Surgeon General's Workshop on Improving Health Literacy
Executive Summary
On September 7, 2006, Acting Surgeon General Kenneth Moritsugu held a
Surgeon General's Workshop on Improving Health Literacy. The goal of the
workshop was to present the state of the science in the field of health
literacy from a variety of perspectives, including those of health care
organizations and providers, the research community, and educators. During the
course of the one-day workshop, participants identified the public health
consequences of limited health literacy and established an evidence base for
taking action.
Limited Health Literacy: A Public Health Problem
People make choices about their health everyday, such as what they eat
or how they exercise. In order to stay healthy, Americans must know how to read
the labels on food and medicine, describe symptoms, or use a map to locate the
closest health center. The ability to read, understand, and act on health
information is called health literacy.
Health literacy impacts Americans of all ages, races, incomes, and
education levels. It affects our ability to search for and use health
information, adopt healthy behaviors, and act on important public health
alerts.
Workshop Highlights
The Surgeon General's Workshop on Improving Health Literacy was divided
into three expert panels. Key findings from each panel are summarized
below.
Panel 1: Health Literacy, Literacy, and Health Outcomes
- According to the National Assessment of Adult Literacy, only 12% of
Americans have proficient health literacy skills. The majority of adults may
have difficultly completing routine health tasks like understanding a drug
label or vaccination table.
- There is a strong, independent association between health literacy
and health outcomes. These outcomes include emergency department use,
hospitalization, self-reported physical health, and mortality.
- In order to understand and improve health literacy, we must examine
both sides of the issue: 1) the demands of our health care system; and 2) the
skills of individuals who use it.
- Communication characteristics of the health care system such
as lack of time and reliance on only written or verbal communication
contribute to poor health care, particularly for those with limited literacy.
There is growing research to suggest that restructuring the health care system
may improve the reach and effectiveness of care for persons with limited health
literacy.
- Interventions to mitigate the effects of low literacy in patients
with chronic conditions have been shown to improve health outcomes. In some
cases, the interventions appear to be more effective for low literacy users
compared with higher literacy users.
Panel 2: Meeting the Health Literacy Needs of Special Populations
- To ensure that improvements in health literacy result in improved
quality of life and reductions in health disparities, we must marry health
literacy improvement with appropriate access to recommended health care.
- Quality of care is compromised when patients with limited English
proficiency do not have access to interpreters or use untrained, ad hoc
interpreters such as children.
- Much of today's health information exceeds the cognitive capabilities
of older adults, even those who are well-educated. Older adults have particular
problems with medical issues when they must assimilate new information or make
complex decisions about treatments.
- Despite large gaps in their understanding, research strongly suggests
that children of all ages have the potential to understand a great deal about
health and about how to access health information.
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Panel 3: Toward an Informed and Engaged Public
- The ability to understand health information is dependent on multiple
factors, including: difficulty of the information; skill of the user; and
motivation of the user. Even when people have a high degree of skill, they may
not expend the effort necessary to understand written text. For people with
lower literacy skills, increased motivation can lead to greater
understanding.
- Health literacy, like any competency, is a continuum. A health
literate person is able to use health concepts and information generatively
applying information to novel situations. This is critical to our
efforts to prepare the public to react to complex public health
emergencies.
- Simply increasing the volume of health information will not improve
health literacy. Information must be adapted to the following elements of
communication: source, message, channel, and receiver.
- There is strong evidence that participatory or user-centered design
improves communication for the participant groups, including persons with low
health literacy. Communication designed by and for persons with low health
literacy is often preferred by all readers since it is written in a clear and
concise style.
Conclusions
Based on the evidence presented at the workshop, Acting Surgeon General
Moritsugu made the following conclusions:
- First, public health professionals must provide clear,
understandable, science-based health information to the American people. In the
absence of clear communication and access to services, we cannot expect people
to adopt the health behaviors we champion.
- Second, the promises of medical research, health information
technology, and advances in health care delivery cannot be realized without
also addressing health literacy.
- Third, we need to look at health literacy in the context of large
systems social systems, cultural systems, education systems, and the
public health system. Limited health literacy is not an individual deficit but
a systematic problem that should be addressed by ensuring that health care and
health information systems are aligned with the needs of the public.
- Lastly, more research is needed, but there is already enough good
information that we can use to make practical improvements in health literacy.
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Last revised: December 11, 2007