Chris Gibbons - The coming communication crisis in U.S. healthcare
Can You Hear Me Now?“The coming Communications Crisis in US Healthcare ” Plain Talk Conference 2012 Chris Gibbons, MD MPH JOHNS HOPKINS URBAN HEALTH INSTITUTE
“BIG” Problems in US Healthcare Cost of Healthcare Access to Healthcare Prevalence in Chronic Disease Increase numbers of Seniors Increase in numbers of immigrants and minorities Intractable Disparities Provider Shortage Others????
Which one is the BIGGEST Problem? Cost of Healthcare Access to Healthcare Prevalence in Chronic Disease Increase numbers of Seniors Increase in numbers of immigrants and minorities Intractable Disparities Provider Shortage ????
The BIGGEST Problem?Inability to Communicate with the Healthcare system Definition – Inability to understand or be understood.
The largest drivers of the Problem?Poor Health LiteracyPoor English Language Fluency
How big is the Problem? 2007 Census/ACS Does this person speak a language other than English at home? What is this language? How well does this person speak English (very well, well, not well, not at all) Peoplespeaking below the “very well” category are thought to need English assistance in some situations
How big is the Problem? The Voting Rights Act of 1965 uses these criteria to determine the need for bilingual election materials. Self-reported data on English-speaking ability have demonstrated the measure to be highly reliable and usable. “How Good Is How Well? An Examination of the Census English-Speaking Ability Question,” <http://www.census.gov/population/www/socdemo/lang_use.html>.
How big is the Problem? In 2007 55 million people (20% US pop) spoke a language other than English at home. What are they Speaking? Spanish including Spanish, Spanish Creole, and Ladino. (62%) Other Indo-European languages including most languages of Europe and the Indic languages of India. These include the Germanic languages, such as German, Yiddish, and Dutch; the Scandinavian languages, such as Swedish and Norwegian; the Romance languages, such as French, Italian, and Portuguese; the Slavic languages, such as Russian, Polish, and Serbo-Croatian; the Indic languages, such as Hindi, Gujarati, Punjabi, and Urdu; Celtic languages; Greek; Baltic languages; and Iranian languages. (19%) Asian and Pacific Island languages include Chinese; Korean; Japanese; Vietnamese; Hmong; Khmer; Lao; Thai; Tagalog or Pilipino; the Dravidian languages of India, such as Telugu, Tamil, and Malayalam; and other languages of Asia and the Pacific, including the Philippine, Polynesian, and Micronesian languages. (15%) All Other languages include Uralic languages, such as Hungarian; the Semitic languages, such as Arabic and Hebrew; languages of Africa; native North American languages, including the American Indian and Alaska native languages; and indigenous languages of Central and South America (4%)
How big is the Problem? 50% (25 million) of non English Speakers reported that they did not speak English “Very Well” Proportions were higher among older Spanish speakers 57% of those aged 41-64 65% of those over the age of 65 7 of 17 languages had more than 1 million speakers Spanish – 34 million Chinese – 2 million French, Tagalog, Vietnamese, German, Korean – 1 million
How fast is the Problem changing? From 1980-2007 Vietnamese saw 511% increase > 200% increase Spanish, Russian, Persian, Chinese, Korean, Tagalog Substantial variability across states W Virginia (2%), California (43%) Southwest and East Coast States had substantial rates All 50 states had some increase
Bottom Line In 2007 25 million people were not able to speak English Very well Their numbers are rapidly increasing They are not just in New York, California, Florida and Texas Most speak Spanish, but also many other languages involved
The full Story Dialects, slangs, vernaculars, Jargons Gullah Southern Drawl Urban - Phat, Cold, Mad, Badonkadonk In 2012 ~ 30 million people with LEP Healthcare Reform – 30 million more in 2014 Health Literacy? 40% of Americans can not understand health information 115 million people
Impact on Healthcare System Sites of “care” Hospital Clinic Emergency Room Doctor’s Office Pharmacy School Work
Impact on Healthcare System Patient Trust Engagement Satisfaction with care Healthcare decision making Adherence Provider Patient centeredness Readmissions Reimbursements Outcomes System/Population Costs Waiting times Disparities
Impact on Healthcare System Add in Aging Provider workforce Nursing shortage Inability to manage “care in the community” Recipe for a “Communication Crisis in Healthcare”
What can we do about it? Wait for the Healthcare system Explore powerful emerging resources More U.S. adults used the Internet than doctors to obtain health and medical information The Internet has considerably more influence over consumer health decisions and actions than traditional channels like print, TV and radio Thousands of Translator Apps (Google, Android and Apple) WordLens, Google Translate, many others Refuse to accept the status quo
What can we do about it? Refuse the status quo in health communication Now – one time, paper based, word dense communication Future - Paper + Electronic information – thumb drives etc Take anywhere On Demand health information – 1-800 xxx xxxx Obtain anytime Video based vs. Graphic Based information Culturally appropriate Cloud based web services information Access by any device PN & CHW based services
Bottom Line Refuse Status quo Utilize available emerging tools & technologies Request/Inform Advocate City, state and government Reps Organize Information support groups “Patients like me” “Cure together” Let your voice be heard Editorials, Blogs, Petitions
Be Part of the Solution Prepare to be the advisors and expert consultants they will need. Design our own new innovative solutions. Prepare to be tomorrows designers and developers.
Thank YouTogether, we will find the “cure” forthe coming “communications crisis”.