A two-year-old is diagnosed with an inner ear infection and prescribed an antibiotic. Her mother understands that her daughter should take the prescribed medication twice a day. After carefully studying the label on the bottle and deciding that it doesn’t tell how to take the medicine, she fills a teaspoon and pours the antibiotic into her daughter’s painful ear (Parker et al., 2003).

Modern health systems make complex demands on the health consumer. As self-management of health care increases, individuals are asked to assume new roles in seeking information, understanding rights and responsibilities, and making health decisions for themselves and others. Underlying these demands are assumptions about people’s knowledge and skills.

National and international assessments of adults’ ability to use written information suggest that these assumptions may be faulty. Current evidence reveals a mismatch between people’s skills and the demands of health systems (Rudd et al., 2000a). Many people who deal effectively with other aspects of their lives may find health information difficult to obtain, understand, or use. While farmers may be able to use fertilizers effectively, they may not understand the safety information provided with the fertilizer. Chefs may create excellent dishes, but may not know how to create a healthy diet. Indeed, health literacy can be a hidden problem—because it is often not recognized by policy makers and health care providers, and because people with low literacy skills or who are confused about health care may be ashamed to speak up about problems they encounter with the increasingly complex health system (Baker et al., 1996; Parikh et al., 1996). Without improvements in health literacy, the promise of scientific advances for improving health outcomes will be diminished.

The Institute of Medicine (IOM) convened the Committee on Health Literacy, composed of experts from a wide range of academic disciplines and backgrounds, to assess the problem of limited health literacy and to consider the next steps in this field. The committee addressed the following charge:

  1. Define the scope of the problem of health literacy. The intent is to clarify the root problems that underlie health illiteracy. This would include identifying the affected populations and estimating the costs for society. Develop a set of basic indicators of health literacy to allow assessment of the extent of the problem at the individual, community, and national levels.

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