Health Literacy in America Remains an Issue

November 24, 2014|9:36 a.m.| Jane Esworthy

Health literacy remains a major issue in the United States, resulting in increased rates of hospitalization and emergency care use, as well as lower rates of recommended screenings and vaccinations. HRSA defines health literacy as "the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness." In 2003, the National Assessment of Adult Literacy found that 14 percent of U.S. adults had poor health literacy, and only 12 percent had proficient health literacy. Although low health literacy impacts the wellbeing of Americans across all ages, races, incomes, and education levels, it particularly affects older adults, minority populations, medically underserved individuals, and low-income communities.

Moreover, social determinants of health-such as economic stability, education, access, and social support-affect people's ability to seek, understand, and use health information. According to CDC, more than 75 percent of healthcare costs in the United States are due to chronic conditions, many of which are preventable. People with low health literacy may have issues finding providers and services, understanding directions on medicine, and managing and preventing health conditions.People with low health literacy may have issues finding providers and services, understanding directions on medicine, and managing and preventing health conditions. Additionally, English language proficiency and general adult literacy issues can complicate the low health literacy problem.

Improving education levels and eliminating barriers to health services and care can improve health literacy and prevent its many repercussions. Some tools to increase health literacy include expanding access to health interpreter services, providers developing cultural competency, and public health professionals and the healthcare and public health systems designing health communications materials that can meet a variety of audiences' needs.

Public health and healthcare professionals also need to always use common terminology and present clear messages in their communication materials. The CDC resource Simply Put: A guide for creating easy-to-understand materials helps health educators translate complicated scientific and technical information into communication materials that audiences can relate to and understand. Additionally, the Harvard School of Public Health's Health Literacy Studies program is involved in research efforts focused on communication and literacy skills, specifically related to literacy-related barriers to a variety of health services and care.

Many state health departments are partnering with organizations to address health equity issues related to health literacy in their states, such as the Arkansas Department of Health (ADH). In 2013, ADH released its state health assessment and improvement plan "Arkansas's Big Health Problems and How We Plan to Solve Them." The report reveals that short life expectancy, high infant mortality, and low health literacy are priority health issues in the state. An estimated 820,000 adults in Arkansas have low health literacy, which is 37 percent of the adult population. Arkansas has a high portion of people in groups that are more likely to have low health literacy, including people aged 65 and older, blacks and other minorities, people with less than a high school education, people living in rural areas, and people living in poverty.

ADH is focusing on health literacy for children through its Reach Out and Read program, which encourages doctors to give books to families of young children at well-child visits. There are 30 Reach Out and Read programs in Arkansas that reach about 40,000 children with books and early literacy advice. ADH is also working with Arkansas Literacy Councils to expand literacy councils to counties in Arkansas without services and provide training in the use of Florida's Staying Healthy curriculum. The Arkansas Literacy Councils is a non-profit organization that supports county-level literacy councils for adults in over 60 Arkansas counties, offering tutoring for reading, writing, and speaking.

CDC has compiled the following list of state and local collaborations with academic, government, and nonprofit organizations with a health literacy focus.

Arizona Health Literacy Coalition

Partnership for Health Literacy in Arkansas

Indiana Center for Intercultural Communication

Health Literacy Kansas

Health Literacy Kentucky

Minnesota Health Literacy Partnership

Health Literacy Missouri

Health Literacy Nebraska


New York
Literacy Assistance Center Health Literacy Initiative

North Carolina
North Carolina Health Literacy Council

North Carolina Program on Health Literacy

Collaborative for Clear Health Communication

Oklahoma Health Equity Campaign

Regional Health Literacy Coalition

San Antonio Health Literacy Initiative

Health Literacy Wisconsin

To learn more about health equity issues, visit ASTHO's Health Equity page.