First Report

National Health Literacy Survey

ON September 6, 2006, the National Center for Educational Statistics of the U.S. Department of Education released The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy (NAAL).

The results are based on assessment tasks designed specifically to measure the health literacy of adults living in the United States. Health literacy was reported using four performance levels used in the NAAL study: Below Basic, Basic, Intermediate, and Proficient.

The majority of adults (53 percent) had Intermediate health literacy. About 22 percent had Basic and 14 percent had Below Basic health literacy. The report looked at health insurance coverage and where adults get information about health issues.

For example, adults with Below Basic or Basic health literacy were less likely than adults with higher health literacy to get information about health issues from written sources (newspapers, magazines, books, brochures, or the Internet) and more likely than adults with higher health literacy to get a lot of information about health issues from radio and television.

For the full report, see: http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483

Low literacy and the costs of health care

Since 1974, when health officials became aware of the effects of low literacy on health, literacy problems have grown. A more complex health-care system requires better reading skills to negotiate the system and take more responsibility for self-care.

The classic work on using plain language in health and medical materials. Highly recommended.

Using a nationally representative sample of the U.S. adult population age 16 and older, the National Academy on an Aging Society in 2002 examined the impact of literacy on the use of health care services. The study found that people with low health-literacy skills use more health care services.

Among adults who stayed overnight in a hospital in 1994, those with low health literacy skills averaged 6 percent more hospital visits, and stayed in the hospital nearly 2 days longer than adults with higher health literacy skills.

The added health-care costs of low literacy are estimated at $73 billion in 1998 dollars. This includes $30 billion for the Level 2 population plus $43 billion for the Level 1 population. The total is about what Medicare pays for doctor services, dental services, home health care, prescription drugs, and nursing-home care combined.

Writing health-care information

It is well known that old age, illness, and other forms of stress all impair reading skill, memory, and powers of concentration. For these reasons, medical experts recommend writing health information at the 5th-grade level. This includes consent forms, prescription labels, and other health and medical instructions.

Reading in the Workplace

Pathways to Employee Success

There is a strong relationship between reading skill and job performance.

LOW levels of literacy cause costly and dangerous mistakes in the workplace. There are other costs—in billions of dollars— resulting from low productivity, poor quality of products and services, mistakes, absenteeism, and lost management time.

The1992 National Assessment of Adult Literacy and the 1994-98 international survey included a number of questions about the respondents' work at the time of the survey and in the prior year, their weekly wages and annual earnings, and their recent educational and training activities.

The Educational Testing Service published a policy report based on those findings, Pathways to Labor Market Success: The Literacy Proficiencies of U.S. Adults.

Like the U.S. military studies of literacy, this report showed the relationship between reading skills and job performance. The report showed that the proficiency gaps between U.S. workers at the top of the skills distribution and those at the bottom were consistently larger than the gaps found in other high-income countries. In fact, inequality in the distribution of literacy skills among the employed in the United States was among the largest of all the high-income countries examined.

The employment percentages of U.S. adults of different literacy levels.
Source: IALS 1994.

Those with the highest levels of literacy skills had the highest and best paid positions. Those with the lowest levels of literacy skills had the lowest positions and income. The mean annual earnings of the employed with a Level-5 proficiency were typically three times as high as those of workers who scored in Level 1. Workers whose job duties involved more reading, writing, and math-related tasks were considerably more likely to have received education or training from their employers.

Perhaps the most striking finding is that a large majority of workers in the United States, even in Levels 1 and 2, believe that their existing reading, writing, and arithmetic skills on their current jobs are good or excellent. Relatively few workers believe that their existing proficiencies will limit their future job opportunities.

For the full report, see: Pathways to Labor-Market Success:

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Plain Language in the News

Ontario Securities Commission to cut through financial jargon:
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Simple language improves health-care outcomes:

Small businesses to benefit from regulatory Web site:
archive/2006/10/23/ bureau1.html?market=nashville

Would-be entrepeneurs need plain English:

Bosses using jargon to impress:

Report "incomprehensible to any normal person:"

Teaching workplace basics:

Doublespeak causes word insecurity:

Undergraduates lacking technological literacy:

Hungry people can't eat D.C. jargon:

Business and business schools fight bad writing: