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Your Good Health: Treatment of heartburn, indigestion requires diagnosis

Dear Dr. Roach: What cures heartburn and indigestion?


It’s easier to answer what causes heartburn and indigestion, because treatment depends on the underlying problem. The most common cause of heartburn is gastroesophageal reflux disease. The contents of the stomach, which normally are strongly acidic, go backward into the esophagus, the long, muscular tube that connects the back of the throat with the stomach. The burning sensation is caused by sensory nerves in the esophagus, which is not supposed to have acid and can be damaged by recurrent exposure to it. Not everybody with GERD gets heartburn: Some people have a cough; some people have the sensation of food and acid going all the way into the back of the mouth, but some have less-typical symptoms, including voice changes, difficulty swallowing, excessive salivation, chest pain mimicking angina and nausea.

GERD usually is caused by relative weakness in the lower esophageal sphincter, a muscular valve structure at the bottom of the esophagus. If the pressure in the stomach pushing contents upward is greater than what the valve can prevent, then acid will flow backward into the esophagus.

In addition to GERD, indigestion can be caused by stomach or duodenal (the first part of the small intestine) ulcers, gallstones, inflammation of the stomach, pancreatic disease, side-effects of medications and many other things.

The first step in treating indigestion and heartburn is to make a diagnosis. Often, clinicians will give a trial of medication to treat symptoms. This might be antacids (which work immediately, but wear off quickly); proton pump inhibitors, such as omeprazole (Prilosec); or a class of medications called H2 — for “histamine type 2” — blockers, which include ranitidine (Zantac) and famotidine (Pepcid). Rapid relief of symptoms while on these medications is strong, but imperfect evidence that the symptoms are being caused by a stomach-acid-related problem (GERD, gastritis and stomach ulcers being the most common). Persistent symptoms should trigger a more thorough workup, potentially including an examination of the esophagus, gastrum (stomach) and duodenum. This is done with a type of endoscopy usually called an EGD, or upper endoscopy, as opposed to a lower endoscopy (colonoscopy).

GERD symptoms usually are not cured, since “cure” means permanent relief from symptoms of the condition as well as resolution of the underlying mechanism. The only treatment likely to cure GERD is surgery to increase the ability of the lower esophageal sphincter to resist acid flow. Newer techniques allow this procedure to be done endoscopically. However, people who have had this surgery often develop other symptoms, including bloating and gas from the inability to belch and relieve swallowed air. However, GERD symptoms usually are manageable with lifestyle changes and medications.

Dear Dr. Roach: I am a 73-year-old male and have been diagnosed with pulmonary fibrosis. My doctor wants me to begin a very expensive medication called Esbriet. From what I’ve read, it could cause very serious side-effects. I feel great — no shortness of breath, a little coughing when breathing in cold air or around my cat. I would just like your thoughts on the disease and the medication Esbriet.


I haven’t discussed pulmonary fibrosis since pirfenidone (Esbriet) was approved. Several trials have shown that it improves lung function, exercise ability and disease-free survival in people with mild-to-moderate disease. It can cause a rash, nausea and diarrhea, and it is, as you say, very expensive. However, if you can afford it or have insurance coverage, I recommend pirfenidone.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to

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Your Good Health: Doctor’s talk of ‘lesion’ does not mean ‘cancer’

Dear Dr. Roach: I am having a “push endoscope,” or forced endoscope, tomorrow. They said they found a lesion in a CT scan and want to look into it further. Is “lesion” a fancy name for cancer?


The word “lesion” is a Latin word for “injury.” In medical parlance, it means pretty much anything that is abnormal. While it is true that doctors will use the term “lesion” to describe something that will later turn out to be cancer, “lesions” definitely are not always cancer.

Push endoscopy, also called push enteroscopy, refers to pushing a small endoscope through the stomach further down into the small intestine, so I suspect that your doctors think that whatever abnormality was seen on the CT scan is in the upper small intestine.

Cancer is rare in the small intestine, but unfortunately there are several types that do occur. Carcinoid, now considered a malignant tumour, is the most common.
The enteroscopy will allow your doctor to look at the abnormality and take a biopsy, if appropriate (which I suspect it will be, if a lesion is found).

Some of the possibilities include benign tumours, such as adenomas and lipomas. I also have seen times when a CT scan abnormality has turned out to be nothing at all on endoscopy. Please let me know what is found.

Dear Dr. Roach: What would cause abdominal bloating after meals, with no gas, no pain, no diarrhea and no indigestion? After a big meal, my daughter’s abdomen (she is 46, but this has been going on for many years) looks like she is six months pregnant.


There are many possibilities. The first is air, which many people swallow when eating food.

Most people are not aware that they are doing so, and the amount of air tends to be increased in people who are anxious or who eat rapidly. Most of the gas is eructated (that’s the fancy medical name for “burped”), but much will enter the intestine, where some will be absorbed and some passed later.

The name for abdominal enlargement after eating is “distension.”

Irritable bowel syndrome is a common cause of distension, but it normally is associated with some degree of abdominal discomfort and a bloating sensation. It’s thought that swallowed air and gas produced by colonic bacteria combine with non-co-ordinated movement of the abdominal muscles to produce the visible abdominal distension. The vast majority of people with irritable bowel syndrome have diarrhea or constipation.

Poor absorption of food, such as from celiac disease or lactose intolerance, can cause abdominal distension, though diarrhea is common.

Small-intestine bacterial overgrowth also may cause distension, but again I would expect accompanying diarrhea or gas.

There are other, less common causes, and a gastroenterologist certainly would be able to review the possibilities and discuss treatment with your daughter. However, since this has been going on for many years, and it doesn’t seem to be causing her many (if any) symptoms, I am not sure an evaluation is mandatory. Still, some possibilities, such as celiac, are worth knowing about, since there may be subtle symptoms she has learned to live with that might be improved with dietary modification.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to

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Skier found ‘in good health’ after overnight ordeal – Aspen Daily News

A backcountry skier reported missing on Saturday near Marble emerged “in good health” on Sunday afternoon, after reportedly touring for miles until 1 a.m. to stay warm Saturday night then bedding down under a space blanket.

Greg Berry of Boulder told a Pitkin County Sheriff’s deputy that he went for what was intended to be short tour late morning on Saturday, but became lost and disoriented. The experienced backcountry skier was staying in the Crystal River Valley with some friends celebrating a birthday and wanted to get some exercise, telling his companions that he would “stay safe and stay below treeline,” said Alex Burchetta, director of operations for the Pitkin County Sheriff’s Office.

When Berry did not return later in the day, the friends did some searching of their own and then contacted authorities. Though Marble, high in the Crystal River Valley, is most easily accessed from Pitkin County, it is in fact in Gunnison County. Still, the Pitkin County Sheriff’s Office and Mountain Rescue Aspen (MRA) often assist with Gunnison County operations in the Elk Mountains.

Authorities in the Roaring Fork Valley were notified of the missing skier around 9 p.m. Saturday, and a team of five MRA volunteers, supported by others at the C.B. Cameron Rescue Center in Aspen, deployed at first light Sunday. They were joined by searchers from West Elk Mountain Rescue in Paonia and Crested Butte Search and Rescue, who made the four-hour drive required in winter to reach this side of the Elks.

The teams searched the popular backcountry skiing zone accessed via the Quarry Road in Marble until 3 p.m. but could not locate Berry. As they were debriefing at the trailhead, the rescuers were informed that Berry had turned up near Paonia Reservoir on Highway 133, which is located on the other side of McClure Pass and the Ragged Mountains from Marble. He had hitchhiked from there into Paonia, where he contacted his friends to let them know he was OK. 

Burchetta said Berry told another deputy that after he realized he was lost, he determined to keep moving on his alpine touring gear, presumably in an attempt to stay warm. He kept at it until about 1 a.m., when his headlamp died. Berry took shelter under a space blanket he was carrying until the sun came up, then continued with the tour.

Temperatures in the high country near Marble dropped into the teens Saturday night and early Sunday morning, as a winter storm enveloped the area. It grew even colder on Sunday as at least a foot of snow accumulated.

Berry, who works for a Front Range wealth management firm, could not be reached on Monday. Officials with the various rescue agencies involved said they were unsure what route Berry took in his travels.

A Gunnison County Sheriff’s Office press briefing stated that Berry was “in good health” upon his exit from the backcountry on Sunday.

A note on the Mountain Rescue Aspen Facebook page Monday stated that 17 team members, between searchers in the field and support staff at the rescue center, aided in the effort.

“Anytime someone makes it out alive, with or without our help, we are happy with the outcome,” the online post said.

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Free healthy living workshop available soon in Waverly

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‘Brain Breaks’ promote healthy living in elementary students

HARRISONBURG, Va. (WHSV) — According to Sentara RMH, the RMH Community Health Needs Assessment in 2012 showed that among children 10-17 years old within the Sentara Medical Center service region, 18% are considered overweight, and 34% are less physically active than recommended.

Now, the Community Health office is working with a grant from the Virginia Foundation for Healthy Youth to help get children active and healthy. They are working with schools in Harrisonburg to purchase tools to help teachers implement “Brain Breaks” for the kids. Through the “Brain Break” program, students dance or do other exercises to get energy out.

So far, Smithland Elementary is having great success with the program. The school has implemented using dance videos in the classroom, instructional yoga and mats, and even a stationary bike. Some classrooms also use alternative seating, so they have stools, standing desks, and yoga balls for kids to sit on. Community Health Educator Olivia Resto goes into the schools to help teachers learn different strategies for the “Brain Breaks.”

“Smithland has been overly successful with brain breaks, the teachers are very much invested in both the academic, and physical well-being of their students, which makes the program so much more successful,” said Resto.

The Community Health Office is now reaching out to schools in the county to help them implement “Brain Breaks” into their school.

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Learn How To Eat Healthy, Live Healthy At The Community Healthy Living Expo

People of All Ages are invited to the Community Healthy Living Expo on Saturday, January 27, at First United Methodist Church, 950 7th Street, from 9:30 am-2:00 pm.

Free health screenings will include blood pressure checks, hearing tests, skin cancer checks, glucose testing, BMI test, spine alignments and much more.  Find out how Thermal Imaging can detect breast cancer and other health issues 6 months before they show up on an MRI.  Speak with doctors and nurses about health concerns.

Eighty vendors, chef demonstrations and samplings, food trucks, entertainment and door prizes will be part of the day of healthy learnings.

For the Kids: Storytime with the Alphabet Chef will be held at 11:30 am.  A food demonstration designed for children to learn better healthy eating options is scheduled. In addition, there is a Kids Zone, train rides, pony rides, petting farm, bounce house, face painting and games.

For a full seminar schedule, visit website site For additional information, contact Sandy Farnsworth at 352-617-8788 or


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Tips to Be Fit: Answers to health questions

Breast size and running

“I’ve just begun a running program and I love it. My problem is that I have large breasts and a lot of my friends tell me I shouldn’t run because running will cause my breast to sag. Is that true and are there some exercises that I can do to avoid the sagging? Or should I just give up running?” — Betty, Houston

You don’t have to stop running. We’ve checked with several doctors whom work with runners and all of them said there is no proof that running causes sagging or that it is a detriment to the muscles that lie under the breasts. The skin will stretch somewhat from any exercise. Wearing a support running bra will help guard against this problem. There are a lot of companies that specialize in running bras.

Breast tissue is made up of fat, nodes, ducts and connective tissue, so there is no muscle that can be toned in the breast. The muscle under the breast can be toned to aid in supporting the breast. This can also help you with your posture. To strengthen your chest muscles, you should do three to four exercises for two to three sets for eight to 10 repetitions that work the chest muscles. If you can’t do eight reps then the weight is too heavy and if you do more than 10 reps the weight is too light.

The running you’re doing will also decrease the size of your breasts because running burns body fat. This will also decrease the sagging and some of your discomfort. So don’t stop running, wear a good sports bra when you run and strengthen the chest muscles.


”Are starchy foods like corn bad for you if you’re losing weight? I like corn.” — Robin, Pittsburgh

Starchy foods are important for balanced nutrition. They supply you with needed fiber, minerals and vitamins. Starchy foods are also low in fat. The fat content increases when you add butter or other high-calorie sauces that contain saturated fat.

Don’t stop eating corn. It’s an excellent source of vitamin A and C. It’s also low in sodium and fat. Sweet corn can be either yellow or white. Ears should be full with firm, bright, milky kernels, but give a little when pressed. Look for fresh green husks. The husk should be dry and the silk yellow.

There are several ways to cook corn. When boiling, use enough water to cover the corn. You should cover the pot and cook rapidly for 7 to 10 minutes. You can season your corn by adding oregano, parsley and Italian seasoning to the water.

You can also add cooked corn kernels to your pancakes, waffles and muffins. You shouldn’t eat corn with proteins because it’s a starchy food. Corn will digest best with other vegetables.


“I can’t seem to get into aerobic dancing or jogging. What else can I do to get in an aerobic workout?” — Jane, Philadelphia

Unlike many other aerobic exercises, walking is relatively free from many hazards of aerobic exercises. Aerobic exercises such as jogging, jumping rope or high impact aerobics can cause joint pain, stress fractures, muscle pulls and other problems. Studies have shown that you can get the same benefits by walking 60 minutes, four times a week as you can by running 30 minutes three times a week. This means that walking offers the same aerobic benefits as more strenuous exercises without the hazards.

How fast should you walk to get in a good workout from walking? You should take about 130 to 140 steps per minute for a good walking workout. According to the Surgeon General you should walk about six to seven times a week.

Although walking is relatively free from injuries, you can still overdo it. If you begin to feel pain, stop walking for a couple of days, then slowly work your way back into your program.

Caffeine running

“Can caffeine improve my time in my 10K? I need a boost to improve my time.”

— Judy, Tampa, Fla.

Caffeine is a psychoactive stimulant. It will increase alertness, decrease fatigue, give euphoria and elevate your mood. The bad effects of caffeine can include sleeplessness, irritability, anxiety and depression. It’s been shown that just the amount of caffeine found in a few cups of coffee can improve endurance and performance. But not all scientists agree. The studies say yes and no. Caffeine in large doses will cause you to lose an Olympic medal because it’s on the banned substance. This is not to say that a few cups of coffee or a couple of cans of soda will make you a world-class runner. The link between caffeine and performance is in the drugs apparent ability to improve the body’s ability to burn body fat and conserve glycogen in your muscles. Caffeine is not without side affects. If you drink more than 250 mg of caffeine a day, which is about two and a half cups, you can suffer from caffeine intoxication. The symptoms include restlessness, nervousness, excitement, excessive urination, insomnia, heartburn, muscle twitching and rambling thought and speech.

If you’re not allergic to caffeine a few cups of coffee before your race may help and it may not.

Diet and metabolism?

“What is the difference between losing weight by dieting alone and losing weight by exercising?” — Janet, Jacksonville, Miss.

Dieting alone to lose weight will lead to a muscle mass loss of around 50 percent and a fat and water loss of around 50 percent. Weight lost through proper diet and exercise will lead to a fat loss of around 98 percent and lean muscle mass should increase. The loss of lean muscle will weaken the muscles and organs and slow down metabolism. The rate at which the body burns calories is directly related to lean body weight. In other words, muscle helps burn calories. When you lose weight by dieting alone your metabolism burns calories at a slower rate. When you quit dieting your body continues to burn calories slowly. Consequently, you gain the weight you lost and sometimes more. Each time you diet this way, your metabolism is strained, as well as heart function, kidney function, and bone and muscle production.

Instead of cutting calories, workout for 30-60 minutes three to five times a week. Walking is great for the beginner and jogging can become addictive. You’ll also want to do toning exercises for each part of the body, such as weight training or calisthenics. Experiment with different workouts and find something you enjoy. Make sure you consume between 12 to 15 calories per pound of body weight daily.

Exercise and iron

”I’m 27 years old. I’ve just gotten back into exercise and I want to know if I need to eat meat to get in the iron I need. I’m getting a lot of opinions. Do I need beef if I exercise?” — Veronica, Cherry Hill, N.J.

Do females who exercise need to eat beef? Dietary facts suggest that we should include red meat in our diets. The mineral iron is found in vegetables and fruits but this iron is a nonheme form of iron. This iron can be used by the body, but not as easily as the iron found in beef and other meats. When a group of female exercisers who ate beef were compared to a similar group of non-beef eaters, they found that the non-beef eaters had problems with low iron levels. Good usable iron is also found in chicken and fish but beef still provides the most easily used iron. Remember only 3-4 ounces of lean beef is a serving and will give you the iron you need, not a whole steak.

Buying a treadmill

“We’re in the market to buy a treadmill and we need some tips to help us get a good one.” — Rita, Jacksonville, Fla.

First, decide how much space you have for a treadmill. This will help you decide how big your treadmill can be. If you want to get a quality machine with a lot of bells and whistles plan to spend at least $1,500. You can also find a non-motorized treadmill for as little as $125. Find out what the store policy is on trying the treadmill out before you buy it. If they won’t let you try it at home, try it out at the store. If you buy from a catalog or a TV special don’t forget to get a street address for a catalog or TV sale. Post office boxes don’t count. No matter where you buy your treadmill find out about the return policy. If you buy a treadmill that is cushioned to absorb shock be careful because too much spring can cause an injury instead of preventing them. Hideaway treadmills may not be a great buy. What you gain in space you lose in durability and quality. Fancy bells and whistles for control are not always worth the value. You should go for something basic that includes inclining capabilities, speed control, distance measurement and time measurement. The treadmill should have a belt that is at least 17 inches wide and 48 inches long. A two-ply belt is all you need. Machines advertising more than a two-ply belt are just gluing layers together making the belt less durable. You also want your treadmill to have at least 1.5 horsepower. If you don’t have at least 1.5 you’ll probably be able to stop the belt with your foot.

Once you buy your treadmill make sure you use it.

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Women’s heart health tips topic of ‘Go Red Symposium’

JACKSON, MI – Henry Ford Allegiance Health, Consumers Energy and the American Heart Health Association are teaming up to raise awareness for women’s heart health.

The three entities are hosting the Go Red Symposium, a day-long event designed to educate the community on strategies for better heart care and well-being, a press release says.

The symposium begins at 1 p.m. Wednesday, Jan. 31, at the CE Innovation Center, 165 W. Michigan Ave. Registration and reception begin at 12:45 p.m.

The event is free and open to the public.

Six speakers are slated to discuss heart health with the audience.

Here’s the full schedule and speaker lineup.

12:45-1 p.m.: Registration and reception

1-1:05 p.m.: Welcome and Safety Moment

1:05-1:50 p.m.: Keynote Speaker Dr. Cathy L. Glick, cardiologist at
Henry Ford Allegiance Health, discusses “Heart Disease in Women.” A question and answer session will follow.

1:55-2:15 p.m.: Sue Whitmarsh, owner of Breathe Yoga of Chelsea, will do a chair yoga demonstration.

2:15-2:35 p.m.: Bea Furman, owner of Healing Song Therapeutic Massage, discussion titled “Reiki and Energy Boosting Techniques.”

2:35-2:55 p.m.: Sindhujah Kalimuthu leads a guided meditation

2:55-3 p.m.: Door prizes and closing words

Attendees are encouraged to wear red-colored clothing to “Go Red,” the release says.

Send an email to to register prior to the event.

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HEALTH TIPS: How to isolate cold and flu germs at home … – Sarasota Herald

Coughing, sneezing and misery are a part of many households these days as cold and flu season kicks into high gear. It’s no fun to live with someone who is sick, and in no way do you want what they have. We spoke to Carolyn Forte, director of the Good Housekeeping Home Appliances, Cleaning Products, and Textiles Lab, about simple things you can do to try to prevent the spread of germs. 

• Wash your hands. Often. This is the single most important thing to do to prevent the spread of germs. Soap up between your fingers and don’t forget your thumbs, Forte advises. Scrub for about 20 seconds. You can use any soap, but she prefers a liquid pump bottle.

“You don’t have that goopy bar in a soap dish,” she says. “You can even touch the pump with your elbow to get the soap out.”

• Isolate toothbrushes. Once a household member has a cold, it’s best to separate their toothbrush from the rest of the pack to avoid germ contamination. After the person gets well, replace the toothbrush or toothbrush head with a new one. 

• Launder bedding frequently. The best thing is to put the sick person in a separate room to sleep, preventing the spread of germs as well as preserving your precious sleep. If you must share the same bed, wash your sheets frequently in hot water. It even helps to wash just the pillowcases every few days, Forte says. Bath towels should be washed every day or two. 

• Consider disposables. Paper towels and paper cups can be your friends when germs are an issue. Give the sick person a roll of paper towels to use when washing hands in the bathroom, instead of using a communal towel. There is usually a lot of water-drinking and pill-taking, so instead of having to wash glasses in hot water, switch to paper for the duration of the illness. If you are washing the sick individual’s plates or flatware in your dishwasher, select a sanitizing cycle if that is an option on your model, as it bumps up the temperature of the final rinse. 

• Clean your humidifier. Humidifiers help soothe sinuses and nasal passages. But if you are using your humidifier daily to make your patient feel better, you should empty the tank daily and then wipe it down until it’s dry. Clean it thoroughly at least weekly, following the directions provided for your particular model. “You don’t want germs breeding in there and spewing out into the room,” Forte says. 

• Keep the remotes wiped off. Flu sufferers are likely to spend long hours on the couch sniffling and feeling sorry for themselves, clicking through Netflix and HBO offerings. So all those remotes will be covered in germs. Keep a container of antibacterial wipes around so you can clean the remotes daily; clean light switches and doorknobs with them, too. Put a small wastebasket in the TV room with a plastic liner for all the wet tissues and used wipes, and empty it once or twice a day.

— Jura Koncius, The Washington Post 

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Kentucky’s New Idea for Medicaid Access: Pass Health Literacy Course


Supported by

The New Health Care

A lot of people could do with a little more health and financial literacy, not just Medicaid recipients. But linking it to retaining medical eligibility may not make sense.


Jan. 22, 2018

Matt Bevin, the governor of Kentucky, with President Trump last week in Washington. Kentucky is the first state to win approval from the Trump administration to impose a work requirement on many Medicaid recipients.CreditCarolyn Kaster/Associated Press

If you’re on Medicaid in Kentucky and are kicked off the rolls for failing to meet the state’s new work requirements, Kentucky will be offering a novel way to reactivate your medical coverage: a health or financial literacy course you must pass.

The precise content of the courses is not yet worked out but may include instruction on household budgeting, opening a checking account, weight management and chronic disease management, said Kristi Putnam, a manager with Kentucky Health, the new state Medicaid program that includes work requirements. She said quizzes would be included that people must pass to complete the course.

Kentucky says the courses, along with the bigger elements of the recently approved waiver it received from federal Medicaid rules, will help to “empower individuals to improve their health.”

The courses are just one way people subject to and failing to meet work requirements could regain coverage. But some health policy experts express dismay with the approach. For one thing, many Americans, not just those who seek Medicaid, struggle with health and financial literacy. And to some, literacy quizzes — however well intentioned — evoke the tests used to impede voting registration of black Americans in the Jim Crow South.

“Requiring people to pass a health literacy course to get care — care for conditions that might prevent them from passing — is just expensive, punitive and cruel,” said Atul Gawande, a surgeon and a health care researcher with the Harvard T.H. Chan School of Public Health. “It serves no health benefit whatsoever. You have to be concerned about requirements like literacy tests, which states have a bad history of applying selectively and arbitrarily.”

Ms. Putnam said the courses were “intended to be a tool/support for people to improve both health and finances, and not a barrier in any way.” Her agency, she said, is looking into ways to provide help to people who might struggle with understanding the courses.

There is no standard definition for health literacy. Ms. Putnam said Kentucky’s “pertains to learning about healthy habits, how to manage chronic conditions, effectively utilizing health care benefits and understanding commercial market insurance concepts.”

However defined, health literacy is related to literacy and numeracy more generally. To understand and use health-related information, you need some fluency with written or spoken language, and usually with numbers and basic math as well. People with low skills in other forms of literacy or numeracy also have lower health literacy.

Apart from instruction aimed at specific populations with certain conditions — such as training to self-manage chronic diseases like diabetes and hypertension, or even birth training classes for pregnant women and their partners — health literacy courses are uncommon. (Say Ah! is one source for health literacy resources.)

Financial literacy courses are more widely available but still not a routine part of general education.

“If these topics are taught at all in primary education, they certainly aren’t addressed consistently or in an evidence-based way,” said Harold Pollack, a professor at the University of Chicago who was a co-author of a book on basic financial education. “But singling out the Medicaid population for classes as a condition for access to insurance suggests that shrinking and stigmatizing the program, not literacy, is the goal.”

Numerous studies document the widespread need for greater health and financial literacy. By one estimate, one-third of adults have health literacy deficits. For example, most people make errors in selecting health plans and don’t know basic features of the plans they choose.

The last large national survey of U.S. adult literacy (including health literacy) was conducted in 2003. One study found that 60 percent of Medicaid enrollees had only “basic” or “below basic” health literacy, meaning, for example, they could not recognize a medical appointment on a hospital appointment form (below basic) or would have trouble understanding why a specific test was recommended for someone with certain symptoms, even when given a clearly written and accurate explanation (basic).

But Medicaid enrollees are not the only ones. Nearly the same proportion of Medicare enrollees also had basic or below basic health literacy. Privately insured people scored better. They are typically younger than Medicare enrollees, and they typically have higher education levels and are less likely to have cognitive impairments than those with public coverage. However, only a small minority even of the privately insured had a “proficient” level of health literacy — meaning, for example, that they could deduce the employee share of health insurance costs from a table that listed that cost as a function of income and family size.

Another study, based on data collected in 2013, showed adults’ blood test results alongside the normal range (typical of reports many of us receive from our doctors after blood tests). Only about half of the subjects could recognize if the blood glucose level indicated on the test was outside the normal range. Of those with diabetes — to whom blood glucose measurement and levels should be familiar given the importance to their condition — only 56 percent could identify out-of-range values.

Poor health literacy is associated with worse health care outcomes and higher health care spending. But causality could run both ways. It is likely that people in greater need of health care are also less likely to have high literacy skills in general. It’s also possible that poor health literacy contributes to worse self-management of health and lifestyle issues that could result in worsening health and increased health care use.

Likewise, low financial literacy can contribute to insufficient or inefficient saving. One national survey found that only 14 percent of respondents got all the answers right on a five-question quiz about financial topics like interest rates, inflation, bond prices and mortgages. Only 37 percent got four out of five. (As an example of its difficulty, the true/false mortgage question was: “A 15-year mortgage typically requires higher monthly payments than a 30-year mortgage, but the total interest paid over the life of the loan will be less.”)

Other research documents high rates of errors in financial decision making even among highly educated people, including mistakes made in 401(k) investing, selection of mutual funds, use of credit, receipt of payday loans and others.

Addressing these issues through financial literacy education improves financial outcomes. A recent review of financial literacy research found that providing financial literacy education in school settings is effective. So is the approach of targeting education during teachable moments, as when individuals are making financial decisions: taking out a loan, establishing a saving plan, and the like. The Kentucky program would do neither.

Though policy experts are divided on the merits of Kentucky’s health and financial literacy program, they may at least be in agreement that education in both needs improvement. That’s true not just for would-be Medicaid enrollees, but for many of the rest of us, too.


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