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PRESIDENT’S
MESSAGE

Health Literacy:

A Social Determinant of Health

By Rodolfo Molina, MD, 2021 BCMS President

Part 2. Recent Events and Actionable Proposals
The purpose of Part 1 of this article was to ground us with a historical medical vocabulary and
perspective and a working definition of health literacy. In this Part 2, preventative/primary
I wish to explore recent events and actionable proposals to carry us for- healthcare concerns for
ward to improve our level of health literacy in the population. all Texas high school
What is San Antonio and Bexar County doing to improve the students
health of our population? During the COVID-19 pandemic, while • Dedicated lecture series
being home-bound, we heard daily reports from our local leaders, for our medical students on nutrition and how to counsel patients
Mayor Ron Nirenberg and County Judge Nelson Wolff. Aside from on lifestyle modification
giving us local statistics, they repeatedly told us to wear masks, adhere • Expanded social services to include adequate follow-up after hos-
to social distancing and to wash our hands frequently. Good advice - pital discharge for all patients, regardless of insurance status, and
the fact that it was so often repeated made it a very clear message to require insurance companies to provide this service
understand. In a letter to the editor, Abel and McQueen used the term • Require insurance companies to contact all their clients and help
“critical health literacy” describing the urgency for the need of every them with any issues they have encountered after a doctor’s visit
individual to make an effort of understanding facts from fiction in the • Non-politicized platform from the city council (local newspaper
“exploding market of COVID-19” information. They further stated, clipping, local radio, flyers, commercials, etc.) with which medical
“While accepting to sacrifice some part of one’s own individual free- providers can provide healthy tips and /or information on resources
dom for the sake of a collective good may be seen as a matter of hu- available locally
manistic social values, in the case of the COVID-19 pandemic there • Appropriate compensation for social work and case management
4
is little time for philosophical rationales.” teams within the medical field, and easy access to these services for
Even before the pandemic, over ten years ago, then Mayor Julian the general public
Castro initiated the Mayors Fitness Council. Its primary focus then • Mandate limits on pharmaceutical costs on a national level regard-
was to target obesity by educating the population on nutrition and less of insurance status, especially for common medications such as
providing spaces for exercise. Recently, the Council has branched out those for high blood pressure, high cholesterol, and diabetes
to address mental illness. The council has been working with various
business owners and our school districts to promote mental health These thoughts and recommendations are neither meant to be all-
awareness and have been recognized as a model for other Texas cities. inclusive nor final in their draft, but rather a starting point with which
These are two specific examples of how to improve our population we can begin a conversation to address the much-needed changes in
health and each with specific goals in education and community in- how we view and interact with health and our healthcare system.
volvement. These examples are an excellent beginning in a path leading It is essential that we maintain a complete understanding and ap-
towards improved public health for everyone in Bexar County, but preciation of the value that health literacy adds to the betterment of
we have much more exciting work ahead of us. Through these efforts all our patients.
to improve health education, we are both directly and indirectly tar-
geting and improving health literacy in our community. References
1. Taylor, R., Rieger, A,. Medicine as Social Science: Rudolf Virchow On The

Typhus Epidemic in Upper Silesia. International Journal of Health Services,
Below are some fundamental steps that should be considered by
Vol. 15, No. 4, 1985.
our community, healthcare providers, healthcare mentors, and our 2. Berkman, N. D., DeWalt, D. A., Pignone, M. P., Sheridan, S. L., Lohr, K. N.,
politicians. Lux, L. et al. (2004). Literacy and health outcomes: Summary. In AHRQ evi-
• Engaging students as early as elementary school, by teaching healthy dence report summaries. Agency for Healthcare Research and Quality (US).
eating habits in school and providing parents with resources to pro- 3. Kindig, D. A., Panzer, A. M., & Nielsen-Bohlman, L. (Eds.). (2004). Health
literacy: a prescription to end confusion. National Academies Press.
mote these habits at home
4. Abel T, McQueen D. Health Promotion International, daaa040,
• Require schools to provide healthy options for all students at https://doi.org/10.1093/heapro/daaa040. 02 April 2020.
school-provided lunches
• Consider offering or requiring a one-semester course on basic Rodolfo (Rudy) Molina, MD, MACR, FACP is a Practicing Rheuma-
healthy living principles including basic human anatomy, simple tologist and 2021 President of the Bexar County Medical Society.

8 SAN ANTONIO MEDICINE • February 2021