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Public Health Rep. 2010 Nov-Dec; 125(6): 784–785.
PMCID: PMC2966655

Improving Health by Improving Health Literacy

Prevention is the foundation of the public health system and the heart of my work as Surgeon General. But we cannot begin to address prevention if our patients do not know what we are trying to say to them. Accordingly, improving the nation's health literacy is critical to creating a system of care based on wellness and prevention.

Imagine yourself as an elderly widow recently diagnosed with diabetes. Or a new parent whose infant was born with a metabolic disorder. Or a recent immigrant who has become ill from the workplace. Then imagine hearing the words “insulin,” “carbohydrates,” “phenylketonuria,” “hypertension,” “pneumoconiosis,” or other medical terms. These words are likely to be incomprehensible jargon, especially for the nine out of 10 adults who have difficulty understanding health information.1

As clinicians, what we say does not matter unless our patients are able to understand the information we give them well enough to use it to make good health-care decisions. Otherwise, we didn't reach them, and that is the same as if we didn't treat them.

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.”2 Individuals with limited health literacy may have trouble reading and understanding food labels, completing health assessment forms, communicating symptoms to a clinician, measuring medications, navigating the health-care system, or following self-care instructions.

Numerous studies demonstrate the correlation between low health literacy and poor health status. The lack of health literacy results in the underutilization of preventive resources such as vaccinations and routine screenings. It influences a patient's understanding of clinicians' instructions on medication that may affect management of chronic conditions such as diabetes, asthma, or high blood pressure.3 Among adults, there is a direct association between low health literacy and a poor understanding of preventive care information and access to preventive care services.4

There is also a strong correlation between health literacy and health disparities. HHS reports that the cultural and linguistic differences among patients directly impact their health literacy levels, which, in turn, contributes to an increased prevalence of health disparities5 among elderly adults, racial/ethnic minorities, recent refugees and immigrants, low-income individuals, and non-native speakers of English. And while promoting health literacy is a strategy to reduce disparities, it also improves the provision of patient-centered care.6

Health literacy is as important for clinicians as it is for patients. To bridge the gap between the medical information provided and its implementation, we need health professionals who are able to speak the language and understand the culture of their patients.

Because clinicians don't always know which individuals have limited health literacy, clear communication practices and the removal of literacy-related barriers will improve care for all patients. Tools are available to help primary care practitioners who are interested in restructuring their services and patient interactions to improve the way in which they offer health information. One such tool is the Health Literacy Universal Precautions Toolkit from the Agency for Healthcare Research and Quality (AHRQ).7 The Toolkit offers a way to assess services for health literacy considerations and raise awareness of the entire practice staff.

Increasing the nation's health literacy requires a collaborative effort. Therefore, HHS has worked with more than 700 public and private sector partners to develop a National Action Plan to Improve Health Literacy.8 This action plan seeks to engage organizations, professionals, policy makers, communities, individuals, and families in a linked, multi-sector effort to improve health literacy. It is based on the principles that (1) everyone has the right to health information that helps them make informed decisions and (2) health services should be delivered in ways that are understandable and beneficial to health, longevity, and quality of life. With the proper delivery of information, we can foster a culture of improved health literacy to improve the health of individuals and of all communities.

As “America's doctor,” I want us to become a healthy and fit nation. I want all Americans to live long and healthy lives. Improving health literacy can help us do just that. Please join me as we strive to ensure that our nation becomes more health-literate.

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VADM Regina M. Benjamin, Surgeon General
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1. Kutner M, Greenberg E, Jin Y, Paulsen C. Washington: Department of Education (US); 2006. [cited 2010 Sep 9]. The health literacy of America's adults: results from the 2003 National Assessment of Adult Literacy. Also available from: URL:
2. Department of Health and Human Services (US). 2nd ed. Volumes 1 and 2. Washington: U.S. Government Printing Office; 2000. Healthy people 2010: with understanding and improving health and objectives for improving health.
3. Berkman ND, Dewalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, et al. Literacy and health outcomes. Evid Rep Technol Assess (Summ) 2004;(87):1–8. [PubMed]
4. Sanders LM, Shaw JS, Guez G, Baur C, Rudd R. Health literacy and child health promotion: implications for research, clinical care, and public policy. Pediatrics. 2009;124(Suppl 3):S306–14. [PubMed]
5. Department of Health and Human Services (US) National standards on culturally and linguistically appropriate services. [cited 2010 Sep 9]. Available from: URL:
6. Hasnain-Wynia R, Wolf MS. Promoting health care equity: is health literacy a missing link? Health Serv Res. 2010;45:897–903. [PMC free article] [PubMed]
7. Department of Health and Human Services, Agency for Healthcare Research and Quality (US) Health literacy universal precautions toolkit [AHRQ publication no. 10-0046-EF] [cited 2010 Sep 9]. Available from: URL:
8. Department of Health and Human Services, Offi ce of Disease Prevention and Health Promotion (US) National action plan to improve health literacy. [cited 2010 Sep 9]. Available from: URL:

Articles from Public Health Reports are provided here courtesy of Association of Schools of Public Health