As a transplant specialist, I am very concerned with the question of how we can increase health literacy in society. Which paths lead to better health? I am currently trying to promote this topic in cooperation with my municipality, the city of Essen (Germany). This is not only a matter for hospitals and primary care providers, but also for cities that are trying to do something for their population. And that must be the goal here: to improve health and not just cure illnesses, or, in other words, to "repair" people. That's why I came up with the hashtag ‘repair medicine’; we have to get away from that mindset.
By the time patients come to the doctor, many opportunities for a healthy life have often already been missed. We need to do much more to prevent illness and work more on staying healthy.
One idea in the city of Essen is that of the "intercultural health guides". I have been involved in this since we sat down to discuss how we can promote organ donation. Health guides are people who are trained in a range of very different topics - depending on their needs, education and interests. They are not doctors, but mostly social workers and other people from the health care sector.
They can be commissioned by associations, institutions, companies and businesses on a fee basis to educate and train people. They also give lectures and workshops. We will also train health guides on the topic of organ donation. Otherwise, we would simply reach our limits in effectively educating 65 million people about organ donation.
The figure given is based on the fact that we would provide information from the age of 13 or 14 at the earliest. From the age of 14, people can decide for or against organ donation, and that's when education can start. Everyone should be educated on the subject – and not just once. After a lecture or a Q&A session, people have not yet made a clear decision. It takes more time and expertise. So we need to find more multipliers.
And organ donation is just one topic among many. It is also about nutrition, vaccinations, sports, and much more, where everyone's expertise is needed. It is obvious that not only doctors can do this. They are often overburdened anyway and in many places there is even a shortage of doctors.
Prevention and health literacy are not currently rewarded in medicine. There is no money for it. That's disastrous. So how do you deal with it when it's not paid for? Do you just let it go? Do you exploit yourself more? What is the right way? That's where I see the opportunity for intercultural medicine. We need to find out how we can get different groups of people interested in education and how we can reach as many as possible, including healthy people who want to stay healthy.
Maybe cooking classes and sports should be included. Maybe we need to go to playgrounds where we can meet mothers and children? I want us to reach everyone and cast our net as wide as possible to attract their interest and attention. Why aren't we working with pharmacists yet? They are trusted, have a great deal of expertise, and are consulted anyway – even if someone comes from the doctor, they are happy to check with the pharmacist again.
What I mean to say is that we, as doctors, have to take an innovative and creative approach to educating people about health literacy. We have to involve all medical professions if we want to get away from repair medicine. And I think that is what a great many people very much want.
Of course, education and prevention in medicine should be paid for! In the long term, you can't do it for free and at some point, politicians will understand that. But we can't wait until there is money. Since the tendency is rather one of austerity, prevention will not be the next thing to be adequately paid for. Unfortunately, it is also the case that after good prevention and education, it is not so easy to say what the result is. We just don't see a prevented illness. If I start with my children today, I will probably only see the benefits in five legislative periods. And very few politicians think in such long terms. That means that unfortunately prevention is of no use politically.
I think sometimes you have to take the initiative – especially in medicine. It's a process that takes time. And doing nothing in the meantime is not an option for me. We need a long breath. So we have to take matters into our own hands and get many people on board, such as our health guides, pharmacists and medical supply stores. And all together, we have to think outside the box to see where we can all work together, hand in hand, to promote health literacy.
Dr Ebru Yildiz has been Head of the West German Centre for Organ Transplantation (In German: Westdeutsche Zentrum für Organtransplantation) in Essen since 2019. While a specialist in internal medicine and nephrology, she has additional training in transplant medicine and internal intensive care medicine.