Running head: HEALTH LITERACY

Health Literacy Among Immigrants Policy Brief

Erich Bonilla, Valentina Chawdhury

California State University of San Bernardino

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Executive Summary

This policy brief summarizes the importance of health literacy among the

immigrant population and addresses what can be done to bridge the gap of

understanding healthcare and applying that knowledge to better a low health literate

patient’s life. Having a high sense of health literacy enables an individual to reach their

optimal health by being armed with the knowledge and confidence to make their own

health decisions. Being classified as having low health literacy results in individuals not

properly expressing their symptoms to their physicians, not understanding instructions

for treatment, and not taking medication properly. This is especially true among the

immigrant population as a language barrier exists which inhibits proper communication

and understanding among patients and physicians.

Immigrants make a large portion of the American population. Specifically, there

are 26.3 million immigrants in America, many of those are considered low-income

(Kimbrough, 2007). Being considered low-income is another factor which attributes to

low health literacy. That is why it is essential to address and open communication to

rectify the gap in healthcare that low health literacy immigrants face. Currently, there are

no policies in existence which aim to solve the issue of low health literacy among the

immigrant population. This policy brief proposes the solution of creating a federal

mandate. A federal mandate could provide a framework for the integration on health

education services into healthcare provider services, expediting the introduction of such

services to areas that still do not have access to them. This same mandate could be

used to frame an education service for medical personnel, that could provide cultural

competence training.
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Health Literacy Among Immigrants Policy Brief

I. Context and Importance of the Problem

A. Statement of Problem

Health literacy is defined as the ability to obtain, understand, and use information

needed to make wise health choices (Kimbrough, 2007). A lack of health literacy limits

the amount of knowledge a person has regarding body systems, their function or the

causes and symptoms associated with a disease (Kimbrough, 2007). This lack of

understanding can impact many segments of a population including the elderly, people

with poor reading skills, immigrants, and cultural minorities (Kimbrough, 2007). By

providing health education services that are tied to a healthcare provider, health literacy

can be improved among the affected populations and even strengthen the

understanding of those with higher levels of health literacy, which could improve the

health outcomes.

B. Root of the Problem

According to the latest census data there are currently 42.4 million immigrants

living in the United States (Camarota & Zeigler, 2016) encompassing approximately 350

languages (Castillo, 2015) and a diverse set of cultures. As the number of immigrants

continues to rise, healthcare providers are rushing to provide medical care to these

patients. Many times, however, there are health literacy issues that prevent the patient

from achieving optimal health. There are also, at times, cultural competency issues

which prevent healthcare workers in properly explaining to the patient what their options

toward health are. Lacking the skills necessary to be health literate can have many

detrimental effects to their health. This is especially true for the immigrant community,
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not only is there a language barrier associated with immigrants, many times cultural

practices and beliefs, their level of education, and the communication and translation

that is used when interacting with a physician make it difficult for an immigrant patient to

manage their health. These all may lead to the patient not understanding the physician’s

directions, having mistrust of the system, or improper use of medication. Also,

interpreters are given limited space to work with non-native English speakers, as they

are only allowed to verbatim interpret and not explain in detail the dialogue between

patient and healthcare provider. Physicians do not always understand the specific

needs their patients demand due to cultural differences; therefore, patients may follow

home remedies which could hinder their growth towards health. Understanding the roll

each of these areas play when attempting to improve patient outcomes, will allow us to

address them in a more precise manner.

C. Policy Implications

Currently, there is no national health education policy in place that helps address

health literacy in the immigrant population. Therefore, there is no attention being

brought to this important issue. The lack of policy has prevented the impacted

populations from becoming active participants in their health. In developing a health

education policy that will assist immigrants, other impacted populations would also

benefit from this service. In this way, it would become a domino effect of aiding one

vulnerable population resulting in aiding other vulnerable populations. Therefore, it is

necessary to create a policy to provide and make a positive impact.

II. Critique of Policy Option(s)

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A. Overview of Policy Options

As discussed earlier, addressing the disparity among immigrants and health

literacy is essential in providing proper care to a population that constitutes a large

proportion of this nation. Although in different communities, efforts have been made to

provide temporary solutions, currently, there are no policies in place to address this dire

need in bridging the gap. One example of an effort made was discussed by TED Talk

speaker Rebecca Onie, in her talk “What If Our Healthcare System Kept Us Healthy.”

Onie (2012) spoke about a program “Health Leads” which focused on trying to

understand what other resources a patient needs besides medication. The program

provides the opportunity for patients to discuss what they are lacking and how those

gaps can be closed. The program also utilized waiting rooms in hospitals and clinics to

target individuals and make productive use of their time. This tactic is beneficial in that it

not only makes the patient’s needs felt heard, but it also uses their waiting time wisely

where the physician does not need to repeat questions asked during this time.

Therefore, making the patient’s time with his or her physician spent discussing solutions

to their issues rather than repetitio of the same information. Some factors that were

found to attribute to this gap are communication with a provider, education on proper

nutrition, and time spent in the waiting room. Onie (2012) discussed an approach to

address the issue of obtaining nutritious food items through the use of the “prescription

pads,” created by D. Geiger. In this method, Dr. Geiger prescribed foods to his patients

so they would know what items to get to improve their health. In this way, Dr. Geiger

listened to his patients, understood their needs, and addressed an important external

factor which aided his patients in bettering their health. This proves that making a policy
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to combat these issues can greatly make a positive effect on this population further

leading to positive health outcomes.

B. Effects of Improving the Failing of Lack of Policy

With programs such as Health Leads taking the time to listen to patients in the

waiting room to connect them to resources, the possibility to bridge the gap in

immigrants with low health literacy is very much attainable. By utilizing time patients

spend in the waiting room to discuss what their needs are that are inhibiting their

journey towards health and physician collaboration in proper communication to further

establish patients’ needs, great improvements in this area can be developed. Once

patients are connected to proper resources then they will feel autonomous and be able

to take control of their own health and make their own educated decisions. With the

proper management of their health, money can be saved which can then be placed in

areas to release the burden on healthcare providers. Also, patients will not visit the

emergency room as often to receive treatment for basic issues. With a policy in place,

other factors such as cultural competency and general education among healthcare

providers can be given attention to further better understand the needs of low health

literate immigrant patients. Therefore, with the creation of policy to improve immigrant

health literacy and the health disparities they face, individuals affected will be equipped

with the appropriate resources to attain a better and healthier life. By not creating a

policy for this issue, a population is being left vulnerable which could lead to many

negative consequences, such as higher healthcare costs or mismanagement of chronic

conditions.
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III. Policy recommendations

A. Measure that Needs to Be Implemented

With the rising numbers of immigrants accessing healthcare services, and the

changes made to healthcare services making the patient the center of their healthcare

team, reform is needed to ensure patients have a true understanding of their health.

Although many healthcare providers are now working with health education

departments, which has improved health literacy among immigrants, there is still a need

to continue the expansion of health educators as part of a healthcare team. A federal

mandate without any restrictions would streamline the process of providing health

education services to not just immigrants, but other impacted populations. By mandating

health education services, we could increase access, while reducing the cost of

mismanaged chronic diseases. The funds saved from these cost reductions, could then

be used to offset the cost of the health education department, minimizing the burden on

the healthcare providers. This is essential as healthcare providers are overburdened

with more patients than they can handle which results in less time spent with their

patients. The health education mandate could also serve to address cultural

competence in health care providers, which could be offered as continued education

classes for healthcare providers. Cultural competence is an important issue to address

to prevent misunderstandings and miscommunication among immigrant patients and

physicians. This would help primary care providers to develop a trusting and lasting

relationship with their patient.

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B. Conclusion

Health literacy impacts many populations however, none are affected as much as

immigrants are. Implementing a policy that can help address health literacy issues,

through education services, will allow those impacted to become active members in the

maintenance and improvement of their own health. This will have a multi-tiered effect in

that it will reduce cost of patient visits to the emergency room for chronic disease

mismanagement, while reducing the number of visits to the primary care physician for

information that can be accessed through a health education department. As a

healthcare provider there is also a responsibility to have an understanding of the

different cultures that may require healthcare services. By educating healthcare

providers in different cultural practices, the doctor/patient relationship can lead to better

health outcomes. Therefore, it is essential to improve cultural competence among

healthcare providers to solidify trust among patients.

The creation of a federal mandate of health education services will increase

access by bridging the gap of health disparities low health literacy immigrants face,

sponsoring public health departments with saved money from reduced costs, and

alleviate healthcare provider burdens. The success of this policy implementation has

been demonstrated in similar and minor, yet impactful, attempts as discussed earlier.

With the proven potential of addressing these issues, creating a policy is of utmost

importance in order to solve one of the many public health issues in existence today. If

the issue of addressing the effects of having low health literacy are met, then there

could be many positive benefits, all due to the implementation of a policy that could help

many.
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References

Camarota, S. A., & Zeigler, K. (2016, October 3). Immigrants in the United States.

Retrieved from https://cis.org/Report/Immigrants-United-States

Castillo, J. (2015, November 04). Guess how many languages are spoken in US

homes? Retrieved June 06, 2018, from https://www.cnbc.com/2015/11/04/at-

least-350-languages-spoken-in-us-homes-new-report.html

Kimbrough J. B., (2007). Health literacy as a contributor to immigrant health disparities.

Retrieved from

https://digitalscholarship.unlv.edu/cgi/viewcontent?article=1114&context=jhdp

Onie, Rebecca. (2012). What if our healthcare system kept us healthy. [Video file].

Retrieved from https://.youtu.be/BoRUrWcdkQ4