What is Health Literacy?

Health literacy - the ability to read, understand and act on health information - is one of the least recognized yet most widespread challenges to achieving better health outcomes and lowering health care costs in the United States. By some accounts, low health literacy is estimated to cost the U.S. health care system more than $58 billion annually. Yet many health care providers, payers and policymakers remain largely unaware of the extent of the problem.

Health literacy involves more than a measurement of reading skills - it also relates to listening, speaking and conceptual knowledge. Low health literacy can affect any population segment, regardless of age, race, education or income, and cannot be detected by physical symptoms or examinations. Because health literacy is a hidden health care crisis arising from varying educational, social and cultural factors, it requires that diverse fields work together to fully penetrate and improve upon the issue.

Health literacy statistics:

• Nearly half of the U.S. adult population (90 million people) have low functional health literacy (National Adult Literacy Survey (NALS) data)
• 11 million adults are non-literate in English (2003 National Assessment of Adult Literacy (NAAL) data)
• 7.8 million seniors can only perform the most simple and concrete literacy skills (Below Basic) (2003 National Assessment of Adult Literacy (NAAL) data)

Literacy Levels of Adults in America: Sample of Tasks Typical of Level (NAAL)

Below Basic

• Searching a short, simple text to find out what a patient is allowed to drink before a medical test
• Signing a form
• Adding amounts on a deposit slip

Basic

• Finding in a pamphlet for prospective jurors an explanation of how people were selected for the juror process
• Using a television guide to find out what programs are on
• Comparing the ticket prices for two events

Intermediate

• Consulting reference materials to find out which foods contain a certain vitamin
• Identifying a specific location on a map
• Calculating the total cost of ordering office supplies from a catalog

Proficient

• Comparing viewpoints in two editorials
• Interpreting a table about blood pressure, age and physical activity
• Computing and comparing the cost per ounce of food items

The average reading level in the U.S. is 8th grade, and 20 percent read at the 5th grade level or below. (NALS data)

• 40 percent of seniors read at or below the 5th grade level (Doak, Doak, and Root)
• 50 percent of African Americans and Hispanics read at or below the 5th grade reading level (Center for Health Care Strategies)
• Most health-related material is written at the 10th grade reading level or higher (Institute of Medicine)
• Literacy skills are a stronger predictor of health status than age, income, employment status, education level or racial/ethnic group (Partnership for Clear Health Communication)

Literacy and Age: Percentage of Population Reading at Basic and Below Basic Levels

Overall Population	Age, 16-18	Age, 19-24	Age, 25-39	Age, 40-49	Age, 50-64	Age, 65+
43%	48%	40%	37%	38%	40%	61%

People with low functional health literacy have:

• Poorer health status
• Less treatment adherence and a greater number of medication/treatment errors
• Higher rates of health services utilization, including 29 - 69 percent higher hospitalization rates
• Higher health care costs:
• $50 - $73 billion in additional health expenditures annually
• $7,500 more in annual health care costs for a person with limited health literacy, versus a person with higher health literacy skills