When we think of the United States, certain images come to mind like strength, independence, wealth and good quality of living. Despite the many positive characteristics, we have a significant health literacy problem in our country. Some studies report that 9 out of 10 adults lack health literacy skills required to manage their own health and prevent illnesses from developing. Can it truly be that only 10-12% of adults have these skills? If we break such health literacy skills down into specific actions such as understanding instructions on prescribed medications, care instructions after a physician’s appointment or recent hospitalization, understanding consent forms, navigating a complex health care system, and distinguishing valid health information from unreliable information found online, then maybe that statistic is sadly true.
Defining Health Literacy
First and foremost, there appears to be no single, agreed-upon definition of health literacy. Healthy People 2020 defines it as the “capacity to obtain, communicate, process, and understand basic health information and services”. The World Health Organization (WHO) defines it somewhat differently and states that health literacy is “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health”. And the American Medical Association (AMA) defines it as “a constellation of skills, including the ability to perform basic reading and numerical tasks required to function in the health care environment”. Each definition gives a slightly different perspective, so which is best? No one agrees.
What are Health Literacy Capacity and Skills?
Each definition alludes to the individual’s capacity and skills, but what exactly are they and why are they important? Capacity refers to the potential a person has to do or accomplish something. What can be accomplished? Finishing a prescription medication in its entirety, exercising on a routine basis, going to therapy as scheduled, and following a prescribed and therapeutic diet for diabetes are some examples. Skills, on the other hand, are used by people to realize their potential in health situations. They apply such skills to make sense of health information and services. In other words, if I am diagnosed with hypertension and need to exercise more, reduce sodium in my diet, eat cleaner and heart healthier, I understand that my actions do make a difference and I can improve my condition instead of worsening it.
Both capacity and skills are equally important. People who possess them are better able to understand and manage their health care. Low health literacy is associated with many negative outcomes including poorer health and decline as well as higher health care costs. Having the potential to accomplish a health-related act and having the ability to realize potentially positive or negative outcomes are both necessary for a healthy life.
Reading Levels Matter
Did you know that many newspapers around the country are written between a 5th to 8th grade reading level? Some may be written at a higher grade level of 10th or 11th grade. Why is this? So the majority of Americans can purchase and read newspapers. Here are some facts – 1 in 5 American adults reads at a 5th grade level or below and the average American reads at an 8th to 9th grade level. But here is the problem: most written health care materials are written above the 10th or 11th grade levels. This produces a fairly wide gap in ability to read and understand health care information.
Final Words
We have a health care literacy crisis in our country, but when is the past time you heard about it on the news, on a commercial or anywhere else? Limited health literacy increases the already existing disparity in health access among segments of our population and specifically among vulnerable groups including the elderly and minorities. The worse the literacy, the poorer the health outcomes and quality of life for millions of Americans. In a country as great as ours, why does this exist and how long will it plague both our citizens and health care system?