Health Literacy

The field of inquiry known as health literacy now represents a robust area of research in public health and medicine and is expanding into oral health and mental health. More than 1,000 published studies, multiple annual national conferences, white papers, and reports from prestigious government agencies and academies have put health literacy on the national agenda. For example, Surgeon General Richard Carmona noted, in 2004, that ‘health literacy is the currency for everything I do.’ Health literacy is considered a critical issue for consideration in analyses of health disparities and for all health-related communications. This entry focuses on definitions and measures of health literacy, as well as on links between health, health literacy, and other factors such as socioeconomic status and education.

Reports from the U.S. Department of Health and Human Services (DHHS) (2003) and the Institute of Medicine (IOM) use the following definition of health literacy: ‘The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions’ (U.S. DHHS, 2003, p. 42).

At the same time, however, both the DHHS report Communicating Health: Priorities and Strategies for[Page 483]Progress and the IOM report Health Literacy: A Prescription to End Confusion propose an expanded conceptualization of the term so that both the skills of individuals and the demands of health systems be considered. Thus, the Committee on Health Literacy proposes in the IOM report that health literacy ‘occurs when the expectations, preferences, and skills of individuals seeking health information and services meet the expectations, preferences, and skills of the people providing health information and services’ (IOM, 2004, p. 2).

Unfortunately, well over 600 studies that focused on assessments of health materials and published in medical and public health journals have established a clear mismatch between the reading level of health materials and the reading skills of U.S. adults. National and international studies indicate that health systems are becoming increasingly complex in industrialized nations and require more of health care consumers than ever before.

Literacy and Health Outcomes, an analysis commissioned by the Agency for Healthcare Research and Quality (AHRQ, 2004), indicates that research findings have established a link between reading skills of patients and health outcomes. A number of research studies indicate that those with poor reading skills know less about their disease, medicine, or regimen and are less likely to engage in many healthful behaviors. In addition, studies indicated that those with poor reading skills are more likely to be hospitalized, have increased levels of depression and/or other mental health issues, and have increased rates of cervical cancer than do patients with strong reading skills. Furthermore, studies of diabetic patients found that those with poor reading skills are more likely to have diminished anticoagulation control or lower glycemic control. The AHRQ report concludes that the body of research accumulating over the past three decades offers substantive evidence of an association between reading skills of patients and a variety of health outcomes.