Understanding Health Literacy: Article Excerpt

April 1, 2021
April 1, 2021

This blog post is the first in a series of three excerpts from our recent article, Prioritizing Health Literacy in Your Organization Will Improve Patient Access While Cutting Costs.

There is an undeniable link between health literacy and health outcomes, but unfortunately only a small portion of Americans have the proficiency needed to manage their health. While government agencies are making efforts to improve the health of Americans by creating accessible health information, healthcare professionals and systems must work alongside them to ensure that their patients are receiving understandable health services and information. Improving patient access to health information has the potential to improve patient health, increase the use of preventative services, decrease rate of hospitalization, and cut healthcare costs.

Connecting Health Literacy and Health Communication

A person’s health literacy skills can significantly affect his or her ability to navigate the healthcare system. The U.S. Department of Health and Human Services’ (HHS) Office of Disease Prevention and Health Promotion (ODPHP) suggests that a person’s health literacy level influences the way he or she completes forms, locates providers, reports personal health information, and manages diagnoses. ODPHP cites individual and systemic factors that affect health literacy, including (ODPHP, 2006):

  • Communication skills of lay persons and professionals
  • Lay and professional knowledge of health topics
  • Culture
  • Demands of the healthcare and public health systems
  • Demands of the situation/context

Understanding the importance of and connection between health communication and health literacy is a part of ODPHP’s work. ODPHP defines health communication as “human and digital interactions that occur during the process of improving health and health care.” Health literacy is defined as “the degree to which a person has the capacity to obtain, communicate, process, and understand basic health information and services in order to make appropriate health decisions (ODPHP, 2018).”

Improving health communication and increasing national health literacy are central to ODPHP’s goal to improve the health of all Americans. These two are interconnected, and efforts must be made to change the way health professionals communicate with patients in order to ensure that their patients understand the health information given to them (ODPHP, 2018).

Prevalence of Health Literacy

According to the 2003 National Assessment of Adult Literacy (NAAL), which assessed the English literacy of adults in the United States, only 12% had proficient health literacy. Fifty-three percent had intermediate health literacy, 22% had basic health literacy, and the remaining 14% had below basic health literacy (NCES, 2006). Referencing the Healthy People 2010 report, ODPHP (2010) suggests, “Everyday health promotion and disease prevention activities, along with effective navigation of today’s health care system and response to public health alerts and recommendations, require proficient health literacy.” If only 12% of American adults have the skills needed to simply navigate the system and appropriately understand their health, it should not be surprising that a disproportionate number of patients end up unnecessarily in the emergency room or are hospitalized for what should have been a preventable admission.

At-Risk Populations

Although people from across diverse backgrounds are affected by low health literacy, ODPHP reports, “Limited health literacy affects people of all ages, races, incomes, and education levels, but the impact of limited health literacy disproportionately affects lower socioeconomic and minority groups.” They cite the following populations as most likely to experience limited health literacy (ODPHP, 2010):

  • Adults over the age of 65 years
  • Racial and ethnic groups other than white
  • Recent refugees and immigrants
  • People with less than a high school degree or GED
  • People with incomes at or below the poverty level
  • Non-native speakers of English

National Health Literacy Initiatives

ODPHP was created in 1976 to “lead disease prevention and health promotion efforts and disseminate health information” (ODPHP, 2018). One of their initiatives focuses on health literacy and clear communication between caregivers and patients. ODPHP co-leads the Health Literacy Workgroup, a collaboration of all operating agencies under HHS that prioritizes the improvement of health literacy. In 2010 the workgroup created the National Action Plan to Improve Health Literacy, an action plan that outlines goals and strategies to improve health literacy. Additionally, in partnership with the CDC and the Office of the National Coordinator for Health IT (ONC), ODPHP aids in the development and tracking of Healthy People objectives (ODPHP, 2018).


National Center for Education Statistics (NCES). 2006. The health literacy of America’s adults: Results from the 2003 national assessment of adult literacy. U.S. Department of Education. Retrieved from https://nces.ed.gov/pubs2006/2006483.pdf

Office of Disease Prevention and Health Promotion (ODPHP). (2006). Quick guide to health literacy. U.S. Department of Health and Human Services. Retrieved from https://health.gov/communication/literacy/quickguide/Quickguide.pdf

Office of Disease Prevention and Health Promotion (ODPHP). (2010). National action plan to improve health literacy. U.S. Department of Health and Human Services. Retrieved from https://health.gov/communication/HLActionPlan/pdf/Health_Literacy_Action_Plan.pdf

Office of Disease Prevention and Health Promotion (ODPHP). (2018). Health literacy and communication. Retrieved from https://health.gov/communication/

Download the entire article here.