Health Literacy

Contents

1. Find, understand and use
2. Personal and organizational
3. How the definition changed
4. How common limits are
5. Reading levels and written materials
6. What limited health literacy is linked to
7. Plain language as a tool
8. Digital health literacy
9. National goals

As her years in practice went on, Candace Cooley’s work turned more and more toward preventive care for women and toward gynecology done in the office, settings that rely on information passing cleanly between clinician and patient, and the field that studies that passage is called health literacy. Taken apart, the federal definition has three verbs and two levels. Healthy People 2030 describes personal health literacy as the degree to which people are able to find, understand and use information and services to guide decisions for themselves and others, and organizational health literacy as the degree to which organizations make that possible.¹ Each verb names a different step, and each level names a different party responsible for it.

Find, understand and use

The three verbs describe a sequence. Finding means reaching the right information or service. Understanding means making sense of it. Using means turning it into a decision or an action. The Healthy People authors note that the newest definition stresses use over understanding alone, and encourages work on the skills that carry people from comprehension to action.¹ A Harvard T.H. Chan School of Public Health explainer puts the same point simply: health literacy is more than the ability to read.³

Personal and organizational

The second half of the definition moved part of the burden. By defining organizational health literacy, Healthy People acknowledged that a person’s skills depend on context and that the producers of health information share responsibility for whether it is usable.¹ A federal literature summary goes further, classing limited personal health literacy as a social risk and organizational health literacy as a social determinant of health, and observing that even people with strong personal skills can be harmed by organizations that communicate poorly.²

How the definition changed

The older wording came from the Institute of Medicine. When it reported on the subject in 2004, NBC News summarized its definition as the capacity to obtain, process and understand basic information and services needed to make appropriate health decisions.⁹ Healthy People used similar language in 2010 and 2020. The 2030 revision changed it in four ways: it emphasizes using information rather than only understanding it, aims at well informed decisions rather than appropriate ones, adds a public health perspective, and gives organizations a stated responsibility.¹

Figure

How the federal definition changed

	Healthy People 2010 and 2020	Healthy People 2030
Core skills	Obtain, process and understand	Find, understand and use
Kind of decision	Appropriate	Well informed
Who carries it	The individual	Individuals and organizations
Point of view	Personal	Adds a public health view

How common limits are

Estimates vary with the measure. The literature summary reports that the only national assessment, given in English, found that over a third of adults in the United States had limited personal health literacy.² The Center for Health Care Strategies states that nearly nine in ten adults struggle with health literacy in some way and that the burden falls hardest on marginalized groups.⁴ The 2004 Institute of Medicine report put the number of adults lacking the skills to understand basic health information at as many as 90 million.⁹ The summary also cautions that measurement at a single moment is imprecise, because a person’s skills can drop during illness or stress.²

Reading levels and written materials

Much of the gap sits on the page. A CBS News report from 2002 cited education statistics showing that one adult in five reads below a sixth grade level, while most health materials are written at a tenth grade level or above.¹⁰ The Harvard explainer adds that most health information online is too complicated for at least half of Americans and that the readability of patient information has not improved in half a century.³ An article in Medical Writing notes that health information is often unfamiliar and technical even for readers with many years of schooling.⁵

What limited health literacy is linked to

The literature summary associates limited personal health literacy with worse care and worse outcomes, including a higher chance of misunderstanding important information or getting lost in a fragmented system.² The Institute of Medicine panel found studies linking poor literacy skills to more preventable hospital visits and more unnecessary emergency visits, but it also noted that only a handful of the 684 studies it reviewed tested direct links, and that whether the relationship is causal remained unknown.⁹ Improvements, the Harvard explainer reports, have been tied to greater use of preventive services such as Pap tests and to better conversations about shared decisions.³

Plain language as a tool

Plain language is the most direct remedy. The Medical Writing article describes how the Centers for Disease Control and Prevention has worked to build a clear communication culture so that its audiences can understand and act on what it publishes.⁵ The examples are often small. The CBS report pointed to the gap between saying a tumor is benign and saying it is not cancer.¹⁰ On the patient side, the Harvard explainer describes the Ask Me Three method, built around the main problem, what to do and why it matters.³ The entry on shared decision making shows where those conversations lead.

Figure

Where adults in 30 countries turn for trusted health information

• Medical providers40.7
• Checking several sources31.2
• Government sources21.6
• Family or friends6.5

percent

Digital health literacy

The skills now extend to screens. A 2025 survey of 31,000 adults in 30 countries, reported by News Medical, found digital health literacy highest in poorer nations and lowest in wealthy ones, and found that people valued information that was easy to reach, easy to understand and clear about its source.⁶ The Harvard explainer estimates that about 90 percent of Americans use social media to look for health information.³ Tools for judging that material exist: a library guide at Eastern Illinois University reproduces a MedlinePlus checklist, and Testing Treatments lists a MedlinePlus tutorial on weighing health claims found online.⁷⁸

Figure

Four questions for a health website

1. 01
   ProviderWho runs the site, why it exists and whether the owner can be reached.
2. 02
   FundingWhere the money comes from and whether advertisements are labeled.
3. 03
   QualityWhere the content comes from, whether experts review it and whether it is current.
4. 04
   PrivacyWhether the site asks for personal information and explains how it will be used.

National goals

Healthy People 2030 makes health literacy one of its overarching goals and lists six related objectives.¹ They include raising the share of adults whose clinician checked their understanding, lowering the share who report poor communication, raising the share involved in decisions as much as they wanted, and making online medical records easier to follow.¹ Several of these depend on the clinic as much as the patient, which is one reason the research keeps returning to relationships that last, the theme of continuity of care.

The next step is measurement. The literature summary reports that there is currently no national measure of personal health literacy, that no measure yet captures organizational health literacy across the country, and that studies of organizational efforts have been largely descriptive, with few reported effects.² The 2004 report had already asked for a broad research program on causes and consequences.⁹ It also asked medical schools to teach communication as a routine part of training, and it noted that few doctors in busy clinics had the time to confirm that patients understood their advice.⁹ What any of this means for one woman’s questions at a visit is best worked out with her own clinician.