Glenn Ellis

*Research shows that most consumers need help understanding health care information; regardless of reading level, patients prefer medical information that is easy to read and understand. For people who don’t have strong reading skills, however, easy-to-read health care materials are essential.

The health of 90 million people in the U.S. may be at risk because of the difficulty some patients experience in understanding and acting upon health information.

One out of five American adults reads at the 5th grade level or below, and the average American reads at the 8th to 9th grade level, yet most health care materials are written above the 10th grade level.

Limited health literacy increases the disparity in health care access among exceptionally vulnerable populations (such as racial/ethnic minorities and the elderly).

According to the Center for Health Care Strategies, a disproportionate number of minorities and immigrants are estimated to have literacy problems:

• 50% of Hispanics

• 40% of Blacks

• 33% of Asians

In fact, more than 66% of US adults age 60 and over have either inadequate or marginal literacy skills, and 50% of welfare recipients read below fifth grade level!

So, imagine what this means in major urban cities around this country where the populations are mostly brown and black people.

Never mind that all of these cities have world-class medical centers, hospitals, and the latest in pharmaceuticals and treatments. They mean nothing to people who are disproportionately sicker, poorer, and uneducated. How is it possible for them to benefit?

And it’s not just these poor souls who suffer. Low health literacy is an enormous cost burden on the American healthcare system – annual health care costs for individuals with low literacy skills are 4 times higher than those with higher literacy skills.

Even problems with patient compliance and medical errors may be based on poor understanding of health care information. Only about 50% of all patients take medications as directed.

Patients with low health literacy and chronic diseases, such as diabetes, asthma, or hypertension, have less knowledge of their disease and its treatment and fewer correct self-management skills than literate patients. Patients with low literacy skills have a 50% increased risk of hospitalization, compared with patients who had adequate literacy skills.

The research suggests that people with low literacy:

• Make more medication or treatment errors

• Are less able to comply with treatments

• Lack the skills needed to successfully negotiate the health care system

• Are at a higher risk for hospitalization than people with adequate literacy skills

Let’s not forget that in the wake of the new national health reform, health systems, health plans, providers, and policy makers are attempting to see what can be done to contain health care costs. For them, it is important to understand that health care spending is not distributed evenly across the population—or by condition. In fact, just five percent of the U.S. population—those with the most complex and extensive medical conditions—accounts for almost half (49 percent) of total U.S. health care spending, and 20 percent of the population accounts for 80 percent of total spending.

In medicine, a chronic disease is a disease that is long lasting or recurrent. The most common chronic conditions are high blood pressure, diabetes, arthritis, high cholesterol, and respiratory diseases like asthma and emphysema. These are the very conditions commonly mentioned when we hear talk of “health disparities”, in reference to minorities and people of color.

According to an Institute of Medicine (2004) report, low health literacy negatively affects the treatment outcome and safety of care delivery. The report points out that these patients have a higher risk of hospitalization and longer hospital stays, are less likely to comply with treatment, are more likely to make errors with medication, and are more ill when they seek medical care.

In Pennsylvania, like other states, chronic diseases are the leading cause of death and disability and account for 80 percent of all health care costs. About half of all Pennsylvanians have a chronic disease, including diabetes, asthma, heart conditions, and others. God only knows how severe this is in a city like Philadelphia!

Thirty-seven percent of Philadelphia public school students who start 6th grade will drop out but before graduating, and 34% of the city is on Medicaid. For African-American males, that number jumps to 43 percent, and it’s 51 percent for young Latino men.  Poor and uneducated, what hope is there to live healthy and productive lives?

Those with poor health literacy are more likely to have a chronic disease and less likely to get the health care they need. Individuals with inadequate functional health literacy often struggle with basic tasks when managing a chronic condition such as reading and comprehending prescription bottles, appointment slips, self-management instructions, and educational brochures. Inadequate functional health literacy can be a barrier to controlling disease and can subsequently lead to poor health outcomes and increased health care costs.

Chronic conditions are the leading cause of death and disability in the U.S. and treating patients with comorbid chronic conditions costs up to seven times as much as treating patients who have only one chronic condition. Modifiable health risk factors, such as cigarette smoking and overweight/obesity, are responsible for much of the illness, healthcare utilization, and subsequent costs related to chronic disease.

Reading abilities are typically three to five grade levels below the last year of school completed. Therefore, people with a high school diploma, typically read at a seventh or eighth grade reading level.

Every school day, more than 7,200 students fall through the cracks of America’s public high schools. Three out of every 10 members of this year’s graduating class, 1.3 million students in all, will fail to graduate with a diploma. The effects of this graduation crisis fall disproportionately on the nation’s most vulnerable youths and communities. A majority of non-graduates are members of historically disadvantaged minorities and other educationally underserved groups. They are more likely to attend school in large, urban districts. And they come disproportionately from communities challenged by severe poverty and economic hardship.

The average adult in the United States reads at an eighth-grade level yet most patient education materials are written on a high-school or college reading level!

In case you haven’t noticed, I am deeply saddened by the countless, helpless millions all over this country who don’t stand a chance.

Over the years, I have become absolutely convinced of the intersection between health and basic education, and I have witnessed countless horror stories to prove it.

Hospitalizations; Clinical Trials; Medication Errors; Unhealthy Behaviors…just to name a few.

Yes, America, we should all be ashamed.

Regardless of how we have allowed our health and public education systems to degenerate, the fact remains that all of us deserve to enjoy the ability to be healthy and to be educated. It’s not a privilege, it’s a right!

As we consider how to “reset” the Health Reform Act, and “reform” our public education system, we need to look at what we have become as a society.

Here’s another word definition:

Degenerate – Having lost the physical, mental, or moral qualities considered normal and desirable; showing evidence of decline

While pondering this, let me leave you with this:

“The most certain test by which we judge whether a country is really free is the amount of security enjoyed by minorities”

– John E. E. Dalberg, Lord Acton, The History of Freedom in Antiquity, 1877 –


Remember, I’m not a doctor. I just sound like one.

Take good care of yourself, and live the best life possible!

Glenn Ellis,  is a Health Advocacy Communications Specialist. He is the author of Which Doctor?, and is  a health columnist and radio commentator who lectures, and is an active media contributor nationally and internationally on health related topics.

His next book, “Information is the Best Medicine”, is due out Fall, 20111. Contact him via his website: