Chris Gibbons - The coming communication crisis in U.S. healthcare


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Presented by M. Chris Gibbons, MD, MPH, on September 7, 2012 at the third annual Center for Health Literacy Conference: Plain Talk in Complex Times.

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Chris Gibbons - The coming communication crisis in U.S. healthcare

  1. 1. 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
  2. 2. “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????
  3. 3. 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 ????
  4. 4. The BIGGEST Problem?Inability to Communicate with the Healthcare system  Definition – Inability to understand or be understood.
  5. 5. The largest drivers of the Problem?Poor Health LiteracyPoor English Language Fluency
  6. 6. 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
  7. 7. 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,” <>.
  8. 8. 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%)
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. Impact on Healthcare System Sites of “care”  Hospital  Clinic  Emergency Room  Doctor’s Office  Pharmacy  School  Work
  14. 14. 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
  15. 15. 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”
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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.
  20. 20. Thank YouTogether, we will find the “cure” forthe coming “communications crisis”.