“The coming Communications Crisis in US Healthcare”

Plain Talk Conference 2012

Chris Gibbons, MD MPH J O H N S H O P K I N S U R B A N H E A L T H I N S T I T U T E

Can You Hear Me Now?

“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 Literacy

Poor 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)

People speaking 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 You

Together, we will find the “cure” for

the coming “communications crisis”.