The Truth About Health Literacy In India

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MediBuddy
Treading The Path To Health Literacy
More than 2 lakh women1 around the world are
diagnosed with ovarian cancer each year and 15
of them die within two months of their
diagnosis. Chronic back pain can halt the way a
person lives and unfortunately, it has now
become the fourth highest cause of disability2
in India. Patients with H1N1 in Tamil Nadu wait
till the disease becomes life-threatening3 to
go to a doctor. Could these incidents have been
prevented?
In India
There is a common thread to these incidents- the
patient dies or has a chronic illness because
they wait too long to seek medical help unaware
of the severity of their symptoms. A study of
women with ovarian cancer indicates that 2/3rd
of women had never heard of the disease till
their own diagnosis1. In the case of lower back
pain, people depend on painkillers instead of
addressing the root cause, delaying doctor visits
until the pain becomes crippling. In fact,
almost 45 of patients waited for 7 weeks before
seeking help2. Unless it is a comorbid case, late
diagnosis or late treatment could be avoidable
in H1N1 cases3, according to the Health Secretary
of Tamil Nadu. Lack of awareness is becoming the
number one reason for the increased incidence of
poor health. Helping people make informed health
decisions could mean the difference between life
and death. Health literacy is the right armour
to combat poor health choices.
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Health Literacy In India Health literacy refers
to a persons ability to access, read,
understand and use information to make informed
healthcare decisions and follow instructions for
treatment. Here are two studies to suggest that
India needs to improve health literacy rates. A
study4 done in a dental OPD on 500 subjects, in
Bangalore, Karnataka showed that around 60 had
low levels of oral health literacy. This result
suggests that poor health literacy may interfere
with their ability to process and understand
basic oral health information. India has the
highest burden5 of tuberculosis and
drug-resistant TB in the world. A study6 on
disease-speci?c literacy on tuberculosis among
the Saharia tribe in Central India concluded that
nearly half of the respondents had not heard of
TB. This indicated an important gap in education
regarding TB. The Dangers Of Poor Health
Literacy Poor levels of health literacy act as a
barrier at every level of healthcare. Here is
what poor health literacy leads to. Dif?culty in
understanding health information Understanding
clinicians advice, instructions on a medicine
bottle, how to ?ll out patient forms or hospital
consent forms, etc. is extremely necessary for
good health outcomes. Language may also be a
barrier to understanding health information, for
eg., when instructions on medicine bottles and
consent forms are in English rather than regional
languages. Lack of awareness about illnesses
People wait too long to visit a doctor because
they dont understand the severity of their
symptoms. This leads to the patient reaching the
hospital only at the end stages of the disease.
On the other hand, mild illnesses that could be
taken care of at home reach emergency rooms or a
hospital which takes away valuable time from a
real emergency case. Lack of information about
factors contributing to illness Its vital to
understand the causes behind illnesses. For
example, unsafe drinking water, improper waste
management and bad sanitary practices cause ill
health. Contaminated water can transmit diseases
like typhoid, diarrhoea and dysentery. People are
unaware that malnutrition is a serious illness
and due to the lack of comprehensive sexual
education in India, unsafe sex practices lead to
increased prevalence of sexually transmitted
diseases (STD). Missing health screenings and
routine immunizations Health Checkups can help
?nd health problems before they start. Diagnosis
at an early stage can help snip the ailment in
the bud or give the patient room to manage the
condition. People who are unaware of how
diseases spread are unlikely to take these
preventive measures. Stigma surrounding
illnesses Lack of awareness can lead to stigma
and stereotyping, especially in the case of
mental or critical illnesses like
tuberculosis. An unhealthy community
Communities in their entirety need to be
empowered to make appropriate health decisions.
Ignorance about health issues impacts everyone
who is part of it. For instance, if the community
lacks information about safe reproduction
methods, this puts mothers and babies at risk.
Poor health outcomes are expected if the entire
community is not health literate.
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Health Literacy for Better Health Outcomes In
India Increase in health literacy has bene?ts
such as adoption of disease prevention methods
and adherence to and understanding of treatments
leading to improved health. Through a mix of
government initiatives, media initiatives and
digital initiatives, the health literacy movement
in India is gaining momentum. Heading in the
right direction, heres what government and
related agencies have been doing to create
awareness on health issues and health
decisions. Making information on health
accessible Health literacy is enabled through
promoting health content. Mediums like
newspapers, magazines, blogs, apps, social media
and more can all be utilised to promote content
related to general well-being as well as
disease-speci?c guidelines. A small drop of
awareness can have an ocean of an impact.
As far back as 2002, Doordarshan attempted to
bust myths about health problems like malaria,
HIV and more in India. Receiving several awards
including Gates Malaria Award, Kalyani7 has
become the longest running health campaign on
Indian television.
MedWatch8, an app launched by the Indian Air
Force, has features like basic ?rst aid, health
information, BMI calculator, helplines and more.
Tackling Sanitation Issues With the help of the
media, the government is trying to play an
integral part in ending Indias sanitation woes,
which would then reduce the incidence of
diarrhoea and malnutrition in the country. On a
larger scale, Swachh Bharat has gotten
As of January 2018 60 mn rural households and 4.2
mn urban households have a toilet. 11 states,
1,846 cities and 314,824 villages have declared
themselves open-defecation-free.11
accolades from Bill Gates9 and also the the
UNICEF on what the West calls The Greatest
Toilet-Building Spree in Human History10. However,
the real challenge would be to educate and
inform people about the bene?ts of using a
toilet.
A government-sponsored ad featured Indian
celebrity, Akshay Kumar, talking about the
bene?ts of using a sanitary napkin for women.
This ad, though not disease-speci?c, shows the
importance of sanitation during
menstruation. Mobilising Community Health An
individuals ability to perceive and seek care
can depend on their communitys level of health
literacy. Making India 100 health literate is a
goal that requires community-based tools to be
sustainable. The government-run ASHA (Accredited
Social Health Activists)12 program promotes
healthcare in rural communities where health
activists from within the community are
responsible for creating awareness on health and
its social determinants, mobilising the community
towards health planning. Preventive health takes
the forefront as the government tackles
malnutrition and stunting of children with
POSHAN Abhiyaan13. This scheme helps a family
have multiple touchpoints with the healthcare
system starting from a womans pregnancy.
Community engagement can be a tool to combat
nutrition issues through POSHAN Abhiyaan.
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The concept of a mitra (friend) to enable
patients to understand healthcare information is
becoming popular in public health schemes. These
mitras help patients demystify what the doctor
has said about their ailment and treatment plan,
reducing the errors sprouting from a
communication gap. For example, Health
coordinators, also called Arogya Mitras, under
the Atal Amrit Abhiyan14 scheme guide
bene?ciaries by counselling the patient about the
surgery, facilitate consultation with doctors and
do much more. NGOs play a critical role in
community-based health literacy. Here are two
success stories.
Problem In the Channapatna community of Ramnagar
district of Karnataka, an alarming 40 of people
screened suffered from diabetes and hypertension
owing to lack of awareness. Solved Through Health
Literacy The local women were trained to be
Health Navigators15 by an NGO They were armed
with handheld devices for screening, covering
50,000 people over a three year period.
Problem Araku valley in Andhra Pradesh had a
high maternal and neonatal mortality rate.
Visiting a medical facility or a doctor was
never practised there. Solved Through Health
Literacy Maternal Health literacy led to a
transformation in behaviour. Zero maternal deaths
have been reported in the past 2 years.16
Through initiatives by a leading NGO, tribal
women in the valley are having safer deliveries
and taking care of their prenatal and antenatal
health as well.
Health Alerts And Labels Related To
Health Patient safety can be also improved by
timely, contextual health information. The
warning labels on cigarette packets in India are
saving lives. According to a report17, there is
extensive evidence to show that health warning
labels on smoked tobacco prevent relapse in
former smokers and deter youngsters from
experimenting with smoking. Medicine labelling is
vital to a layman as it provides instructions and
important information like expiry date. This
lowers medication-related errors. Health alerts
during disease outbreaks and health messages
about vaccinations, critical illnesses, common
communicable diseases, etc., put up at Primary
Health Care centres, arm a person with knowledge
and reduce poor health outcomes. The scenario
towards health literacy is changing, but is it
too slow? The initiatives and measures taken by
the government show that health is on the mind
of the nation. However, the lack of data on
health literacy makes it dif?cult to know the
extent of the problem. Health information must be
understood and used by all Indians. Increased
efforts towards health literacy will help
individuals in maintaining, protecting and
promoting their health by making appropriate
health choices leading to a to a truly Healthy
India.

• References
• Times Now News
• India Times
• Times Of India
• DCruz A and Aradhya M, 2013, Health literacy
  among Indian adults seeking dental care,
  ncbi.nlm.nih.gov (20/11/2018)
• The Bureau Investigates
• Muniyandi M, Rao V G, Bhat J, Yadav R, Sharma R
  K, Bhondeley M K. Health literacy
• on tuberculosis amongst vulnerable segment of
  population special reference to Saharia tribe
  in central India . Indian J Med Res
  2015141640-7
• Usha Bhasin, Kalyani Episode 1, Jan 9 2015
• Apps.mgov.gov.in

1. India Today
2. Independent
3. India Spend
4. National Health Mission
5. POSHAN Abhiyaan
6. Atal Amrit Abhiyan
7. The Better India
8. The News Minute
9. Global Tobacco Control

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