Health literacy for all Filipinos

I was in a drugstore in Los Baños recently, and the man in front of me presented one of the staff with an empty blister pack of amoxicillin capsules. “Can I have more of this?” he asked. The staff told him that he needed a prescription.

“I just need a few for my heart!” he pleaded.

“But that’s not a medicine for the heart!” the staff countered.

“It’s for my ‘high blood’ then,” the man insisted.

“That’s not for high blood either. Come back with a prescription,” the staff patiently replied.

Kudos to the pharmacy assistant, I told myself, for being firm in upholding the no-prescription rule while being nice to the man. But amoxicillin for hypertension? As a medical doctor, I am saddened to see that even today, medicines remain completely misused and misunderstood by many Filipinos.

One response seen by policymakers to this predicament is the pursuit of health literacy — that is, increasing the public’s baseline health knowledge. The recently passed universal health care (UHC) law, in Section 30, calls on the Department of Health, via a transformed Health Promotion Bureau, to pursue health literacy, and on the Department of Education to integrate it “into the existing school curricula.”

This is a welcome development. But I hope this “health literacy” will be both practical and conceptual, teaching young people how to navigate the health system — e.g. who and when to consult, what to do in case of an emergency, how to avail of PhilHealth benefits and assert their rights as patients, but at the same time giving them principles to live by—for instance, preventive medicine, antimicrobial resistance, healthy versus unhealthy food and the science behind vaccinations (the only Jenner our kids really need to know about is named Edward).

Amid all the fake medicines being advertised both on TV and on social media, I would also like our young people to develop the skill of critically evaluating therapeutic claims.

Crucially, moreover, the curriculum should also speak to their concerns, tackling issues like weight loss and fad diets; bodybuilding and skin whitening; smoking, alcohol and drugs; sexual and reproductive health as well as mental health.

Of course, health literacy is just one side of the coin; even when people actually know which foods are healthy, they will still end up buying superprocessed, superunhealthy foods if those are the only ones available and affordable. As

Dr. Terence Kua pointed out in a recent Young Blood essay, even when they know they need to consult with health workers, they may not do so because they need to keep working, and the nearest clinic is still too far. These constraints should temper our expectations as to what health literacy can do—and prod us to redouble our efforts in addressing the social (and corporate) determinants of health and nutrition.

Another caveat is that by counting on the educational system as the platform for this effort, we are limited by its actual reach. What about out-of-school youths, and adults who also need to receive this information? We must also bring health literacy to the general public through well-designed information campaigns, and via the health care system itself. Are we maximizing our health centers and empowering our midwives and barangay health workers to be sources of health literacy? Are our doctors taking the time to actually educate their patients?

Despite its limitations and challenges, however, health literacy can still do a lot of good. The man I saw at the pharmacy, for instance, actually had the money to buy medicines, and could have benefited from knowing what antibiotics are for, and how to avail of free health services within his neighborhood. I must hasten to add that health literacy is not for the poor alone; as my fellow MDs will attest, Filipinos of all backgrounds often don’t know what to do in medical emergencies—and their moments of inaction and indecision can have fatal consequences.

And so I urge the Departments of Health and Education to work together with health professionals, educators, social scientists, communications experts and patient groups in making sure the health literacy mandated in the new UHC law is pursued vigorously and urgently. Health literacy by itself may not be able to improve people’s health, but it can certainly help.

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