According to The United Nations Educational, Scientific and Cultural (UNESCO), “Literacy is the ability to identify, understand, interpret, create, communicate, compute and use printed and written materials associated with varying contexts. Literacy involves a continuum of learning to enable an individual to achieve his or her goals, to develop his or her knowledge and potential, and to participate fully in the wider society” (UNESCO, 2003). Today, the term literacy often refers to adequate reading and writing skills that would facilitate basic communication or at a level that is understandable. Age is often a major factor in determining literacy skills and in the development of core improvement strategies. Individuals often experience the effects of aging not just physically, but in their cognitive functions as well. In relation to health, the Institute of Medicine 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” (National Research Council, 2004). This means that literacy pertains not only to reading and writing, but the ability to analyze situations and make a decision pertaining to a health issue. Health literacy is also a more powerful indicator and predictor of an individual’s health status compared to other factors such as age, financial capacity, education level or race as stated by the American Medical Association (Weiss & AMA, 2007). In fact, low levels of health literacy are associated with an increased risk of mortality as well as more frequent hospitalizations or physician consultations. An individual may be able to function independently in various settings such as at home or at a work environment but their health literacy may also be limited.
The NAAL or the National Assessment of Adult Literacy attempts to measure the level of health literacy of adults within the United States. The assessment was based on four levels of performance consisting of below basic, basic, intermediate and proficient. Based on the results of the said assessment, approximately 36% adults have limited health literacy in the United States, comprising of 22% who attained basic levels of health literacy and 14% that achieved a below basic level of health literacy. Furthermore, an additional 5% of the total population cannot speak, read, write or even understand the English language. Overall, only 12% of the sample population achieved a proficient level of health literacy (Kutner et al., 2006).
Another aspect of health literacy is delivery of services to vulnerable populations. The term vulnerable populations refers to individuals or a group of persons that have greater predisposition to experiencing inequalities and disparities in health due to their cultural, ethnic, geographic, and economic characteristics or attributes. This segregation places these groups at risk for health issues as they do not often seek medical assistance or access available basic health services. Examples of vulnerable populations include the elderly, the disabled or those with chronic or long-term sickness, racial minorities, the poor and migrants. Perhaps, the majority of vulnerable populations consist of the elderly as this period is characterized by acquisition of chronic diseases, decline in physical and cognitive abilities and they also require complex care (Williams, 1995). Issues that older adults may face in line with health literacy can include difficulty of understanding complex documents and instructions and difficulty in performing calculations. The older adult group also visit a doctor twice as much than any other age group. However, according to Weiss and the American Medical Association (2007), they estimate that about 75% of older adults do not often understand the information that was given to them, particularly those that relate to medications and their prescriptions. In fact, the CDC (2011) states that 71.5 million adults will be aged 65 years and older by the year 2030 and this fact further emphasizes the importance of improving communicating with older adults and improving their health literacy.
Today, the issue of health literacy is now recognized as an issue for the healthcare system rather than an individual’s deficit (Rudd, 2010). There is increasing recognition within the industry that continued efforts must be pursued to reduce health disparities and a key ingredient to achieve success is by improving the health literacy of the nation. In fact, the Joint Commission (2007) stresses the importance of communicating with clients and achieving cultural competencies in improving the health literacy of the country. One such federal policy that attempts to address health literacy is the Affordable Care Act by President Obama. This policy clearly provides the importance of delivering quality care and emphasizing patient-centered care through becoming culturally competent, become proficient in communication and emphasizing prevention. There is a strong need to establish positive community relations and it is communication that bridges the gap between health care providers and the members of the community. Communication is also crucial in establishing trust and in identifying and addressing the concerns of the community. Continuous evaluation of practices and interventions is also essential in order to make sure that the needs of the community, particularly the vulnerable groups, are met.
Centers for Disease Control and Prevention (2011). Older Adults: Why Is Health Literacy Important? Retrieved from http://www.cdc.gov/healthliteracy/DevelopMaterials/ Audiences/OlderAdults/importance.html
Joint Commission. (2007). What did the doctor say?: Improving health literacy to protect patient safety. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations.
Kutner, M. et al. (2006). The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy. U.S.Department of Education.Washington, DC: National Center for Education Statistics.
National Research Council (2004). Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.
UNESCO Statistics (2003). Literacy Skills for the World of Tomorrow: Further Results from PISA. OECD Publications
Weiss, B.D. & American Medical Association (2007). Health literacy and patient safety: Help patients understand. Chicago, Ill: AMA Foundation.