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affected by general literacy, and the skills, preferences and expectations of healthcare providers; it is complicated by dissimilar cultural and educational backgrounds between a patient and provider, as well as the shame and stigma suffered by those who lack it. Nearly half of all adult Americans may receive diminished care due to deficient health literacy. Consequences include poorer health status, unnecessary provider visits and hospital stays, and far higher expenses.

Health literacy is fundamental to safe, equitable, patient-centered care. Individuals lacking functional health literacy have difficulty understanding information given by healthcare providers, using medications properly, keeping appointments, and navigating the health system to obtain needed services. They are also less likely to receive important health screenings such as mammograms and pap smears, get vaccines, or to arrange for well-child care. Especially in areas of racial and ethnic diversity such as New York City, the situation is complicated by the need to provide culturally relevant patient education.

White non-Hispanics have significantly higher health literacy proficiency than African-American, Hispanic and other groups, as do native-born adults, especially when compared with people born in Spanish-speaking countries. Younger populations also have higher health literacy than do those aged 45 or older. Health literacy also correlates with affluence and educational attainment. Good health is also associated with proficiency, and health literacy generally declines as the likelihood, number and severity of health conditions increase. In New York State and New York City, data is lacking, but a relatively large percentage of the population does not speak English well or at all, so the issue of health literacy is more critical here.

The need to address health literacy has become even more important with the increased complexity of the health care system. Also, those among whom health literacy is lowest – the elderly and minorities – are becoming larger relative to the overall population. For those lacking proficiency, adverse consequences include misdiagnosis, errors in medication and treatment, and disempowerment. Without gains in health literacy, success is less likely for attempts to improve the quality of care and reduce health care costs and disparities.

Currently, health workers lack the education, training and practice opportunities enabling them to develop skills for improving health literacy. In all settings, the issue must be addressed in the context of culture and language. The Partnership for Clear Health Communication, a coalition of national organizations, is focusing on the information gap between providers and patients by targeting high-risk patients with tools to assess health literacy. The partnership promotes Ask Me 3, which is three simple but essential questions that patients should ask their providers in every healthcare interaction, and providers should always encourage their patients to understand the answers to: What is my main problem? What do I need to do? Why is it important for me to do this?

Locally, the Bronx Health Link emphasizes training providers in health education methods appropriate to the communities they serve, and advocates involving consumers in developing related materials suitable for their needs. Recently, the Bronx Health Literacy Collaborative has been formed to promote better understanding of the challenge of improved health literacy and the coordination of solutions. The U.S. Department of Health and Human Services is developing similar programs, and is also training health professionals in communications science and technologies.


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