9/15/2020

Is COVID-19 Content Leaving Entire Communities Behind?

Healthwise Communications Team

In our last blog, Health Literacy Lessons From COVID-19, we discussed the fact that many government agencies are publishing health information written at such a high level that many people can’t understand it. Even the CDC failed to meet its own readability recommendations. This week, we’ll dive a bit more into who is being left behind and why we all have to look at how we present crucial health information to the populations we work with.

The Health Perks of Being a Young, White College Graduate

When writing to reach as many people as possible, you must think about two things: readability and inclusivity. Actually, readability is part of inclusivity, but since it can benefit virtually anyone who reads your content, we’ll break it out separately.

Health content that exceeds readability standards hurts everyone, but it can be especially hard on certain populations (read: anyone who’s not a young, white, American-born English-speaking college graduate). One study found evidence that race, nationality, age, and education all play a part in a person’s ability to make informed decisions about their health.¹

• Non-native English speakers have lower health literacy than native English speakers.
• People older than 65 are often less health-literate than younger adults.
• Higher education levels correlate with higher degrees of health literacy.
• Hispanics have a lower average health literacy level than any other population.

It’s certainly not because these populations are less intelligent or less invested in their care. Their needs are just unique.

The problem is that much of the public-facing health content in the U.S. targets just a small percentage of our country’s population. And the health content about COVID-19 over the past year has been no different. We’re still seeing far too much generic coronavirus education published online and distributed throughout hospital systems—content that fails to acknowledge the unique obstacles faced by many people because of the color of their skin.²

According to the Centers for Disease Control (CDC), several social determinants of health have made some communities more vulnerable to COVID-19.

• Discrimination. Systemic racism and discrimination in healthcare—even when unintended—put people from some racial and ethnic minority groups at increased risk, particularly if they have dark skin or don’t speak English well.
• Healthcare access. White people are more likely to have insurance, child care, and the ability to take time off work than some minorities. They are also more likely to live in communities with award-winning hospitals that are adequately staffed and funded.
• Occupation. Minorities hold a disproportionately high percentage of “essential worker” positions, so they can’t self-isolate or work from home.
• Education and money. People with fewer job options lack the flexibility and income to take time off work. They’re also more likely to be laid off.
• Housing. Racial and ethnic minority groups who live in crowded conditions or have multiple generations under one roof find it harder to practice self-isolation.

Why Are Black Americans at an Even Higher Risk Than Other Groups?

In May, the Pew Research Center polled 11,000 Americans to see if they could verify reports that black Americans were accounting for a disproportionate share of COVID-19 deaths. Black people represent 13% of the U.S. population, yet 24% of the people who died from coronavirus were black. The biggest disparities in the country were seen in Kansas and Wisconsin: In those states, only 6% of the population is black, yet black people accounted for 26-29% of deaths from the virus there.

Many theories were posited, but one recurring theme throughout the surveys could not be ignored: Black respondents generally showed less trust in healthcare systems, medical research, experimental drugs, and science. And in line with past Pew Center surveys, a majority of black and Hispanic Americans said that misconduct among medical experts is a big problem, while less than half of white people polled agreed (71%, 63%, and 42%, respectively).³

Taken together, the CDC findings and Pew results point to an alarming picture: Fewer people of color are even seeking out health care. Some don’t have access, some can’t afford it, some can’t find child care, and many are just too suspicious of an institution they fear will make them feel excluded.

Medical content that fails to address these social determinants of health fails everyone. If 88% of our country struggles to find COVID-19 information they trust and understand, then 100% of the population is at risk.

So What Can Hospital Systems and Content Creators Do to Improve Health Literacy in Their Own Communities?

It all starts with caring—with acknowledging that there are potential gaps in patient education and knowing the value of bridging those gaps. No one ever wrote patient handouts or made wellness videos with the intention of excluding patients! But it still happened, and now is the time to start looking at more inclusive solutions, whether that means taking inventory of your own in-house materials or choosing a health education company that prioritizes every patient from every background.

• Know your demographics. For example, Atlanta serves a population that may look much different from, say, San Diego. And Miami’s clientele might need more interventions targeted to older adults.
• Perform user testing on the material you use, to see where you’re coming up short. You’ll then know which content to revamp or which demographics to focus on.
• Create a Diversity and Inclusion (D&I) committee within your organization, or ask if the health education vendor you’ve chosen has one in place. But don’t stop there—make sure these committees are populated with voices from diverse backgrounds. A responsible D&I committee knows the value of hearing from people with different perspectives, so it should be made up of people from various races, genders, ages, ethnicities, and sexual orientations.
• Learn the basic principles of plain-language writing. Or better yet (and far easier), find a health education vendor that specializes in it and can share details about how they evaluate the readability of everything they write.
• Choose a health education vendor that has already taken strides to make their content inclusive. Do their videos show people of color? Same-sex relationships? Do diet guidelines include low-cost foods that families on a budget can afford?

But perhaps the most important thing you can do to improve health literacy in your community is to ask questions! Talk to the people you serve, whether in the office or when you meet them on the street. Understand what kinds of barriers they face when trying to attain better health outcomes for their families. Speak on their behalf when it’s time to make decisions in your organization.

Remember that anyone can be health literate when health information is presented in a way that feels readable, relevant, and trustworthy to them. It’s our job as clinicians, administrators, and content creators to help set every American up for success.

For examples of health content that’s both inclusive and written in plain language, check out some of our award-winning health education.

¹ https://nces.ed.gov/pubs2006/2006483.pdf
² https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html  
³ https://www.pewresearch.org/science/2019/08/02/americans-often-trust-practitioners-more-than-researchers-but-are-skeptical-about-scientific-integrity/#blacks-hispanics-more-likely-than-whites-to-consider-scientific-misconduct-a-big-problem