Health Literacy Improvement as a National Priority

As the 18th Surgeon General of the United States, improving the health and wellness of all Americans is my top priority. Unfortunately, achieving this goal will be difficult if we don't improve the ways in which we communicate about health. To make progress on the most pressing public health issues, it is important that we increase the health literacy of our Nation.

Prior to becoming the Surgeon General, I practiced family medicine in a rural coastal Alabama shrimping village. I saw first-hand what the research reported in this journal confirms: health professionals cannot assume that everything we tell our patients is perfectly clear to them. What we say doesn't matter as much as what patients understand, remember, and do. If their understanding is incorrect or incomplete, we did not find the right way to reach them. Being health literate is just as important for clinicians as it is for patients.

In 2006, the Office of the Surgeon General convened a workshop to review the science on health literacy (Office of the Surgeon General, 2006). The workshop produced the first population level data on adults' health literacy skills. According to the National Assessment of Adult Literacy, 9 out of 10 adults have difficulty using everyday health information (Kutner, Greenberg, Jin, & Paulsen, 2006). Research from the National Science Foundation confirms that adults have little knowledge of basic scientific and biological processes, making it even more difficult to communicate routine health information (National Science Foundation, 2008). The workshop presentations outlined research gaps and opportunities that still need to be filled. It is not enough, however, to do the research. We must apply the research to the development of effective interventions that are evaluated and refined.

The U.S. Department of Health and Human Services (HHS) defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (U.S. Department of Health and Human Services, 2000). The Institute of Medicine emphasizes that health literacy results from the interaction between the skills of individuals and the requirements and assumptions health professionals, including health communicators, make about what people know and are able to do for their health (Institute of Medicine, 2004).

Literacy itself is the issue for one-third of the adult population (Kutner, Greenberg, & Baer, 2005). As defined by the National Literacy Act of 1991, literacy is having “the ability to read, write, speak, and compute and solve problems at levels necessary to function on the job and in society, to achieve one's goals, and develop one's knowledge and potential.” An estimated 30 million adults in this country can only do the most simple and concrete literacy tasks and another 63 million can only do simple, everyday tasks (Kutner et al., 2005). Individuals with limited literacy have trouble reading bus schedules, writing answers on forms, measuring medications, and understanding nutrition labels.

The research presented at the 2006 Surgeon General's Workshop established that the level of health literacy in a society affects the ability to

	Access and navigate the healthcare system
	Manage chronic diseases
	Use preventive services, including screenings
	Understand and adhere to medical advice and instructions
	Be involved in health decisions

Cultural and linguistic differences also affect health literacy levels and contribute to health disparities (U.S. Department of Health and Human Services, 2007). At the time of the workshop, new research on the links between health literacy and cognitive processes, life stage, prior knowledge, and message characteristics, among other factors, was emerging. The results deepened our understanding of the complexity of the health literacy concept.

Since 2006, research funded in large part by the National Institutes of Health and the Agency for Healthcare Research and Quality has further added to our understanding of the causes and consequences of limited health literacy. The work reported in this special issue highlights opportunities to improve health literacy. As both a practicing physician and the Surgeon General, I recognize we must communicate in ways that make sense to the people we are trying to reach. The new research suggests, however, we must go beyond clear communication and correct the conditions that make it difficult for people to use health information and services (Paasche-Orlow, Schillinger, Greene, and Wagner, 2006).

HHS, in collaboration with over 700 public and private sector entities, developed a National Action Plan to Improve Health Literacy (released in May 2010) that provides a framework for future research and action. The plan includes seven goals and high-priority strategies that researchers and practitioners can use to design studies and interventions. As the number of interventions grows, evaluating their success in improving health literacy will be increasingly necessary and important. Good intentions will not be enough; it is our professional obligation to find those methods that make limited health literacy a problem of the past.

As the Surgeon General—as America's doctor—I have more than 300 million patients. I want all of them to live longer, healthier lives, and improving health literacy can help them do so. Please join me as we strive to ensure that our nation becomes more health literate.

Notes

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