Reconsidering Health Literacy: The Role of Implicit Bias

Abstract

Low health literacy in the United States has numerous negative impacts on health outcomes. Efforts to equip physicians with the ability to better identify patients with low health literacy have consistently shown lackluster and transient results. The transient nature of these results closely mirror those seen in the implicit bias literature, implying that health literacy may be better addressed if considered a type of coded bias among clinicians. In this paper, a review of the literature is presented which includes the impact of health literacy on patient outcomes, physician understanding and ability to screen for low health literacy, past interventions aimed at improving physician ability to identify and assist low health literacy patients, and the existing literature involving implicit bias among physicians. This review allows for the argument that interventions aimed at helping physicians better identify low health literacy patients would be more effective if designed to address unconscious biases rather than a knowledge deficit. Finally, the ethical imperative to address these biases in the healthcare setting is described.