Disparities in Health Literacy

American Public Health Association 

People with poor health literacy may have problems communicating with their physician, reading instructions and labels on medicines, completing medical and insurance forms and understanding many other aspects of health care. Over half of the people living in the United States are affected by health literacy.[1]

  • Minority patients. Minority patients are more likely to have difficulties communicating with their healthcare providers than white patients - up to 20 percent of Spanish-speaking Latinos do not seek medical advice due to language barriers.[3] Asians and Hispanics often report difficulties understanding written information from doctor's offices and instructions on prescription bottles.[8] Up to 40 percent of African-Americans have problems reading.[1]

  • Older patients. Two thirds of U.S. adults age 60 and over have inadequate or marginal literacy skills, and 81 percent of patients age 60 and older at a public hospital could not read or understand basic materials such as prescription labels.[8]

  • Low-income patients. Approximately half of welfare recipients read below the fifth-grade level.[1]

  • According to the American Medical Association, poor health literacy is "a stronger predictor of a person's health than age, income, employment status, education level and race."[2]

  • People with poor literacy are more likely to have a chronic disease and less likely to get the health care they need.[6]

  • A study of low-income men found that poor literacy is a better predictor than race or age of advanced prostate cancer.[1]

  • Diabetes patients with poor literacy are nearly twice as likely to have poorly controlled blood sugar and serious long-term complications.[3]

  • HIV-positive adults with poor literacy are more likely to miss treatment doses than those with high literacy due to confusion about instructions.[1]

  • Twice as many asthma patients reading below the third-grade level had poor metered-dose inhaler technique as patients reading at high school level.[1]

  • Adults with poor literacy are likely to have three times as many prescriptions filled as adults with higher literacy.[4]

  • Emergency room patients with poor literacy are twice as likely to be hospitalized as those with higher literacy.[6]

  • A study of outpatients found that 42 percent did not understand instructions to "take medication on an empty stomach," and 49 percent could not determine whether they were eligible for free care from a hospital financial aid form.[3]

  • Diversity among health care providers. Lack of diversity among health care providers can be a barrier to communication.Minorities make up 28 percent of the U.S.population, but only 3 percent of medical school faculty, 16 percent of public health school faculty and 17 percent of all city and county health officers.[3]

  • Hidden problem. Patients with poor literacy are not easily recognized by physicians and other healthcare workers.[2] In a recent study, two-thirds of the patients who admitted having reading difficulties had never told their spouse. Six percent of them had told no one about their problem.[6]