creators of this information are often incorrect. Over the past decade, concerns related to literacy skills and health provided a wake-up call to many in the health fields. Health literacy, a newly emerging field of inquiry and practice, focuses on literacy concerns within the context of health. The committee defines health literacy 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” (Ratzan and Parker, 2000), and views health literacy as a shared function of social and individual factors. This chapter will provide an overview of health literacy and this report in a broad societal context; please refer to Chapter 2 for an in-depth discussion of the definition and conceptual basis of health literacy.

SOCIAL AND ECONOMIC FACTORS AND HEALTH

Epidemiologists have been able to document links between socioeconomic status and health, and links between educational attainment and health. A 1998 report from the U.S. Department of Health and Human Services offered evidence from accumulated studies that health, morbidity, and mortality are related to income and education factors (Pamuk et al., 1998). For example, life expectancy is related to family income. So too are death rates from cancer and heart disease, incidences of diabetes and hypertension, and use of health services. Similarly, death rates for chronic disease, communicable diseases, and injuries as reported in 1998 were inversely related to education: those with lower education achievement are more likely to die of a chronic disease than are those with higher education achievement. In essence, the lower your income or educational achievement, the worse your health.

Some researchers have suggested that education provides a key to understanding these relationships. Grossman and Kaestner (1997) asserted that “Years of formal schooling completed is the most important correlate of good health.” House and colleagues (1994) noted that “A causal impact of education on health is highly plausible.” However, research has not yet fully examined other aspects or measures of education beyond years in school such as knowledge and skills. Literacy is one set of skills related to education. National literacy assessments indicate that literacy is a set of measurable skills (Kirsch, 2001) that includes reading, writing, listening, speaking, and arithmetical skills. Chapter 3 discusses the research that exists on the relationship between literacy and health.

Culture and ethnicity also influence health, and Chapter 4 of this report includes a discussion of their relationship with health literacy. Culture and ethnicity are often blended into categories of race which may not represent scientifically sound classifications. As discussed in a recent Institute of Medicine (IOM) report, Speaking of Health (IOM, 2002), race is not a meaning-



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