Written by Ricky Illindala

Knowledge has the power to save lives. When it comes to preserving one’s health, having access to and understanding health information is vital to making the best health-related decisions. This is the definition of “health literacy”. Health literacy has a short, yet vague, definition that encompasses a wide range of health information and activities. Examples of such activities include accessing health care services, communicating with healthcare providers, evaluating the credibility of information online, etc.

Low health literacy has been found to strongly correlate with low health outcomes. A systematic review of such studies in 2004 associated low literacy with increased incidence of chronic illness, poorer intermediate disease markers, and suboptimal use of preventative health services. The recent COVID-19 pandemic has highlighted the prevalence of misinformation and persistent wounds in public health levels of health literacy.

Understanding why health misinformation regarding COVID-19 spreads so quickly is a complex task that involves many distal causes. As a contact tracer for the Cass county health department, my experiences gave me some insight into what might make the public susceptible to misinformation. My job consisted of calling patients who tested positive for the coronavirus, providing them isolation/quarantine instructions and answering any of their concerns. These calls are generally supposed to be straightforward, but they were never as simple as it seems. 

Most patients would cite a plethora of reasons as to why they wouldn’t quarantine. Usually it was just plain stubbornness and a feeling of invincibility that they had. “Oh, I’ve been fine. Haven’t felt a thing. Don’t worry about it.” These patients wouldn’t grasp the idea that they could unknowingly spread the virus to others around them and the resultant consequences. They also tend to underestimate the virus and its potential to infect them. Many would be less ignorant and more hostile, cursing at me and claiming I just wanted to make their lives worse. There seemed to be an ingrained distrust of public health, which could be rooted in the disproportionately high socioeconomic status of scientists and public health experts. 

While most patients cooperated or had shallow obstructions to quarantining that we would work around, some of my most difficult cases involved patients in extremely difficult situations. One mother I spoke to had a child with autism and a brother in poor health who was in the hospital undergoing a serious procedure. She didn’t have anyone else to reach out to, so when I told her she would have to isolate for 10 full days, she started breaking down over the phone. She started telling me about her life and her struggles, begging me to let her at least live with her brother and go to the grocery store. As much as I understood her predicament, I also understood the potential downstream consequences of her entering public places and the public health policy I am paid to abide by. I had another similar experience with a man who lived with his wife and 6 children in a small, 1 room house that by his account made it physically impossible for him to social distance from his family. After talking through their options, the best option we came to was for him to live in their RV outside for 10 days in nearly freezing temperatures. Ironically, the man was putting his own life in more danger to protect those around him. 

As I spoke to more and more cases, I realized that so much of our public health policy is idealistic and does a poor job of addressing the different living situations, financial hardships, and social circles among those of a lower socioeconomic status. For example, the Missouri CARES act, which promises patients their income when they can’t work while in quarantine, only applies to employees in companies with more than 500 employees. This sparsely applied to residents in rural Cass county, who generally work for small, locally owned businesses. 

When all of these hardships are considered, it appears that patients might be willing to accept and practice health information, but are restricted from doing so due to the myriad of troubles that are coupled with following good public health practices. If we can design public health policy to better accommodate lower socioeconomic status persons in difficult situations, it’s possible we could raise the public retention rate of health information and increase cooperation. For example, the CARES act could also include any financial aid resources for employees in small companies, which the state of Missouri doesn’t necessarily need to provide. Attempts at such solutions are already being initiated, such as the health finder application under the Affordable Care Act. This app provides personalized, prevention-decision support for its users. This information and resources should be provided locally and more personable to the population they serve. Such changes would be much more achievable and quicker than changing education levels throughout a population. 

When viewed from a distance, it seems that the most obvious way to improve health literacy is to just raise people’s knowledge through schooling and other resources. However, when viewed through a magnifying glass, it becomes apparent that there are many more working parts in the trail of misinformation. By aiding low SES groups with policies designed to accommodate the frequent hardships they encounter in their lives, we can lend these groups the freedom to make the right choices for their health. 

Edited by Blair Hoeting