Ruth Parker recalls the account of a mother whose
2-year-old was diagnosed with an ear infection and prescribed an
antibiotic. The mother was instructed to administer her daughter’s
medication twice a day, yet after reading the label on the bottle
she filled a teaspoon and poured the medication into her daughter’s
Parker points to this story as a glaring example of the devastating
impact of poor health literacy. According to Parker, associate professor
of medicine and general internist at Grady Hospital, about one in
every three adults in the United States has problems with health
The effect? A 1998 preliminary analysis by the National Academy
on an Aging Society estimated that low health literacy might cost
the health care system between $30 billion and $73 billion annually.
Parker outlines these and other health literacy concerns in a paper
she cowrote for the July/August 2003 issue of Health Affairs.
The paper, geared toward policy makers, focuses on how health literacy
is important for improving the quality of care in this country.
By definition, health literacy is the degree to which people have
the capacity to obtain, process and understand basic health information
and services needed to make appropriate health decisions.
Parker wrote that health literacy is “at the intersection
of health and education,” adding that it has many dimensions,
including the ability to read, understand and communicate important
medical and health information during different phases of life.
Health literacy is a major factor in quality of care, cost containment,
safety and patients’ involvement in health care decisions.
“Health literacy is about what people really understand and
what they need to do to take care of themselves,” said Parker,
who was appointed to the Institute of Medicine’s Committee
on Health Literacy in 2002 to study problems related to poor health
“As physicians, we spend a great deal of time both learning
and creating information through medical science and research,”
she continued. “Yet we don’t spend enough time checking
to see whether people understand the information we convey to them
in clinic visits and other patient encounters.”
In the paper, Parker notes that the elderly are particularly vulnerable.
Progress in health care technology will deepen disparities over
time, and the problem will be greater for sicker, older and more
vulnerable groups. Patients with low literacy are not able to function
as “informed consumers” and are most likely to be left
Parker said the focus on the elderly is intentional. “General
literacy problems are more common among the elderly, and the elderly
are also more likely to have chronic illnesses,” she said.
“Many elderly lack the basic health literacy skills to read
and understand all the prescription bottles and labels they’re
required to take.”
According to the National Adult Literacy Survey (NALS) in 1993,
44 million Americans —about 25 percent of the adult population—have
functional literacy skills that prevent them from performing everyday
tasks. Many of these people, for example, cannot reliably enter
background information on a Social Security application. Another
50 million adults have limited functional literacy skills, making
it difficult to understand a bus schedule, for example. Parker said
these are the same individuals who use the health care system.
Health literacy is a common problem, but we don’t want to
blame the victim,” she said. “Health care is an incredibly
complicated system these days. As doctors, we need to help patients
feel more empowered to say they don’t understand, and we need
to make sure the people who work in medical systems realize how
many people struggle to understand what they need to do to take
care of themselves.”
Parker and her two co-authors also offer a blueprint for change
to improve quality. One goal for health policy should be to ensure
a health-literate America, with support from the federal government
and policy makers to help fund research for interventions. Parker
said that health literacy must be addressed across generations.
“I think there’s a great need to engage the education
world, in making basic health information more a part of standard
education in our school system,” she said. “As a society,
it’s up to all of us to try to build healthier communities.
We’ve got to look at this issue from all levels and recognize
it’s a problem and start figuring out what we can do about