Prison Systems

Inmates in most prisons already have access to literacy improvement programs. Given the large and growing size of the U.S. prison population, however, and the costs associated with providing health care to prisoners, incorporating health literacy content might enhance current literacy improvement programs.

Social Service Agencies

Social service agencies in virtually all U.S. communities interact with low-literate individuals every day, because clientele of these agencies include large numbers of unemployed persons with limited education. Some of these agencies, particularly adult education programs, focus on literacy enhancement as a core mission through adult basic education, GED programs, and “English as a Second Language” programs.

The majority of individuals with limited literacy, however, do not enter such education programs. Rather their interaction with social service agencies is often through county and state public assistance programs, unemployment agencies, childcare programs, and others. These social service agencies spend large sums of money providing services to their clientele, and those sums might be reduced if clientele had better literacy skills that permitted easier entry into the workforce. To the extent that clientele of these agencies have chronic health problems—and many do—costs might further be reduced if clientele had better health literacy.

Public assistance, unemployment, and childcare agencies could link with local adult education programs, or with national literacy programs such as ProLiteracy America (Proliteracy Worldwide, 2002), to facilitate easy referral into literacy training programs. In fact, literacy training programs could be located on site with, or in close geographic proximity to, a variety of social service agencies, including medical clinics whose clients might benefit from literacy enhancement. Such partnerships, some emphasizing health literacy, are currently in place in a number of communities (Community Health Partners, 2003; El Paso Community College/ Community Education Program, 2001). More such partnerships should be encouraged.

Professional Associations

Finally, professional associations representing health-care providers have an interest in assuring and improving health and health care for individual patients. With evidence showing that limited literacy skills are associated with poorer health status, all professional associations representing

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