Economic Considerations of Health Literacy

Roberta Pawlak


Nurs Econ. 2005;23(4):173-180. 

In This Article


Illiteracy is a critical economic problem in the United States. Two areas it affects are health and health care. Health literacy is increasingly important to help people navigate complex health systems and better manage their own health. The consequences of inadequate health literacy include poorer health status, lack of medical care knowledge, impaired comprehension of medical information, lack of knowledge about medical conditions, lack of understanding and use of preventive services, poorer self-reported health, poorer compliance rates with treatment modalities, increased hospitalizations, and increased health care costs (Andrus & Roth, 2002). People with low health literacy are more likely to report poor health, have an incomplete understanding of their health problems and treatment, and are at greater risk of hospitalization (Baker, Parker, Williams, Clark, & Nurss, 1997).

The U.S. government's first study on adult literacy, the National Adult Literacy Survey, found that 48% of adults do not have the literacy skills necessary to function adequately in our society. A set of leading health indicators, which focus on key health improvement activities described in Healthy People 2010: Understanding and Improving Health, all depend to some extent on effective health communication and reducing health disparities in the United States (Department of Health and Human Services [DHHS]). The Institute of Medicine (IOM, 2004) recently published a comprehensive report outlining the current issues related to this topic, and how health outcomes and costs may be influenced by this problem. These reports and initiatives outline the need for practice guidelines to promote better provider-patient communication, as well as additional evidence about the process of health information-seeking behavior and the role of health information in consumer decision making. Differences in the ability to obtain, process, and understand materials related to health services appear to contribute to health disparities.

In addition, organizations such as the American Medical Association (AMA) and the Joint Commission on Accreditation of Health Care Organizations (JCAHO) recognize the importance of identifying and modifying services to reach out to low literate patients (Kefalides, 1999). The AMA Council on Scientific Affairs adopted recommendations in 1998 that recognize illiteracy as a barrier to health care and called for increased funding for research and education of practicing physicians and medical students (Parker, Ratzan, & Lurie, 2003). Standards from JCAHO direct hospitals to evaluate systematically the extent to which patients understand informed consent and instructions (Kefalides, 1999).

Nursing's Social Policy Statement (American Nurses Association [ANA], 2003) calls upon the profession to recognize and be involved in the process of care, public policy, and the health care delivery system as these components of care influence the health and well-being of our society. Specifically, the ANA's Code of Ethics (2001) outlines the patient's right to self-determination (as the philosophical basis for informed consent in health care) and states: "Patients have the moral and legal right to determine what will be done with their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed judgment; to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment; ...and to be given necessary support throughout the decision-making and treatment process" (p. 8).


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