Health illiteracy: an issue politicians are unwilling to tackle

There is a form of illiteracy that is not discussed nearly enough: health illiteracy. It does not simply mean not knowing the name of a disease or failing to understand a medical report. Above all, it means lacking the basic tools to distinguish scientific evidence from opinion, a real risk from a myth, and a public health recommendation from so-called "individual freedom". And the price of this ignorance is not paid solely by those who fall victim to it. We all pay it.

Failing to get vaccinated when a vaccination is recommended, skipping cancer screening, smoking, abusing alcohol, and leading a completely sedentary lifestyle: these are behaviours that can increase the risk of disease and, on a collective scale, add to the burden of chronic conditions on the healthcare system. The World Health Organisation identifies tobacco, harmful use of alcohol and physical inactivity as some of the main modifiable risk factors for cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. It emphasises that preventing these conditions not only saves lives but also reduces economic costs and the pressure on healthcare systems.

Even something as seemingly simple as being more active has enormous consequences. The WHO estimates that, if physical inactivity is not reduced, its cost to global healthcare systems could reach around 300 billion dollars between 2020 and 2030.

This should be one of the cornerstones of any serious policy: prevention is not a luxury; it is one of the most sensible forms of public investment.

Yet prevention is often the first casualty of health illiteracy. Cancer is only tackled once it has already developed, rather than attempting to detect it early through appropriate screening programmes. Vaccination is turned into an ideological issue rather than being assessed on the basis of the available evidence. Smoking is regarded as merely a personal habit, whilst overlooking the fact that its prevalence has enormous health and economic consequences. Alcohol is often excluded from discussions about risks because it is culturally accepted.

The issue, of course, is not to place the blame on individual citizens. People do not choose their health status in a vacuum: factors such as income, education, the environment in which they live, and the practical possibility of accessing treatment and preventative care all play a part, as do commercial and social pressures. This is precisely why the role of politics is crucial: to create the conditions that make healthy behaviours easier and more accessible, rather than merely criticising those who are unable to adopt them.

Then there is a second, even more worrying level: scientific illiteracy.

We saw this during and after the pandemic, when part of the public debate turned scientists, epidemiologists and scientific institutions into political targets. A prime example is that of Anthony Fauci. One can certainly debate his decisions, the strategies adopted during the pandemic, his public communications and any mistakes he may have made: science is not infallible, and no scientist should be exempt from critical scrutiny.

But it is one thing to offer evidence-based criticism; it is quite another to turn a scientist into a political enemy simply because his conclusions have become inconvenient.

Fauci is not simply ‘a TV doctor’. He served as Director of the National Institute of Allergy and Infectious Diseases from 1984 to 2022, led research programmes on HIV/AIDS, tuberculosis, malaria, Ebola, Zika and other infectious diseases, and is a member of the National Academy of Sciences and the National Academy of Medicine. He has also been awarded the Presidential Medal of Freedom.

This does not mean that Fauci has always been right. It means that his scientific track record should demand a serious approach to judgement – neither adulation nor demonisation. Science is not defended by turning scientists into saints; it is defended by demanding evidence, method, transparency and the ability to correct errors. And this is where the issue becomes political.

A democracy needs informed citizens. A citizen who understands the difference between correlation and causation, who knows what relative risk means, who understands why screening programmes exist, who can critically evaluate scientific research and who can distinguish an expert from a charlatan is much harder to manipulate.

On the contrary, a fearful, misinformed electorate lacking the tools to assess the evidence is extraordinarily vulnerable to propaganda.

It is therefore legitimate to question a policy that chooses to fuel mistrust of science rather than invest in scientific and health education. And it would be wrong to turn this criticism into a blanket accusation against "the right" as a whole: there are different positions and perspectives within all political camps. But it is equally legitimate to speak out when, particularly in certain sections of the political and populist right, mistrust of experts, scientific institutions and public health is used as a tool for electoral mobilisation. Because governing an informed public is more difficult.

We must explain the data. We must acknowledge mistakes. We must account for our decisions. We must consult with independent experts. We must invest in education and prevention. We must tell the public that certain choices have consequences not only for individuals, but for the community as a whole.

It is much easier, however, to construct an enemy: the ‘regime-aligned’ doctor, the scientist ‘enslaved by Big Pharma’, the ‘corrupt’ researcher, the ‘imposed’ vaccine, the healthcare institution ‘that wants to control us’. It is a politically effective narrative because it transforms complex issues into simplistic stories, with good guys and bad guys, victims and persecutors. But reality does not work like that. A public health system cannot survive on hospitals, A&E departments, expensive medicines and increasingly complex treatments alone. It needs citizens who are empowered to prevent diseases, recognise them at an early stage and make decisions based on the best available evidence.

The alternative is to continue spending enormous resources on treating conditions that, at least in part, we could have prevented. The WHO emphasises precisely that early intervention in non-communicable diseases can reduce the need for more expensive treatments and represent economically beneficial investments. True freedom, then, is not freedom from scientific evidence. It is the freedom to know.

And a society in which scientific knowledge is devalued, prevention is mocked and experts are automatically treated as enemies is not a freer society. It is a more fragile, more costly and, above all, more easily manipulated society.

Defending public healthcare also means defending scientific culture. Because whenever ignorance about health takes precedence over evidence, the bill eventually comes due: in people’s lives, in hospitals and in the state’s coffers.