Economic Considerations of Health Literacy

Roberta Pawlak


Nurs Econ. 2005;23(4):173-180. 

In This Article

Health Literacy as a Determinant

This author proposes that health literacy has multiple individual and population determinants (age, genetics, language, race and ethnicity, education, employment, SES, environment). Health literacy can be viewed as a health problem resulting from these determinants. Health literacy can also be viewed as a determinant of health as it is a confounding factor for consumer decisions related to appropriate level of care, communication with payer and provider, understanding and utilization of consumer information, as well as treatment compliance. As health literacy improves, it is theorized that improvement will be seen in some of these areas. With improvements it is theorized that disparities in health care are reduced, and improvement in the outcome of population health is realized. Refer to Figure 2 for the Health Literacy Model.

Determinants of Health Literacy: A Determinant of Population Health

This model places health literacy in the center of population health determinants. Determinants that impact this concept are outlined on the left. Individually, or in conjunction with each other, they influence health literacy. In turn, the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions affect the following:

  • Level of care matched with need (an example may include an individual seeking primary care when primary care is needed).

  • Improved communication with payer and provider (this includes navigating the health system, knowing insurance coverage when available, articulating health concerns to the provider, and ability to follow prescribed treatment plans).

  • A consumer that is informed (involves self-care strategies, preventive care, accessing care, managing payer issues, self-advocating, ability in managing language, written material and technology).

  • Treatment compliance (involves understanding the treatment plan, and ability in seeking resources such as therapies prescribed, an awareness of the importance and rationale of treatment, and the motivation and skills required to comply with treatment).

Improvement in any or all of these areas can result in a reduction of health disparities. This reduction, in turn, can result in the improvement of population health.


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