Health Literacy

What is Health Literacy?

A common definition of health literacy is the “degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”1 According to a 2004 Institute of Medicine report, it is important to note that health literacy is contextual—it depends both on the individual’s skills and the cultural, social, and economic environment in which the individual lives.1

Broader perspectives of health literacy

Over the years, our definitions and understanding of health literacy have expanded significantly. Researchers have moved away from focusing on the individual to examining the role of our complex health care system.2 This includes examining the communication systems and skills demonstrated by health brokers such as insurance and advocacy groups, as well as government, non-profit, and clinical care organizations.

Other researchers suggest that the field of health literacy recognize the cognitive abilities that underlie basic reading skills, leading to a “health learning capacity.”3 These abilities may include attention span, information processing speed, short- and long-term memory capabilities, and reasoning.3

As the field continues to develop, the term “health literacy” will keep evolving. However, it is clear that limited health literacy skills will continue to have a major impact on individuals’ lives and the health of the nation.

Mismatch between our health literacy skills and the demands of taking care of our health

Hundreds of studies show the dramatic gap between the demands of our health care system and an individual’s ability to meet these demands. We are expected to choose and use insurance plans and navigate complex care systems. To stay healthy and prevent disease, we need skills and competencies that enable us to read food labels, understand medicine warning labels, go for annual check-ups and interpret test results. If we have a condition such as diabetes, we may see many doctors and have to follow multiple instructions to manage our health.

The only large-scale study of health literacy in the U.S. recorded four levels of health literacy competency: Below Basic, Basic, Intermediate, and Proficient.4 This study found only 12% of adults demonstrated Proficient health literacy skills. Seniors, who use the most health services, demonstrated the lowest levels of health literacy with just 3% able to complete tasks at a Proficient level. A more recent study, The Program for the International Assessment of Adult Competencies (PIAAC), reported that U.S. adults had poor numeracy skills when compared to adults in other developed countries. The study did not specifically measure health literacy, but rather how well adults in countries around the world demonstrated the literacy and numeracy skills needed to participate fully in society. The PIAAC data is relevant to measures of health literacy skills because numeracy skills are a key factor in understanding and managing health information.5

Health information is hard to read and understand

The difficulty and complexity of most print and web-based health information poses additional barriers. Health information is often written at a level that is too high for most people to read and understand and includes unfamiliar health terms and concepts. To understand and use health information, Below Basic and Basic health literacy skills are definitely not adequate and Intermediate skills may not suffice.

Health literacy affects everyone

Research shows that adults with Basic or Below Basic health literacy skills pay a high price in terms of poorer health. But, even adults with Intermediate or Proficient skills find themselves overwhelmed in the health care system when fear, stress, fatigue, or illness impairs their usual abilities.

The need to act

Demographic trends highlight the need to prioritize health literacy as a core policy issue in health care and public health. Groups growing most rapidly in the United States, including seniors and Hispanic/Latino populations, demonstrated the lowest literacy and health literacy skills on the National Assessment of Adult Literacy (NAAL).6

It’s time to act

Addressing the problem will require an ongoing commitment and efforts from multiple sectors of society. The education sector can work to improve health literacy skills in schools and non-formal adult education programs. Health and social service organizations can work to improve their communication methods and tools, as well as train their workforce to use them. They also can work to reduce the complexity of the forms and the processes needed to access services. Medical education and other health professions’ training programs can strive to better prepare the future health care workforce. The federal government and private foundations can develop model policies and fund research.

The cost of inaction

The cost of addressing these system challenges may be high, but the cost of doing nothing is even higher. As we retool health care to meet current challenges, let’s be sure that communication and navigation challenges receive high priority along with the resources needed to address them.


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  1. Nielsen-Bohlman L, Panzer A, Kindig D. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2004.
  2. Brach C, Keller D, Hernandez LM, et al. Ten Attributes of Health Literate Health Care Organizations. Washington, DC: The National Academies Press; 2012.
  3. Wolf M, Wilson E, Rapp D, et al. Literacy and learning in health care. Pediatrics. 2009;124(Supplement):S275-S281. doi:10.1542/peds.2009-1162C
  4. Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006–483). Washington, DC: National Center for Education Statistics; 2006. doi:10.1592/phco.
  5. Goodman M, Finnegan R, Mohadjer L, et al. Literacy, Numeracy, and Problem Solving in Technology-Rich Environments among U.S. Adults: Results from the Program for the International Assessment of Adult Competencies. Washington, D.C.: National Center for Education Statistics; 2012. doi:10.1787/9789264128859-en
  6. Kutner M, Greenberg E, Baer J. National Assessment of Adult Literacy (NAAL): A First Look at the Literacy of America’s Adults in the 21st Century (NCES 2006-470). Washington, DC: National Center for Education Statistics; 2005.