October is health literacy month. Yes, literally, there is a month dedicated to health literacy. When I was researching articles regarding health literacy I found several that were over 70 pages long. I paused to recognize the irony in this because, seriously, who is going to read 70, SEVENTY, pages of words dedicated to making health care more understandable? A simple explanation of health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. While I was typing this it all seemed like a word salad so let me start by giving you a specific example.
During the summer of 1999, I was entering my last year as a pharmacy student and was required to complete twelve one month rotations in different health care settings. In June and July I was selected to serve with Indian Health Services in Sells, AZ with the Tohono O’odham Nation. The reservation was the size of Connecticut and stretched across the Mexican border to the south and bordered California to the west. Just one, small, well, tiny, hospital served that entire area and the people living on the reservation. Some of the elders in the tribe didn’t speak English and spoke a mixture of their native language and Spanish while others spoke their native language mixed with English. As a stu-dent I was responsible for helping my patients understand the im-portance of their medication, their disease state, and long term com-plications of untreated disease. Most of my patients had type 2 diabetes as well as high blood pressure and obesity.
Culturally, my patients celebrated different events than typical Ameri-cans celebrate. One of the big celebrations was called “Singing down the rain” which kicked off monsoon season, (July and August), and tribal members danced, sang, and prayed around a large fire for the harvest season to be fruitful. Not much grew out in the desert, but what could grow did so after monsoon season when the rains provided good soil for the seeds. The elders would ferment the juice off a Saguaro cactus flower and pass around a cup containing the juice to allow each member to have a “vision” for their future. In talking with more senior members of the tribe, this sort of celebration used to be more common in the past but had grown out of favor with the younger generations as most food was brought in to the local grocery, Bashas, from out of town and contained very little of the nutrients that their past food had contained. My patients, those tribe members, were used to growing and hunting their own food. That allowed them plenty of exercise during the harvest season as well as hunting season. Now, they relied on food delivered on a truck to the store that had most of its nutritional components processed out to allow for better shelf stability. My patients weren’t exercising off their excess calories that they had consumed during celebrations because all they had to do now was grab a grocery cart and walk up and down an aisle to find what they wanted to eat. They ate more of the unhealthy foods because their bodies, which were engineered to consume more calories and nutrients due to their active lifestyle, craved the vitamins and minerals they were lacking. Instead of packing in nutrients, they were packing in empty calories that added to their waistline and wrapped their vital organs in fat causing them to fail. Their culture was so vastly different than the White Euro-pean’s culture that when the United States government took over their Tribe, they failed to notice these subtle differences which ultimately failed the people of the tribe. What was good for the “typical” American was not good for the Tohono O’odham nation. These tribe members were developing Type 2 diabetes as young as 13 and were being placed on dialysis as young as 30. The language barriers combined with cultural differences created a very low level of health literacy. The people of the Tohono O’odham nation didn’t understand that the food packaged for a “typical “ American was not as healthy for them because they had a different metabolism and different sets of enzymes that help break down their foods and medications. Not only was the health literacy low among tribal members, it was also low among health care providers trying to care for these members. It wasn’t until the mid to late nineties that actual enzymes and genetic differences were discovered. By that time several generations had fallen prey to a system set up against them.
Health literacy is a complex phenomenon involving patients, family members, communities, and providers. Health literacy incorporates a range of abilities such as reading, comprehending, analyzing information, weighing risks against benefits and ultimately making decisions and taking an action. These days, while health care service on the reservations have become better, the Internet has become a huge source of misinformation leading large communities of people to make poor decisions or uninformed decisions regarding their health. It is increasingly difficult for people to separate evidence-based information from misleading ads and gimmicks. The communication of “risk” in an effective and fair way continues to be a challenge for both the provider and the patient. As always, I or Beth at Sparta Drugs seeks to help you make informed decisions based on your particular circumstance. I will always be honest, transparent, and compassionate when discussing your concerns. I hope that you know that our doors are open for con-versation and as pharmacists we are truly the most accessible health care provider in your corner. Until next week, pharmacy chicks out!