Addressing Disparities in Health Literacy

Health literacy — the ability of people to obtain, process and understand basic health information and health care delivery systems to make appropriate decisions about their well-being — directly affects every person’s ability to live a healthy, productive life. Yet according to a report from the U.S. Department of Education’s National Center for Education Statistics (NCES), only 12 percent of American adults possess “proficient” health literacy, and 14 percent exhibit “below basic” health literacy.

Low health literacy is associated with poorer health outcomes, the inability to manage chronic conditions, and above-average hospitalization rates. People with poor health literacy tend to require more expensive care and seek treatment later in the course of a disease rather than taking advantage of preventive screenings. This adds a substantial financial burden to the overall health care system in the United States.

Improving health literacy not only benefits individuals but also society as a whole. To understand this, we first must establish the facts surrounding the issue of health literacy in the U.S.

Who is at risk for low health literacy?

A 2011 systematic review published in Annals of Internal Medicine found that poor health literacy affects approximately 80 million Americans. Who are these patients?

Health literacy is driven by a variety of social determinants. NCES cites these risk factors for poor health literacy:

  • Race and ethnicity: Studies have shown that some ethnic groups have more barriers to accessing institutions and tools that promote health literacy, which can result in limited proficiency.
  • English language proficiency: Adults who learn English as a second language or read below national average levels can experience difficulty understanding health information, much of which is designed for native English speakers with proficient literacy.
  • Age: Adults older than 65 have significantly less proficient health literacy than their younger counterparts.
  • Educational attainment: Low academic achievement is directly linked to low rates of health literacy, while rates increase with each successive level of education.
  • Socioeconomic status: Income level can influence the type and level of health care coverage for Americans and their families, as well as access to transportation, education and materials that increase health literacy.

How can nurses improve health literacy?

Family nurse practitioners and registered nurses across the spectrum occupy an ideal position for positively impacting health literacy rates. In the course of their work, nurses interact with high volumes of patients, often for greater amounts of time than other medical professionals. Nurses can play key roles in improving patients’ lives by incorporating health literacy assessment and remediation into their encounters.

Furthermore, nurse practitioners possess an arsenal of tools for improving health literacy. They exhibit cultural competency specific to the patients they serve, and they are proficient in identifying the social determinants of health that can lead to disparities in outcomes for their patient populations. When these factors are identified and addressed, health literacy can improve.

Educators, public health officials, social workers and other health advocates also can aid in improving health literacy. A cross-sector approach expands the opportunity to address key threats and issues in diverse populations.

Why use health literacy as a lens to explore health topics?

Because health literacy affects each patient’s ability to understand and manage their health concerns, Nursing@USC will examine a variety of topics within the context of health literacy throughout the year. We will look at the social determinants and impacts of health literacy on the outcomes of various health issues, such as substance abuse and sexual health, to understand how nurse practitioners and other professionals can affect these outcomes by improving health literacy rates.

This exploration will aim to apply health literacy implications to real-world circumstances and shine a light on potential solutions to these problems — solutions that incorporate developmental tools and resources that address international barriers to increasing literacy. We hope to inspire communities to think deeply about the ways in which health literacy affects the populations they serve.

To that end, we ask: What health literacy topics and tools are you most interested in discussing? What experiences have focused your attention on this topic? What dilemmas have you faced (or do you anticipate facing) within the specific patient populations you serve?

We invite your participation as we begin this deep dive into the ramifications of health literacy on the lives of patients and nurses. Let us know what you think on Facebook, Twitter or LinkedIn.