Health Literacy: Building Upon a Strong Foundation

The field of health literacy only had limited research and understanding when the definition of “the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions” was initially developed (in 1998). As we enter this new phase, the United States Department of Health and Human Services (HHS) released a National Action Plan to Improve Health Literacy, and Healthy People 2020 has integrated health literacy into its goals and the Institute of Medicine continues support of research and policy idea, and finalized into law last year. Concomitant, the Agency for Healthcare Research and Quality (AHRQ) and National Center on Minority Health and Health Disparities (NIMHD) supports conferences and publications such as this special edition of the Journal of Health Communication. Similarly, on a global scale, the United Nations adopted a political declaration that states: “We commit to develop, strengthen and implement, as appropriate, multisectoral public policies and action plans to promote health education and health literacy, including through evidence-based education and information strategies and programmes in and out of schools, and through public awareness campaigns, as important factors in furthering the prevention and control of NCDs, recognizing that a strong focus on health literacy is at an early stage in many countries” (20 September 2011).

Earlier this year, AHRQ published a review of health literacy limited studies published from 2003 to May 25, 2010. Researchers found 81 studies addressing health outcomes and 42 studies addressing interventions. It was reported that differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Additionally, health literacy level potentially mediates disparities between blacks and whites.

This evidence-based literature review builds upon the prior research compiled by AHRQ that provides an analysis of the correlation between low health literacy and poor health with evidence-based studies linking health literacy and outcomes with cancer treatment (Merriman, Ades, & Seffrin, 2002), diabetes (Schillinger, 2002), asthma, and hypertension (Williams, Baker, Parker, & Nurss, 1998). Given that these areas constitute the majority of the ever growing challenge of noncommunicable diseases that has galvanized the United Nations to address this challenge, it is indeed salient that the UN has integrated health literacy into its strategic intervention to promote approaches and integration into national action plans.

And recently, in May 2011, Pamela N. Peterson and colleagues published an article in JAMA that assessed the impact of low health literacy on mortality in patients with heart failure. In this study of the US Medicare population, one in three recipients cannot obtain, process, and understand basic health information. And as many as one in five patients in the heart failure analysis were found to have low health literacy, putting them at high risk of dying from the complex disease as they cannot manage their disease because they lack the inability to understand their disease.

This issue of the Journal, edited by Lauren A. McCormack, Steven R. Rush, Namratha R. Kandula, and Michael K. Paasche-Orlow, provides further evidence and ideas on how we can address the health literacy challenge.

As the field develops and we look for approaches to address the health literacy gap—from traditional communication to the new digital technologies—we must continue to gather health literacy resources from public and private sources, support research, develop policies, and continuously improve with evaluation and creativity. Opportunities with mHealth and technology can give consumers more control and power regarding how, what, and when they receive and provide information about health. Advancing knowledge and skills while reducing complexity such that individuals and health providers can make appropriate decisions is a magnanimous task that needs simple, effective, and ongoing intervention and support. It is the hope that this Journal advances the epistemological and ontological approaches while being mindful of the necessity to advance applied research and demonstrate impact for people at all levels of literacy in the hope of advancing health and well-being.

Additional information

Notes on contributors

Scott C. Ratzan

Scott C. Ratzan, MD, MPA, is Editor-in-Chief of Journal of Health Communication: International Perspectives and Vice President of Global Health, Johnson & Johnson. He serves on the Institute of Medicine's Roundtable on Health Literacy.