If you are involved with health promotion and disease prevention programs, health screening programs, health care and patient education or health policy – these data should shock you.
Fewer than 1 in 8 (12% ) American adults are proficient in health literacy skills. What this means is that approximately 191 million Americans cannot:
- Calculate an employee’s share of health insurance costs for a year, using a table that shows how the employee’s monthly cost varies depending on income and family size.
- Find the information required to define a medical term by searching through a complex document.
- Evaluate information to determine which legal document is applicable to a specific health care situation.
Almost half (47%) of adults cannot:
- Determine a healthy weight range for a person of a specified height, based on a graph that relates height and weight to body mass index (BMI).
- Find the age range during which children should receive a particular vaccine, using a chart that shows all the childhood vaccines and the ages children should receive them.
- Determine what time a person can take a prescription medication,based on information on the prescription drug label that relates the timing of medication to eating.
- Identify three substances that may interact with an over-the-counter drug to cause a side effect, using information on the over-the-counter drug label.
These skills all relate to a concept known as health literacy which is defined by the US Department of Health and Human Services and the Institute of Medicine as: The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
The IOM states that health literacy skills are needed for dialogue and discussion, reading health information, interpreting charts, making decisions about participating in research studies, using medical tools for personal or family health care—such as a peak flow meter or thermometer—calculating timing or dosage of medicine, or voting on health or environment issues. Earlier estimates of adults with low literacy skills had placed the figure at about 90 million.
In 2003, for the first time the National Assessment of Adult Literacy (NAAL) also included an assessment of health literacy among a random sample of over 19,000 American adults. This assessment involved having each adult complete tasks designed to measure their ability to handle everyday tasks associated with maintaining their heath and engaging with the health care system. Measures of prose, document and quantitative literacy skills were combined into an overall health literacy score.
Sponsored by the US Department of Education, the health literacy results of this massive household survey were quietly released in September (The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy).
- Women and men have about the same rates of health literacy proficiency (12% vs 11 %).
- Whites (14%) and Asian/Pacific Islanders (18%) have higher rates than Blacks (2%) or Hispanics (4%).
- Rates of proficiency peak among adults 25-39 years old (16%) and decline to 3% in adults 65 years and older.
- Health literacy is associated with education level, yet only 27% of people with a bachelor’s degree are assessed as being proficient.
A ‘basic’ level of health literacy proficiency is identified by tasks such as being able to give two reasons a person with no symptoms of a specific disease should be tested for the disease, based on information in a clearly written pamphlet.
People with self-rated poor or fair overall health were very likely to have ‘below basic’ health literacy skills (42% and 33% respectively). That is, they would not be able to perform the above task.
Between 27-30% of all persons with no health insurance or who received Medicaid or Medicare were assessed as having ‘below basic’ health literacy.
These are sobering statistics in a world where health information is becoming more complex, communication channels are heavily text oriented (37-41% of people with ‘below basic’ health literacy report getting none of their health information from books, brochures, newspapers or magazines and 80% get no health information from the Internet), and the health care system is placing more burdens and responsibilities on consumers as part of the consumer-directed health care movement.
The data should serve as a wake up call for people at all levels of the public health and health care enterprises who believe that a better educated person is a healthier and wiser one. The basic building blocks of health literacy skills are a prerequisite.
I am a member of the Health Communication Working Group for Healthy People 2010, and speaking only for myself, these data-based estimates are the first to document the size of the problem of health illiteracy in the US. They clearly point to the need for both broad-based and targeted programs designed to improve health literacy skills among adults.
The results of NAAL also point to an even greater need for attention by health communicators, patient educators, health care providers – indeed, throughout the entire healthcare system from worksite benefits managers to voluntary health organizations to medical researchers, to assess health literacy skills among their audiences and test their forms, education materials and other products (text, audio and video) for comprehension and ease-of-use among all of their client and patient populations.
Assume that all of your audiences and patients have problems with health literacy skills and you will probably be right 9 times out of 10.