Economic Considerations of Health Literacy

Roberta Pawlak


Nurs Econ. 2005;23(4):173-180. 

In This Article

Model and Health Production Function

Arguably, literacy touches on most boxes in the conceptual framework for Patterns of Determinants of Health shown in Figure 1, as outlined by Evans and Stoddart (1990). In this framework, one can extrapolate that the foundation of genetics can affect cognition and literacy ability. The very young (school age and younger) have limited exposure to developed reading skills. This determinant, however, may also be influenced by genetics, level of education, and socio-economic status (SES). All ages can be affected by illiteracy. Physical environment is depicted in this model, and can include access to health care, as well as access to technology. Physical environment can affect one's ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions (health literacy). The social and physical environment (including employment) can affect individual and group's access to health care. It can also influence access to technology — a disseminator of health information and avenue of health care that our health system is becoming increasingly dependent upon.

Conceptual Framework for Determinants of Population Health

Race, ethnicity, and culture may influence health literacy through social networks and cultural traditions, access to health information from providers and payers, as well as the understanding and utilization of that information. The technological divide, for example, is outlined as a disparity in Healthy People 2010. Not everyone can read. Not everyone has access to computers and the Internet. Not everyone has communication skills to be able to receive, process, and act on information disseminated by health care providers or by our health system(s). As science advances, dependence on technology for research, service, provision of care, and communication becomes greater. Health care providers sometimes make assumptions that everyone has equal access and ability in receiving and processing technology-based communication. In addition to competence and access to technology, individual responses such as motivation, attention disorders, sensory disorders (for example, hearing impairments or blindness), and mental illness can also influence the ability to seek, process, and understand health information. So too can disease.

Adding to this discourse, the U.S. Federal Government (Selden et al., 2000) has chosen to adapt a definition of literacy (as the ability to read, write, and speak in English), which is problematic in a multi-race, multi-cultural, multi-lingual nation. Language ability in English plays a large role in health literacy in this country. SES, as it relates to education, as well as employment status, can also have an impact. A cautionary note, however; it is important to acknowledge that illiteracy does touch individuals in all socio-economic strata.


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