, NY, USADepartment of Health and Behavioral Studies, Teachers College, Columbia University, New York, NY, USAAbstractHealth literacy is an increasingly essential competency required of today’s citizens. Similar in nature toliteracy, in general, adequate health literacy is associated with better health outcomes than inadequate orlow health literacy. Encompassing a broad array of overlapping skills, health literacy can impact one’sability to obtain health services, especially high-quality timely and tailored health services, as well as theability to act on desirable health recommendations. In the context of health equity issues, and the notion ofhealth as a human right, health literacy is increasingly identiﬁed to be of paramount importance, and thosewho lack the will to foster a health-literate citizenry are likely to see wider health gaps and disparities thanwe see today. This essay describes the concept of health literacy, its importance as a health access andmanagement issue, and the bioethics of failing to counter low health literacy wherever it exists.KeywordsBioethics; Culture; Health communication; Health; Health literacy; Health outcomesIntroductionHealth literacy, a multidimensional form of literacy, encompasses the capacity to obtain, process, and acton basic health information (Clark 2011). Strongly linked to individual health outcomes (Williamset al. 2002), health literacy can impact community-wide health efforts directed to the public as a wholeplus the timely attainment of desirable and sustainable public health goals, among other factors(Gazmarian et al. 2005). Ethical Context of Health Literacy Essay Indeed, adequate health literacy seems crucial in today’s world as far as helpingthe public to obtain and access needed health services, for co-decision-making in the context of treatment,for providing helpful support to others concerning their health, for enacting positive health behaviors, andfor positively inﬂuencing provider-client communication processes.Health literacy also inﬂuences the effective use of mass media to communicate health imperatives, theability to utilize social media health applications and to critically evaluate health marketing messages. Asoutlined by Clark (2011), health literacy is key to the ability to make effective, appropriate, responsibleindividual health as well as collective decisions, to appraise the credibility of information and itsrelevance, and to effectively act on the information and navigate increasingly complex physical as wellas virtual health systems and applications. Applying recommendations to self-manage complex healthconditions on a day-to-day basis in a self-determined manner is also strongly inﬂuenced by the magnitudeof a person’s health literacy. A crucial skill –especially for those who reside in countries without standardaccess of care for all policies –health literacy not only encompasses a person’s ability to understand their*Email: rm226@columbia.eduEncyclopedia of Global BioethicsDOI 10.1007/978-3-319-05544-2_455-1#Springer Science+Business Media Dordrecht 2015Page 1 of 8
rights but also affects the ability to effectively advocate for their health needs, and the ability to become aneducated consumer and empowered patient able to engage in effective two-way communications with aprovider.The three overlapping features of health literacy, involving the ability to obtain health information;interpret tests, dosages and instructions, insurance and informed consent documents; and apply theinformation, all of key importance in today’s increasingly complex health care realm, are not a givenhowever in most populations including the United States. As well, the ability to understand medicationlabels, medication contraindications, and appointment cards along with one’s legal rights are other keyfeatures of this competency.This essay aims at describing the problem of low health literacy, some possible solutions, and therelationship of this problem to bioethics. Drawn from 50 years of research, the importance of healthliteracy, which includes three overlapping perspectives, basic literacy or comprehension, interactive/participatory literacy, and critical literacy-involving analysis and action, is clearly growing each year. Yet,many challenges remain that have an array of implications for both providers and patients, as well aspolicymakers and ethicists, especially in the context of health disparities, and the urgent need to curtail theburgeoning prevalence of preventable chronic diseases, and the costs, often passed on inadvertently toothers.Populations Exhibiting Low Health Literacy LevelsAlthough one of the fundamental public health challenges in the twenty-ﬁrst century is the improvementof people’s health literacy, populations commonly experiencing poor health literacy remain the elderly,racial and ethnic minorities, those with low levels of educational attainment, those with low incomes, andthose with compromised health status (Gazmarian et al. 2005; Lubetkin et al. 2015) or chronic diseases(Volandes and Paasche-Orlow 2007). As well, even though health literacy is fundamental to well-being inthe twenty-ﬁrst century, many adults and youth worldwide are currently either health illiterate or onlymarginally “health literate,”and children who depend on their parents may suffer additional challenges iftheir parents cannot read, understand, or comprehend health directives.Volandes and Paasche-Orlow (2007) suggested limited health literacy affects one in three healthconsumers. This situation is frequently compounded because patients are often too embarrassed toadmit their limited understanding, even though they are commonly those who have the highest rates ofchronic disease, drug use and abuse, and infant mortality rates. They may also have limited healthinsurance access, or access to quality health care and health care resources, as well as limited skills tocarry out positive health behaviors and to overcome negative behaviors.BioethicsThe ethical delivery of optimal and equitable health services, and resources, is highly valued by mostsocieties today. Yet, ample research shows many citizens may not be able to take full advantage ofprevailing services and opportunities for maximizing their health, even if they are forthcoming, as a resultof their limited proﬁciency in a variety of health communication- and comprehension-related spheres. Inmany cases, even when it may be critical to reach all members of the public to provide importantpreventive information, such time-sensitive materials may not result in the intended goal if the healthinformation cannot be readily understood and acted on. Beneﬁcence is the obligation of health careprofessionals to do everything possible to improve people’s health. Coupled with the principle of justice,Encyclopedia of Global BioethicsDOI 10.1007/978-3-319-05544-2_455-1#Springer Science+Business Media Dordrecht 2015Page 2 of 8 Ethical Context of Health Literacy Essay
beneﬁcence stresses the need to promote equal health opportunities for all citizens. This is not readilyachieved in the presence of factors extrinsic to the health care system that can affect the uptake of healthinformation, such as having limited health literacy skills. Health illiteracy thus seems a key barrier toapplying basic ethical principles of health care including nonmaleﬁcence.As a result, addressing a nation’s health literacy levels has become both a moral imperative as well as anethical social responsibility (Jotkowitz and Porath 2007). In this respect, efforts to enhance the healthliteracy skills of recipients of health communications, having a clear understanding of the impact of healthliteracy on equity and justice issues, as well as knowledge as to who is at high risk in this respect is of greatimport. As well, the ability to test health literacy and provide appropriate materials and information to thepatient that can be acted on and understood is clearly desirable. Policymakers too cannot ignore the linkbetween social factors that promote or hinder health literacy skills, such as educational gaps andinequities, plus the excess economic and societal burden of not acknowledging this issue. Unfortunately,the desired understanding of this health literacy issue by providers and policymakers is not a given.Outcomes of Low Health LiteracyAmple research shows that low or inadequate health literacy signiﬁcantly impacts an individual’s abilityto participate actively in the health decision-making realm, to critically reﬂect on their options andpersonal situation, and to carry out desired self-management strategies (Nairn 2014). In the context ofethical health care practices, unrecognized health literacy also impacts a patient’s ability to detail her/hishistory adequately, and consequently the provider’s ability to foster the care required. It can also affect aclient’s dignity and understanding of his or her entitlements and rights.Low-health-literate-minority populations may be especially disadvantaged if they have limited accessto culturally appropriate as well as linguistically appropriate information and support services. They mayconsequently be more likely than not to place some or a lot of trust in persons such as family members,friends, and religious leaders or organizations who may not be good referents in the context of healthissues (Lubetkin et al. 2015). In turn, those who have no knowledge or limited knowledge of a preventabledisease are not likely to act on this, or understand how to do this.This inability to avoid preventable disease and injury situations not only has far-reaching bioethicalimplications but is extremely costly to the individual and society. In particular, many today cannot takeeffective health steps, because they are uneducated, and/or don’t read or write in the dominant languagemedium. They may consequently be unable to access and/or process information, make effectivedecisions, know their rights and be able to access these, or make a contribution to the health care visit(Nairn 2014). The fact that those with low health literacy commonly have lower health status than thosewith higher health literacy is true across acute and chronic diseases. Moreover, those with low healthliteracy may seek treatment at later rather than earlier stages of the disease. They may consequently havehigher hospitalization rates, higher multimorbidity rates, a shorter life expectancy, and worse healthstatus. Their increased incidence of chronic illness, a higher risk of death, and deleterious health impactmay be commensurate with that of having diabetes (Volandes and Paasche-Orlow 2007).Some of the additional adverse outcomes of low health literacy that have implications for the equitableattainment of health outcomes for all are•Medical errors (Clark 2011; Nairn 2014)•Infrequent, less optimal, or inappropriate use of health care services (Volandes and Paasche-Orlow2007)•Lower quality or perceived quality of care (Hasnain-Wynia and Wolf 2010)Encyclopedia of Global BioethicsDOI 10.1007/978-3-319-05544-2_455-1#Springer Science+Business Media Dordrecht 2015Page 3 of 8
•Poorer ability to recall information (McCarthy et al. 2012)More than a decade ago, Williams et al. (2002) found a greater lack of understanding of clinicalinstructions in patients with low health literacy, when compared to those with adequate literacy. Thisshould not be surprising given the challenging topics today’s patients are often asked to comprehend, thecomplexity of the approaches used to treat these conditions, and the many logistical barriers to carryingout the recommended behaviors and accessing the required resources in all these realms.The autonomy of low–health literacy health care users may also be jeopardized if forms such as consentforms, patient’s bill of rights, advanced directives, and memos about privacy protection are inaccessible(Volandes and Paasche-Orlow 2007) and the provider is not aware of the importance of health literacy infostering health Ethical Context of Health Literacy Essay outcomes.Implications for BioethicsAs an offshoot of literacy, health literacy, which affects high numbers of health care users worldwide,should be of interest to all health care providers, as well as policymakers interested in improving the healthand successful aging of the populace across the lifespan. As a legal issue, less has been done in the realmof health literacy to assure quality and access (Clark 2011). In this regard, Schillinger (2007) applaudedthe efforts of Volandes and Paasche-Orlow (2007) for presenting a sound argument as to the untowardadverse health effects of limited literacy as reﬂective of a systematic form of injustice on the part of healthcare delivery systems that assumes those using the system are literate. As Shillinger claims, this argumentis important and a vital component of a bigger moral imperative to reverse the “inverse care law,”whereresources are distributed unequally to those in greatest need, a problem that requires a sound well-studiedand practical solution according to Jotkowitz and Porath (2007).With its roots in the bioethical principles of autonomy, justice, and beneﬁcence, health literacy alsoentails the ability to provide informed consent, the right to quality care, and to antidiscrimination (Clark2011). Unfortunately, in addition to provider ignorance of health literacy issues, as Shillinger reports, thegap between those with and without adequate health literacy is commonly magniﬁed if a patient has a poorgrasp of provided information or fails to provide important information or both. As well, this can impede aclinician’s efforts to deal effectively with their patients in a consistent and optimal manner, and both canhave far- reaching bioethical implications within and external to their day-to-day practices (see Fig. 1).Inadequate health literacy and failure to address this adequatelySuboptimal patient provider communicationsDislocations in decision making processesPoor health outcomesHigher rates of health disparities and injusticesDetrimental societal impactsFig. 1 Schematic of bioethical implications of low or inadequate health literacyEncyclopedia of Global BioethicsDOI 10.1007/978-3-319-05544-2_455-1#Springer Science+Business Media Dordrecht 2015Page 4 of 8
Policy changes at both the macro and micro levels that can address the multiple sources of healthilliteracy are increasingly important. Policies that permit more optimal ethical day-to-day health providerpractice opportunities, such as the ability to devote more time to patients with health literacy challenges,as well as resources to do this, would potentially reduce the health disparities gap that prevails in manyspheres (Misra-Hebert and Isaacson 2012), while reducing the health care burden attributable to lowhealth literacy.In this context, clinicians and others are urged to become aware of and sensitized to this prevalentproblem because•An individual’s health literacy may be worse than their general literacy or their ability to read, write,and speak in their native language and is not always immediately apparent.•Not having adequate reading and/or numeracy skills could affect an individual’s ability to understandconcepts/tasks necessary for their own optimal health, as well as the health of signiﬁcant others.•It could affect access to necessary information, the ability to interpret the information accurately, accessto quality care, and the ability for optimal self-care.A study of 2,659 outpatients at two US hospitals showed 42 % did not understand instructions to “takemedication on an empty stomach”and 49 % could not determine whether they were eligible for free carefrom reading a hospital ﬁnancial aid form.The same study also found a 52 % increase in the risk of hospitalization among patients with inadequateliteracy compared with patients with adequate literacy. It was also noted that 42 % patients did notcomprehend basic instructions, while 26 % did not understand appointment slips, and 60 % did notunderstand informed consent form procedures. Thirty-ﬁve percent of the English-speaking patients hadinadequate or marginal functional literacy, and the ﬁgure was higher for the Spanish-speaking patients(Williams et al. 1998a)Williams et al. (1998a) also assessed the relationship between functional health literacy and knowledgeof chronic disease in a cross-sectional survey of patients with hypertension and diabetes. They foundalmost half of the patients had inadequate functional health literacy levels and were less likely to knowbasic information about their diseases and essential self-management skills than those with high func-tional health literacy scores. Only 50 % of the low-literacy patients with diabetes knew the symptoms ofhypoglycemia compared with 94 % of those patients with adequate literacy levels. Another studypublished by Williams et al. (1998b) examined the relationship between literacy and asthma knowledgeand self-management skills. In this convenience sample of 483 patients, lower literacy levels, as measuredby the Rapid Estimate of Adult Literacy in Medicine (REALM), were associated with lower asthmaknowledge scores and improper asthma self-management.ChallengesIn addition to relatively few efforts over the past 15 years to uncover sources of health illiteracy, problemsarise in efforts to both identify as well as intervene effectively in the context of health literacy deﬁciencies.Ethical Context of Health Literacy Essay Not only is there ignorance of this important public health sphere, along with a commonplace assumptionthat the populace has high health literacy and that universal precautions improve knowledge acquisitionamong patients (Gordon and Wolf 2007), but measuring health literacy and obtaining the personnel andresources to address low health literacy where it is identiﬁed remain problematic. In parallel with thefailure over the last 15 years to strategically address the sources of health illiteracy, the increasingprevalence of complex chronic health conditions requiring individual daily self-management, theEncyclopedia of Global BioethicsDOI 10.1007/978-3-319-05544-2_455-1#Springer Science+Business Media Dordrecht 2015Page 5 of 8
complexity of the physical and virtual organizations needed to support these efforts, the multipleresources that must often be navigated, plus linguistic challenges in a monolingual society are a fewadditional challenges. Stigma, shame, and fear as important personal factors precluding disclosure ofliteracy limitations and limited provider understanding of this topic remain.ConclusionLimited health literacy, which impacts one’s ability to understand, access, and act on health information,may be responsible for heightening the immense gap between the haves and have-nots in society in termsof health status. Limited health literacy may also seriously impact the patient’s understanding of theirrights, their ability to access their rights, their ability to be part of the decision-making process, and theirability to navigate today’s complex health environments and to use advanced technologies. More oftenthan not, health illiteracy seriously hampers a wide range of disease prevention efforts, especially theenactment of timely and accurate responses to various health recommendations. While clearly an issuewith far-reaching bioethical and social implications, it appears the bioethical aspect of this topic hasreceived little attention (Volandes and Paasche-Orlow 2007). However, from an examination of theavailable literature, it is concluded that the problems of low health literacy will persist unless theimportance of the issue is more strongly stressed. For example, providers need to be apprised of thepossible literacy challenges of their patients, since these may not be obvious. Another step is to renderhealth information materials accessible to the individual through careful analysis of their health, cultural,and cognitive attributes. Careful editing of complex instructions, where indicated, and explaining how tointerpret information such as blood pressure or glucose content readings may also be helpful. As well,reducing the volume of materials; using charts, short sentences, and pictures; and avoiding complexterminologies and/or Internet information is also advocated for those whose literacy levels are challenged.Others strategies might include the creation of a shame-free environment, a teach-back instructionmethod (Nairn 2014), an improved education system for all including medical personnel, better screeningof potential problems, and policy-related changes.Also helpful may be minimizing the cognitive burden patients might face when trying to manage theirpersonal health, speaking in plain everyday terms (Nairn 2014), staff training, clearer instructions andhelp with completing forms, and adopting a universal assumption of limited health literacy amongpopulations utilizing the health care system (Volandes and Paasche-Orlow 2007). Increasing the diversityand language capacity of the workforce (Schillinger 2007), reducing childhood education inequalities, theuse of surrogate readers, computer-assisted interactive technology, and pictorial presentations may behelpful as well.In sum, addressing the problem of widespread health illiteracy is paramount in the context of ethicalpractice in today’s health arena, including efforts to minimize the growing epidemics of obesity, diabetes,school bullying, and risky behaviors and others that affect young and older citizens. Yet, current modes ofhealth delivery often assume clients understand and can readily act on health recommendations, thuspotentially producing preventable injustices and inequalities. By contrast, targeted efforts that promotehealth literacy and those that can enable all citizens to make beneﬁcial, rather than poor, health-relatedchoices may have far- reaching social beneﬁts, as well as ethical practice beneﬁts. With roots in thebioethical precepts of beneﬁcence, justice, the right to quality care, and autonomy (Clark 2011), the termhealth literacy has thus become one of the central aspirations of citizenship in the postindustrial era(Marks 2009). Greater provider awareness of the impact of low health literacy on health outcomes Ethical Context of Health Literacy Essay

As health care itself has become more complex, the inability of patients to understand medical terms and concepts has become more problematic. At the same time, patient involvement in health care decisions has become even more crucial. Both the JointCommission and the National Committee for Quality Assurance have adopted guidelines aimed at ensuring better communication between patient and provider so that patients can understand their consent forms, care instructions and other medical information.Ethical Context of Health Literacy Essay

Professionals who address health literacy usually place the issue in the context of patient safety, better clinical outcomes or less litigation, because “lack of understanding can lead to medication errors, missed appointments, adverse medical outcomes, and even malpractice lawsuits.”2 I would like to suggest, however, that for those in Catholic health care, health literacy is also — and perhaps even primarily — an ethical issue involving the dignity of the patient and the very integrity of health care itself.Ethical Context of Health Literacy Essay

The U.S. Department of Health and Human Services has defined health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” 3 By some accounts, more than a third of American adults lack sufficient health literacy “to effectively undertake and execute needed medical treatments and preventive health care.”4

To be more specific, according to a recent study, only 12 percent of American adults have attained what researchers have called proficient health literacy. About half of American adults — 53 percent — can be termed intermediate in health literacy, 22 percent have basic health literacy and 14 percent are below basic.5

Health care tasks at the below-basic level generally require only that the patient find relatively simple information in short texts or forms. At the basic level, the patient is able to find more complex information in texts and documents that are somewhat longer and may contain longer words.

At the intermediate health literacy level, patients are able to move beyond simply searching documents for information; they are able to interpret or apply the information they find. Finally, those at the proficient level are able to draw rather abstract inferences from multiple pieces of information within complex texts and apply the information they have retrieved to their medical situation.Ethical Context of Health Literacy Essay

Patients who are at the basic or below-basic levels — roughly a third of all adult patients — are less likely than others to ask the health care professional any questions, yet 26 percent of those patients could not understand when they were supposed to come in for their next appointment. Almost half of them could not understand the instruction to “take medication on an empty stomach.”6

Even well-educated patients have reported difficulties understanding information provided by a health care professional because the vocabulary was unfamiliar. Furthermore, a high percentage of individuals explain that their primary sources for health care information are magazines, television and family members, friends or co-workers.7

It is easy to see why health literacy is an issue in terms of successful patient outcomes and safety. Why, however, should Catholic health care regard it as an ethical issue, as well?

The answer is in the Introduction to Part Three of the Ethical and Religious Directives for Catholic Health Care Services, which describes the ideal relation between the patient and the health care provider: “A person in need of health care and the professional health care provider who accepts that person as a patient enter into a relationship that requires, among other things, mutual respect, trust, honesty, and appropriate confidentiality.”Ethical Context of Health Literacy Essay

It goes on to say that the health care professional must avoid “manipulation, intimidation, or condescension.”8 Going further, the first numbered directive in this section, Directive 23, emphasizes that “the inherent dignity of the human person must be respected and protected regardless of the nature of the person’s health problem or social status.”

In contrast to dominant attitudes in medicine and law that strongly emphasize patient autonomy, the Directives maintain that neither patient nor health care professional acts independently of the other. Rather, both need to work together, each with her or his own personal responsibility: “The health care professional has the knowledge and experience to pursue the goals of healing, the maintenance of health, and the compassionate care of the dying, taking into account the patient’s convictions and spiritual needs, and the moral responsibilities of all concerned. The person in need of health care depends on the skill of the health care provider to assist in preserving life and promoting health of body, mind and spirit. The patient, in turn, has a responsibility to use these physical and mental resources in the service of moral and spiritual goals to the best of his or her ability.”Ethical Context of Health Literacy Essay

These last words place health literacy in a moral and spiritual context of expanding the ability of the patient to participate more fully in a holistic healing process. The thrust of Part Three of the Directives, therefore, describes the co-responsibility of patient and health care provider. A patient’s lack of health literacy becomes an obstacle to such co-responsibility. Removing these obstacles becomes the health care professional’s ethical responsibility because of both the dignity of the patient and the nature of the professional-patient relationship itself.

Regarding the dignity of the patient, Daniel Sulmasy, OFM, MD, PhD, professor of medicine at the University of Chicago, has suggested: “The persons who are most vulnerable, particularly in a health care system, are those whose dignity already has been called into question by society before they ever enter the office, clinic, or emergency room — homeless persons, those living with HIV, injection drug users, retarded persons, demented persons, undocumented aliens, and others. Anyone whose worth has been ascribed to anything other than being a member of the human community is vulnerable. Those whose attributed dignity has been assaulted are most at risk for believing that their own intrinsic dignity has been vanquished. This risk applies, above all, to the sick, frail and dying.”Ethical Context of Health Literacy Essay

Persons whose dignity has been called into question by the larger society are precisely the persons with limited health literacy who may be most intimidated by the health care setting. We already have seen that patients who are at the basic or below-basic health literacy level are less likely to ask physicians questions than their counterparts who are at the intermediate or proficient level. They also are more likely to misinterpret the language — or jargon — typically used in health care.

Within the appropriate context, medical terms and wording articulate precise meanings to those in the health care professions. For many patients, however, technical words and usage can create confusion or outright misunderstanding. For example, a patient may not understand that hypertension refers to blood pressure, not emotional stress, or that in health care usage, a lab test result that comes back “negative” is probably good news, while “positive” usually is not.

The American Medical Association recently has reported that appropriate communication between health care provider and patient lowers the rate of medical errors.11 The Catholic health care tradition also acknowledges effective communication as part of the respect due to patients because of their inherent dignity.Ethical Context of Health Literacy Essay

What’s more, the relationship between the patient and the health care professional necessarily entails a difference in power. The power of the health care professional can be used to enhance the dignity of the patient or contribute to his or her denigration. Even in the best of circumstances, a patient can feel intimidated, no matter what the health care professional does.

Mindful of this, John Abbott Worthley, while professor of public administration at Seton Hall University in South Orange, N.J., stated straightforwardly that in health care, “attitudes and the tone and flavor of official behavior are morally significant.”Ethical Context of Health Literacy Essay

He goes on to suggest that the health care professional must go beyond doing his or her job professionally. Although one needs to be clinically skilled, one also must become aware whether and how one’s words and actions contribute to the patient feeling more vulnerable and intimidated or, on the other hand, respected.

Understanding the culture of the people served by the health care organization, securing language assistance for those who do not speak English well, speaking in ordinary language to all patients, providing easy-to-understand instructions, confirming the patient’s understanding — all of these aid health literacy. In doing so, they also show respect for the dignity of the patient and contribute to the healing relationship. This should be a hallmark of Catholic health care. Ethical Context of Health Literacy Essay