Finding 2-3 Health literacy, as defined in this report, includes a variety of components beyond reading and writing, including numeracy, listening, speaking, and relies on cultural and conceptual knowledge.

Finding 2-4 While health literacy measures in current use have spurred research initiatives and yield valuable insights, they are indicators of reading skills (word recognition or reading comprehension and numeracy), rather than measures of the full range of skills needed for health literacy (cultural and conceptual knowledge, listening, speaking, numeracy, writing and reading). Current assessment tools and research findings cannot differentiate among (1) reading ability, (2) lack of background knowledge in health-related domains, such as biology, (3) lack of familiarity with language and types of materials, and (4) cultural differences in approaches to health and health care. In addition, no current measures of health literacy include oral communication skills or writing skills and none measure the health-literacy demands on individuals within different health contexts.

Recommendation 2-1 The Department of Health and Human Services and other government and private funders should support research leading to the development of causal models explaining the relationships among health literacy, the education system, the health system, and relevant social and cultural systems.

Recommendation 2-2 The Department of Health and Human Services and public and private funders should support the development, testing, and use of culturally appropriate new measures of health literacy. Such measures should be developed for large ongoing population surveys, such as the NAAL Survey, the MEPS, the BHRFSS, and the MBS, as well as for institutional accreditation and quality assessment activities such as those carried out by the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance. Initially, NIH should convene a national consensus conference to initiate the development of operational measures of health literacy that would include contextual measures.

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Adler NE, Ostrove JM. 1999. Socioeconomic status and health: What we know and what we don’t. Annals of the New York Academy of Sciences. 896: 3–15.

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American Medical Association. 1999. Health literacy: Report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. Journal of the American Medical Association. 281(6): 552–557.


Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. 1999. Development of a brief test to measure functional health literacy. Patient Education and Counseling. 38: 33–42.



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