It was April 2000 and then-mayor of New York Rudy Giuliani was at his desk when he got the call. The voice on the other end of the phone was that of his urologist, who was about to deliver the results of Giuliani’s recent biopsy for prostate cancer: “The tests came back and they were positive”. Giuliani said thank you and hung up the phone with relief, believing that ‘positive’ had been used in the literal sense. In his mind, ‘positive’ meant ‘good news’. In fact, a positive test, in medical terms, indicates the presence of the parameter for which the test has been run. Giuliani had prostate cancer.


Health literacy is defined 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". A 2006 study by the U.S. Department of Education found that 36 percent of adults are only able to understand hospital discharge instructions written at, or below, the fifth-grade level. Canadians don’t fare much better. In 2007, the Canadian Council on Learning (CCL) reported that only 40 percent of Canadians had the necessary skills to understand and act upon health information. Both the U.S. and Canadian studies revealed that poor health literacy disproportionately affects the poor, the unemployed, and recent immigrants. Statistics amongst seniors are particularly shocking; 88 percent have less than adequate health literacy skills.  Even geography plays a role, as illustrated graphically in this interactive map produced by CCL as part of their report.

Solutions that bridge the gap between the medical community and the patient abound: the use of computer software to flag jargon and suggest alternatives (e.g. replace ‘hyperlipidemia’ with ‘high cholesterol’), the use of videos or handouts with lots of illustrations, the creation of opportunities for ‘teach-back’ that allow the doctor to confirm that his/her instructions were fully understood, and enhanced follow-up care after discharge to home from hospital.

Why are governments interested in health literacy? Susan Pisano, Vice President of Communications for America’s Health Insurance Plans sums it thusly: “Health literacy affects every single thing we do. The implications are mind-boggling.” Poor health literacy leads to higher rates of hospital readmission, unnecessary complications, and even death. Solid health literacy, in short, contributes to good health.

Jennifer Hartman, guest blogger 

* photo courtesy of iStockphoto