What is Health Literacy?
Health literacy, as defined by Healthy People 2010, the
landmark document that tracks the progress of public health in
this decade in the United States, 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." The arenas or disciplines of health
literacy include all phases of communication theory and practice,
literacy theory and practice (reading, writing, visualization),
health education, cultural competency, public health, and
organizational and systems analysis. Health literacy extends to
the print, audio, and video materials, environments, and
challenges specifically associated with disease prevention and
- Patient-provider communication
- Health intake forms
- Medical instructions and medical compliance
- Health information and other resources
- Informed consent
- Using medical insurance forms
- Giving and taking patient/client histories
- Public health training
- And critically important for ASHA members-- Assessment and
treatment strategies used by audiologists
The skills of reading, comprehending, and analyzing
information, as well as the decoding of instructions, symbols,
charts, and diagrams, and the ability to understand risk and
benefits will, ultimately, allow the individual to make informed
decisions and take action.
Differences or disorders of human communication are faced by 1
out of 6 Americans. These increase the challenges of obtaining
information. These disorders may go unrecognized as contributing
to the inability to get and use health information. These
disorders may also be under-recognized or unrecognized by health
service providers. There are specific communication and health
message challenges for individuals with auditory processing
disorder, hearing loss and deafness, specific language
impairment, and/or dementia, and there may be challenges within
the systems for people who stutter.
Health literacy, however, is not solely about the individual.
For health professionals, it becomes a reciprocal responsibility.
Too often there is a tendency to blame--or "fix" the
victim--and not see the broader roles and responsibilities for
the medical and allied health professionals, the agencies,
organizations, and institutions that individuals encounter in
their desire for health and quality of life.
The Institute of Medicine has described this reciprocal
relationship in health literacy as "where the expectations,
preferences and skills of individuals seeking health information
meet the expectations, preferences and skill of individuals
providing information. Health literacy arises from a convergence
of education, health services, and social and cultural factors,
and brings together research and practice from diverse
More than 90 million Americans struggle to understand basic
health information, according to a study released by the U.S.
Department of Education. According to the 1993 National Literacy
Act Survey, 10 to 22 percent of Americans are at the lowest level
of literacy (unable to read a medicine bottle or poison warning).
Another 18 to 26 percent are considered functionally illiterate
(have trouble filling out a job application form). On average,
the reading level in the United States for Medicaid recipients is
at the fifth grade level. The White House Office of Management
and Budget, in a 2002 report, estimated the number of patient
encounters across language barriers each year at 66 million.
According to current federal data, there are [at least] 329
languages spoken or signed in the United States. In some cities,
less than 60 percent of the population has English as a first
language. We are all familiar with the census statistics showing
the growth of the Hispanic/Latino/Latina population by 2030, but
less attention has been given to the Asian American population,
which is predicted to grow by 132 percent in the same time frame.
This issue is also economic. For example, in a study at the
University of Arizona at Tucson, researchers found that health
care costs for patients enrolled in Medicare who were identified
as having low literacy skills were more than four times as high
as costs for patients with high literacy ability--roughly $13,000
per year vs. $3,000 per year. These data not only indicate the
seriousness of the issue for today, but predict even greater
future obstacles--unless individuals and institutions begin to
create active solutions.
How Can Audiologists Play a Unique Role in the Solution?
The first step is to seek information. There recently has been
an explosion of Web-based information available on health
literacy. Several good places to start include the following:
Then, the next step is to "talk among ourselves" as
we look to the special skills that individuals who are trained in
communication--and in alternative communication strategies--may
be able to contribute to solving the growing health literacy
Marin P. Allen, PhD
Deputy Associate Director for Communications and Public
Liaison and Director of Public Information
National Institutes of Health
- How have literacy challenges affected your professional
- What can I contribute from my experience and observation
that may be helpful in facilitating the work of other
audiologists with people who have literacy challenges?
- How do we communicate the importance of this issue, both
now and for the future, to others in the profession?
- How can audiologists play their unique roles in solving the
health literacy problem?
This article first appeared in the Vol. 4, No. 1,
January/February 2005 issue of