Americans lacking in health literacy

By Terri Coles

TORONTO (Reuters)  From Google Health to Wii Fit, Americans have an increasingly wide array of tools for tracking their health backgrounds and statistics but their understanding of what that data means is poor, threatening their health and costing the economy billions of dollars.

Just 12 percent of American adults are health literate at a level that allows them to manage their care, the latest News and Numbers statement from the Agency for Healthcare Research and Quality (AHRQ) showed.

The AHRQ release is based on information from the 2007 National Healthcare Quality and Disparities Report , which found that the majority of Americans lacked the skills required to correctly complete health care-related activities like reading a prescription bottle, figuring out medication dosage, filling out forms or calculating insurance coverage. That lack of literacy can negatively affect the quality of care a patient receives and costs the U.S. economy between $106 billion and $236 billion annually, the University of Connecticut said in a report  last year. That's enough to insure all of the more than 47 million Americans currently without coverage.

"There is a number of areas and ranges within the health care system where low health literacy really leads to vast inefficiencies and resource utilization," said John Vernon, the report's lead author.

A survey done in 2003 classified Americans into four health literacy categories: proficient, intermediate, basic and below basic. Twenty-two percent were classified as having basic health literacy while 14 percent were below basic. In other words, more than a third of the respondents likely couldn't determine medication dosage from the instructions on a prescription bottle, said Cindy Brach , a health literacy expert with the AHRQ.

Demographics also play a role in literacy levels, the report showed. Hispanics, African Americans and Native Americans, for example, posted higher-than-average results in the below basic and basic health literacy groups. These minority populations are also disproportionately more likely than whites to be uninsured or to lack health insurance altogether.

Older people, who tend to be higher users of the health care system, are also more likely to lack health literacy, Brach said. Many have multiple chronic conditions that require care by multiple doctors, including taking more than one prescription drug daily.

"The changing demographics of the population, in terms of the baby boomers becoming retirement age and older will probably -- unless something's done -- make the health literacy problem even greater," the University of Connecticut's Vernon said.

It's not simply that older Americans are less educated than their younger counterparts and therefore have lower health literacy now, Brach emphasized. People experience cognitive changes during aging that affect their ability to process information, including information about their health, she said.

And while it's generally true that the more educated you are, the higher your health literacy will be, simply having a high school diploma doesn't guarantee an adequate level of health literacy, and there are college graduates with basic and below basic levels, Brach said. A study published last year showed that even when education was controlled for, lower health literacy was associated with higher mortality, she said. "There's something else going on there that is not explained solely by education."

A lack of health literacy affects everyone, Brach said, adding that 40 percent of people in the below basic category for literacy are white. "Addressing health literacy is seen as one of the important strategies for addressing disparities," she said. To that end, the Department of Health and Human Services has set a goal to eliminate health disparities by 2010.

A lack of effective health information communication is part of the problem, Brach said. "Getting it down to really simple language that still expresses the complex concepts that you need to share with the patients is very difficult, but we need to be doing a lot better job of it."

A person's level of health literacy will change over time and in particular situations. Discussions about health are often stressful, and that reduces a person's ability to process and act on the information they're receiving from a health care professional. We often talk about health literacy as measured at a particular point of time under ideal situations, Brach said, but it is more complicated than that. "Most of us will have some challenges regardless of what our education level and our familiarity with health care is."

The AHRQ is developing a universal precautions health literacy tool kit that aims to treat all patients as if they need the clearest communication possible. Even patients with a high level of health literacy benefit from that approach, Brach said, because they still appreciate clearer communication and understand more with it than they do without it.

The relationship between health literacy and mortality is an important reason to work towards improvements, but economic strain is another. Research has shown a direct link between low health literacy and health care resource utilization, Vernon said. That includes increased ER visits, increased use of expensive procedures and an increased need for diagnostic tests.

While the costs for programs not yet developed are uncertain, they would likely cost much less than the billions wasted each year due to high levels of low health literacy, Vernon said.

How has health literacy affected your care? Let us know: HealthMatters@reuters.com