Such are the stark findings of Dr. Dean Schillinger, University of California, San Francisco, associate professor of medicine at San Francisco General Hospital, whose research is drawing a clearer connection between health literacy and the chances of beating, or at least successfully controlling, chronic illness. On Oct. 21, 2002, Schillinger delivered the first lecture in a series on health literacy at the National Institutes of Health. The lecture, titled "Babel Babble: What is the Doctor Saying? What is the Patient Hearing?", was sponsored by the National Institute on Deafness and Other Communication Disorders.
A person's health-literacy skill is his or her ability to read and understand health information and to make decisions based on that information, whether it's following the directions on a bottle of Tylenol or learning on a health Web site how to keep one's cholesterol in check. And one strong measure of a person's health literacy is his or her ability to read in general. If someone struggles to read a sign or bus schedule, for example, how can she or he be expected to read and accurately interpret directions for taking a prescription medication?
Schillinger pointed out that a person's literacy is not a matter of "are you or aren't you able to read?" There are degrees. According to the 1993 National Adult Literacy Survey, 10 to 22 percent of Americans are at the bottommost level of literacy, meaning that they are unable to read a medicine bottle or poison warning. Another 18 to 26 percent are considered functionally illiterate, meaning that they have trouble filling out forms for a job application. The survey also found that, on average, the reading level in the United States is somewhere between the eighth and ninth grades, while the average reading level of Medicaid recipients is significantly lower -- at the fifth grade.
Low literacy is a symptom of a number of underlying factors, according to Schillinger. And it is not a lifelong constant. One surprising finding is that older adults who may have had fine reading, writing, and thinking skills in younger days may have difficulty as they age with reading and understanding information. Vision problems, poverty, learning disabilities, immigration and minority status, and poor education also can contribute to low literacy. Two-thirds of people ages 65 and older have poor literacy skills, while 25 percent of immigrants have poor literacy.
Low health literacy can be tied to three big negatives in the healthcare arena, said Schillinger. First, healthcare costs are generally higher for patients with low literacy. A 1992 study at the University of Arizona, Tucson, found that healthcare costs for patients enrolled in Medicare who were identified with low health-literacy skills were more than four times as high as costs for patients with high literacy -- roughly $13,000 per year compared to $3,000 per year. Second, a patient's own health assessment is usually gloomier if he or she is challenged by low literacy. In a study conducted in Atlanta, Ga., and Torrance, Calif., patients who had low health literacy were more likely to report their health as poor compared with patients who had adequate literacy.
And third, patients with low health literacy tend to be less successful in managing chronic disease.
To continue reading:
Why Johnny Is Sick: Researcher Strengthens Health, Literacy Link (National Institute on Deafness and Other Communication Disorders) 
