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Slides 21–40

Health Literacy

Slide Number Title and Content

Nonliterate in English

Nonliterate in English Below Basic in Health Literacy
Language Barriers Simple Questions
2% (4 Million) 3% (7 Million) 10%
11 Million  
  30 Million

Source: National Center for Education Statistics, Institute for Education Sciences


Difficulty of Selected Health Literacy Tasks


Below Basic

Circle the date of a medical appointment on a hospital appointment slip. (101)
Give two reasons a person should be tested for a specific disease, based on information in a clearly written pamphlet. (202)
Average score: 245 ---->  
Determine what time a person can take a prescription medication, based on information on the drug label that relates the timing of medication to eating. (253)
Calculate an employee's share of health insurance costs for a year, using a table. (382)

Source: National Center for Education Statistics, Institute for Education Sciences


Percentage of Adults in the Below Basic Health Literacy NAAL Population: 2003


Percent in
Below Basic population

Percent in total

Did not graduate from high school 51 15
Did not speak English before starting school 39 13
Adults reporting poor health 10 4
Hispanic adults 35 12
Age 65+ 31 15
No medical insurance 36 18
Did not obtain health information over the Internet1 80 43
Black adults 19 12
One or more disabilities2 48 30

1 The "Did not obtain health information over the Internet" category does not include prison inmates.
2 Disabilities include vision, hearing, learning disability, and other health problems.

Source: U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics, 2003 National Assessment of Adult Literacy (NAAL)


Percentage of Adults in Each Literacy Level, by Self-Assessment of Overall Health: 2003

  Percent Below Basic Percent Basic and above
Below Basic Basic Intermediate Proficient
 Poor 42 27 29 3
 Fair 33 30 34 3
 Good 16 27 51 6
 Very good  9 19 59 13
 Excellent 8 17 57 19

Source: U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics, 2003 National Assessment of Adult Literacy


Sources of Health Information

Percentage of adults with Below Basic or Basic health literacy who get little or no health information from the following sources:

Source Below Basic Basic
Internet 85% 70%
Magazines 64% 47%
Books or Brochures 62% 45%
Newspapers 59% 51%
Family or Friends 47% 40%
Healthcare Providers 35% 30%
Radio or TV 33% 29%

Source: National Center for Education Statistics, Institute for Education Sciences


The Bottom Line

  • Only 12 percent of adults have Proficient health literacy. In other words, nearly 9 out of 10 adults may lack the skills needed to manage their health and prevent disease.

  • Fourteen percent of adults (30 million people) have Below Basic health literacy. These adults are more likely to report their health as poor (42 percent) and are more likely to lack health insurance (28 percent) than adults with Proficient health literacy.


Measuring Health Literacy

Measures of health literacy at the individual level were developed in the 1990s:

  • Rapid Estimate of Adult Literacy in Medicine (REALM)
  • Test of Functional Health Literacy in Adults (TOFHLA and S-TOFHLA)

Measuring Health Literacy

  • Health literacy measures based on functional literacy do not capture the full range of skills needed for health literacy.
  • Current assessment tools (for populations and individuals) cannot differentiate among:
    • Reading ability
    • Lack of health-related background knowledge
    • Lack of familiarity with language and materials
    • Cultural differences in approaches to health.

Who Is at Risk?

  • The problem of limited health literacy is greater among:
    • Older adults
    • Those who are poor
    • People with limited education
    • Minority populations
    • Persons with limited English proficiency (LEP)

Who Is at Risk?

  • Many of the same populations at risk for limited health literacy also suffer from disparities in health status, illness (including heart disease, diabetes, obesity, HIV/AIDS, oral disease, cancer deaths, and low birth weight), and death.

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Health Literacy: Use of Preventive Services

Persons with limited health literacy skills* are more likely to skip preventive measures such as:

  • Mammograms
  • Pap smears
  • Flu shots

*As defined by these studies


Health Literacy: Knowledge About Medical Conditions and Treatment

Persons with limited health literacy skills:

  • Are more likely to have chronic conditions and less likely to manage them effectively.
  • Have less knowledge of their illness (e.g., diabetes, asthma, HIV/AIDS, high blood pressure) and its management.

Health Literacy: Hospitalization and Health Status

Persons with limited health literacy skills:

  • Experience more preventable hospital visits and admissions.
  • Are significantly more likely to report their health as "poor."

Health Literacy: Healthcare Costs

  • Predicted inpatient spending for persons with inadequate health literacy (measured by the S-TOFHLA) was $993 higher than that of persons with adequate health literacy.
  • An earlier analysis found that the additional healthcare resources attributable to inadequate health literacy were $29 billion (assuming that inadequate literacy was equivalent to inadequate health literacy):
    • This number would have grown to $69 billion if even one-half of marginally literate adults were also considered not health literate.

Health Literacy at HHS


Commitment to Health Literacy

  • Secretary Leavitt: Prevention and health information technology (IT) are two big priorities for the healthcare system.
  • Secretary Thompson's Workgroup on Health Literacy
    • Prevention: A Blueprint for Action
      "It is critical that individuals have access to health information in a way they can understand and make appropriate health decisions."

Office of the Surgeon General

  • Health literacy improvement is one of the Surgeon General's seven public health priorities.
  • "Health literacy is the currency of success for everything I am doing as the Surgeon General."
    • —Dr. Richard Carmona in his speech to the AMA
          House of Delegates, June 2003.


Healthy People 2010 Health Communication Objectives

  • 11-1. Internet access in the home
  • 11-2. Health literacy
  • 11-3. Research and evaluation of health communication programs
  • 11-4. Quality of Internet health Web sites
  • 11-5. Centers of Excellence in health communication
  • 11-6. Provider-patient communication

Healthy People 2010 Health Literacy Objectives

11-2. Improve the health literacy of persons with inadequate or marginal literacy skills.

11-6. Increase the proportion of persons who report that their healthcare providers have satisfactory communication skills.



  • NIH program announcement: Understanding and Promoting Health Literacy
    • Three annual submission dates 2004–2006
    • Thirteen sponsoring institutes and offices with AHRQ
    • NIH spending in FY05 for these grants is close to $3 million, and it will total more than $8 million during the life of the awarded grants.
  • HRSA provides funding to community-based organizations for health literacy activities and research.

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