Introduction

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Healthy People 2010 defines health literacy 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.”7 The American Medical Association (AMA) and others expand on this slightly to include the ability to both understand and act on health information.2,8 While exact definitions of health literacy may vary slightly, they all involve the ability to function within the health care system and comprehend the information and instructions it provides, both verbally and in print. Perhaps surprisingly, the ability to read is the strongest predictor of overall health status – more closely linked than race, age, education level, or socioeconomic status.9

Results of the last two national surveys of adult literacy suggest that the average American reads at well below the skill level required to comprehend the majority of forms, drug labels, health education materials and other information provided in a typical medical setting.2,10 As a result, these same sources recommend that all print materials be written at or below the sixth grade level.

While health literacy and general literacy are obviously related, health literacy includes specialized knowledge and abilities related to maintaining good health, preventing illness, and functioning in a medical setting. Today’s health care environment is typically quite complex, often requiring advanced reading and numeracy skills that exceed the abilities of the average patient. Furthermore, patients commonly feel stress and anxiety related to health care interactions, especially during times of new diagnoses such that even people with above average literacy skills may not be able to understand or act on information critical to their health and well-being. College graduates, strong readers, and successful professionals may still have trouble understanding a complicated self-care routine, figuring out how to take a new medicine correctly, or finding their way around a medical facility.

This gap between the complexities of the health care system and the abilities of the average patient creates a host of problems. To date, most health literacy research has examined the impact of low health literacy on health outcomes. The findings are stunning:

  • low health literacy is linked to medication and treatment errors,11,12
  • higher rates of disease,2
  • hospitalization12,13,14 and mortality,15
  • failure to seek preventive care or manage chronic illness effectively,2,14,16,17,18
  • increased use of ER for primary care,2 and
  • higher health care costs19 (estimated annual price cost to the U.S. economy = $100-$238 billion).4

These health literacy issues are also relevant to oral health and to the issue of oral health care disparities.