THE image persists in my mind the day a patient walked into the pharmacy, clutching a bag of medications with a look of confusion and concern. In his late 60s, he had recently been diagnosed with multimorbidity: diabetes, high cholesterol, high blood pressure, and gout. As he handed me his prescriptions, he hesitated and quietly asked, “Can you explain these to me again? I didn’t quite understand what the doctor said”, overwhelmed by the sheer volume of information given to him during his recent doctor’s visit. This patient’s experience is not unique. Every day, someone is in this situation, lost in a sea of medical jargon, unclear instructions, and complicated treatment plans. This gap in understanding is not just frustrating; it is dangerous.

The growing inability of people to understand health information and effectively manage their care is a crisis that demands urgent attention and action. This is the state of low health literacy and poor self-care agency that affects hundreds of Jamaicans, leading to medication errors, unmanaged chronic diseases, and unnecessary hospital visits. Low health literacy and poor self-care agency are two silent epidemics. This twin epidemic not only is undermining individual health but also straining our health-care systems, and together threatening the public health of our country.

Understanding the twin epidemics

Health literacy is the foundation of effective self-care. It involves the capacity to understand basic health information, such as reading prescription labels, following treatment and diet plans, and recognising the importance of preventive measures. Unfortunately, low health literacy is pervasive, with global implications. This issue is particularly prevalent among older adults, people with limited education, and those from marginalised communities.

Self-care agency refers to an individual’s ability to perform self-care activities, which promote their own health, prevent diseases, and maintain health, such as taking medications correctly, monitoring symptoms, and making lifestyle adjustments to cope with illness and or disabilities according to the Global Self-Care Organization. When patients lack the knowledge and confidence to manage their health, they are more likely to experience poor outcomes, including medication errors, uncontrolled chronic conditions, and unnecessary hospitalisations.

The dangerous Intersection of low health literacy, poor self-care, and lifestyle diseases

Low health literacy, poor self-efficacy, and lifestyle diseases form a dangerous feedback loop. Individuals with low health literacy often lack the knowledge and skills necessary to make healthy lifestyle choices, leading to poor diet, lack of physical activity, and other behaviours that contribute to the development of chronic diseases. Moreover, these individuals may struggle to manage their conditions effectively, resulting in more severe health outcomes and higher health-care costs.

For instance, a person with a limited understanding of nutritional information may be unable to interpret food labels or understand the importance of a balanced diet, leading to poor dietary choices that contribute to obesity and diabetes. Similarly, individuals who cannot comprehend medical instructions may misuse medications or fail to adhere to treatment plans, exacerbating their conditions. Thus, low health literacy, poor self-care agency, and lifestyle-related diseases converge to create a public health crisis of unprecedented scale, affecting thousands of Jamaicans and putting immense strain on our healthcare systems.

Socio-economic disparities

Socio-economic factors, such as poverty, low educational attainment, and limited access to health care, worsen both low health literacy and the prevalence of lifestyle diseases. Marginalised communities often face barriers to accessing accurate health information and quality health care, which further deepens health inequities.

In urban areas, fast-paced lifestyles, limited access to healthy food options, and a lack of safe spaces for physical activity contribute to the rise of lifestyle diseases. In rural regions, the challenges are compounded by geographic isolation and inadequate health-care infrastructure, making it even more difficult for residents to receive proper health education and care.

The pharmacist’s role in addressing low health literacy and poor self-care agency

Pharmacists are uniquely positioned to help bridge the health literacy gap. They are often the most accessible health-care professionals, interacting with patients/clients regularly and providing critical information about medications and health management. The complexity of modern health care, coupled with the growing demands on their time, can make it challenging to provide the adequate level of education and support that patients need.

In my experience, people struggle to understand even the most basic aspects of their treatment plans. For example, I frequently encounter patients who are uncertain about what side effects to watch for, or why adherence to their regimen is crucial and even why they should not share medications for chronic lifestyle diseases. This lack of understanding can lead to mistakes, such as taking the wrong dose or discontinuing a medication without consulting a health-care provider, and even inappropriate self-treatment.

To combat these issues, pharmacists are encouraged to prioritise clear, patient-centred communication. This means reducing the use of medical jargon when talking to patients, using visual aids or demonstrations when possible, and ensuring that patients fully understand the information before leaving the pharmacy. Additionally, follow-up consultations, either in person or via telephone or telehealth, can help reinforce important concepts and provide ongoing support.

Strengthening self-care agency through policies, systematic approaches, and high-quality information

Building self-care agency is a critical aspect of improving public health. Patients need more than just information; they need to feel empowered and capable of managing their health. This requires a combination of education, motivation, and practical tools.

Moreover, pharmacists can advocate for systemic changes that support self-care, this includes advocacy for policies that improve not only access to affordable, high-quality healthcare but for patient-pharmacist consultation times, as well as collaborating with other healthcare providers to ensure that patients receive consistent and coordinated care.

As a modifiable determinant, another effective approach is to integrate self-care education in routine pharmacy visits. This can include teaching patients how to monitor their blood pressure at home, offering advice on healthy eating and exercise, or providing resources for managing chronic conditions. Technology can also play a role; mobile apps and online platforms can help patients track their progress, set health goals, and access reliable information.

The broader implications of healthy literacy and self-care agency

The consequences of low health literacy and poor self-care agency extend far beyond the individual level. These issues contribute to the rising burden of chronic diseases, increased healthcare costs, and preventable complications. For instance, patients with low health literacy are more likely to visit emergency departments for issues that could have been managed with proper self-care, leading to overcrowded facilities and strained resources.

Addressing these twin epidemics is not just a matter of improving patient education; it requires a broader commitment to health equity. This means recognising and addressing the social determinants of health, such as poverty, education, and access to care, that disproportionately affect vulnerable populations. Improving health literacy should be prioritised by the government, health-care providers, health educators and individuals (patients), this can be achieved through public health campaigns, educational programs, and community-based initiatives that empower individuals with the knowledge and skills needed to make healthier choices. As trusted health-care providers, the role of the pharmacists and the pharmacists educator is important in bridging the health literacy gap through advocacy. These changes underscore the importance of the pharmacist in bridging the health literacy and self-care literacy gap in patients thereby enhancing better health outcomes. Additionally, integrating health literacy and self-care literacy into the education system can ensure that future generations are better equipped to manage their health.

The need for urgent action

Health literacy and self-care literacy are societal responsibilities that require collaboration between governments, public health organisations, and health-care professionals such as pharmacists and pharmacy educators. Together, we can develop and execute policies that address social determinants of health and build a coalition of like-minded public and private partners who are committed to supporting health literacy and self-care literacy.

The twin epidemics of low health literacy and poor self-care agency are a major threat to global public health. These issues continue to grow and will place an even greater burden on health-care systems, leading to worsening health outcomes. However, with strategic action from all sectors of society, it is possible to break the cycle and create a healthier future for all. In confronting these challenges, we must embrace both individual behavioural shifts and systemic reforms that prioritise health education, equality, and prevention. As an educator, I believe addressing low health literacy and enhancing self-care agency should be a priority in improving public health. By empowering patients with the knowledge, skills, and confidence to take control of their health, thereby reducing the burden of chronic diseases, preventing medication errors, and creating a healthier society.

This twin epidemic is more than a health-care issue; it is a call to action for all in the medical community as we seek to educate and improve health literacy and self-care agency in the people of Jamaica.

Stephanie D Mullings, EdD, MPh, pharmacist, is a lecturer in Epidemiology at the University of Technology, Jamaica.