Health Literacy, a Pandemic, and the Church

Posted Dec 11, 2021 by Sidney C. Roberts, MD, FACR

One year ago, a winter wave of COVID-19 cases was starting to surge. The United States had already seen over 250,000 deaths.[1] The hope of a vaccine was just around the corner. Yet a COVID-19 vaccine misinformation campaign was already well underway.[2] Now we are approaching a staggering 1 million excess deaths due to COVID-19,[3] despite having multiple safe and effective vaccines. Why are so many not only not vaccinated against COVID-19,[4] but angrily opposed only to these particular vaccines against this specific illness?

Also in 2020 – and coincidental to the growing pandemic – UnitedHealth Group issued a report[5] on health literacy, which is the ability of people to access, understand and use information to promote good health. They noted that health literacy, like other social determinants of health[6] – social and physical environments, behaviors, access to healthcare, poverty, education, etc. – varies greatly across the country. Maps of health literacy[7] look similar to maps of county health rankings,[8] obesity,[9] heart disease,[10] poverty,[11] and education level[12] – generally worse across the Deep South.

In the paternalistic days of healthcare, health literacy was not even a concept. Patients relied on their physician to make healthcare decisions, trusting that he (almost all doctors were men) had their best interests at heart. Now we “shop” for healthcare as “consumers” in an increasingly transactional relationship. Big Pharma markets directly to the consumer through television, internet, social media, and streaming services. We Google for healthcare information. But are today’s consumer-patients any more educated or more capable of making informed healthcare decisions?

At a very basic level, health literacy must start with actual literacy. Twenty two percent of adults in my county can’t read a newspaper, which is written at around an 11th-grade level.[13] Add to that the fact that much healthcare information is even more difficult to read and understand, much less process critically. For example, I have otherwise educated patients who cannot tell me the names of the medications they are on and why they were prescribed.

And then along comes a pandemic, a fertile ground for a new, lethal combination of low health literacy and ubiquitous misinformation. A pre-pandemic systematic literature review on the spread of health-related misinformation on social media noted that accurate (often dull) scientific information is easily crowded out by sensationalized news.[14] The Internet of Everything[15] promised to help us live an efficient, informed life. Instead, it has produced a far darker reality of unquashable lies and misinformation that, in this perfect storm of pandemic and politics, has resulted in hundreds of thousands of avoidable deaths.[16] UnitedHealth Group’s report envisioned that increased health literacy might lead to 1 million fewer Medicare hospital visits each year and $25.4 billion in Medicare savings.[17] No small potatoes. They did not foresee this pandemic, where additional and avoidable COVID-19 hospitalization costs totaled $5.7 billion just from June to August 2021.[18]

Unfortunately, the evangelical church, of which I am a member, has been on the wrong side of the health literacy discussion, especially as it pertains to the COVID-19 vaccines.[19] I have written previously about the appalling attempt of many Evangelicals to claim religious exemptions.[20] Rather than a biblical love your neighbor message, the church – at least the Christian Right version of it – has promoted individual rights and selfishness as the greatest good. Rather than teaching the Beatitudes,[21] some in the church want to take over the state,[22] institute a theocracy and claim God’s blessing while doing it. Rather than preaching and being the Good Samaritan[23] to the pandemic ill, the Christian Right has chosen not only to walk on the other side of the road but to add to the toll of injured.

It is tragically ironic that the self-proclaimed pro-life Christian Right has raged against life-saving vaccination. Ted Cruz, the dominionist darling of the Christian Right,[24][25] vilified Big Bird for a “government propaganda” tweet about getting vaccinated.[26] The church – if it will preach the true pro-life gospel – can’t help but shine a light on this hypocrisy. For so many Evangelicals to fight against protecting and caring for others is not reflective of Christ’s teaching and, at a deeper level, heresy.

When it comes to solving the problem of low literacy and misinformation, avoiding social media and the commentary-based news media is a non-starter. Retracting misinformation is difficult, if not impossible. We have to learn to live with social media and understand that misinformation spreads faster and wider than factual information.[27] Health care providers must allocate time at every visit to assess what the patient does and does not know and to explain procedures, interventions, and medications in simple, clear language, avoiding jargon, verifying that the patient understands and can repeat back what they were told.[28] Most importantly, critical thinking should be treated as a core skill in education. We must educate people to be open-minded, to think beyond the noise, to observe and question, to be objective and look for biases, all with humility.[29]

At the end of the day, too many in the Evangelical church allowed fear, misinformation and politics to replace compassion, service, and love. If the COVID-19 pandemic has taught us anything, it should be that loving our neighbors as ourselves is not a hollow commandment;[30] it saves lives.

[1] https://covidtracking.com/data/national/deaths

[2] https://www.npr.org/2020/07/10/889037310/anatomy-of-a-covid-19-conspiracy-theory

[3] https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

[4] https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-19-vaccine-monitor-dashboard/

[5] https://www.unitedhealthgroup.com/content/dam/UHG/PDF/About/Health-Literacy-Brief.pdf

[6] https://www.cdc.gov/nchhstp/socialdeterminants/index.html

[7] https://www.unitedhealthgroup.com/newsroom/research-reports/posts/health-literacy-research-462863.html?axios_adlink=1&cid=EM:axios_v:PA:10.4.21:m:All:OE:S15:SPOM&utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

[8] https://www.countyhealthrankings.org/

[9] https://www.cdc.gov/obesity/data/prevalence-maps.html

[10] https://www.cdc.gov/heartdisease/maps_data.htm

[11] https://www.povertyusa.org/data

[12] https://www.thrillist.com/news/nation/most-educated-states-in-us-mapped