approaches to health literacy, health disparities and health literacy, and health IT. All of the presentation slides are available on the conference website.3 A special issue of the Journal of Health Communication, guest edited by Paasche-Orlow, Lauren McCormack, and Elizabeth Wilson, reported on the HARC meeting and was published in September 2010, with free full text access online for 6 months.4 HARC II took place October 18-20, 2010, during the preparation of this report.
Limited health literacy has been linked to worse health outcomes for a range of medical conditions, Paasche-Orlow said. In addition, limited health literacy is more prevalent in specific racial and ethnic minorities. Although these findings have been widely acknowledged, little systematic research has been conducted to elucidate the role of health literacy in the creation of health disparities or to evaluate the possibility that interventions relating to health literacy may help eliminate health disparities.
In thinking about underlying contributions to health disparities, one perspective is that unneeded complexity in public health and health care systems transforms underlying educational disparities in our society into health disparities. Therefore, health literacy can be a roadmap to developing interventions to address health disparities. To differentiate the pathways through which people experience worse outcomes, both health disparities and health literacy need to be measured.
In a study of 204 patients with HIV, an initial analysis did not include literacy (Osborn et al., 2007). Results appeared to show that African American patients were much more likely to not adhere to their HIV medication regimen than whites. But when literacy was controlled for, the race effect diminished. The literacy variable was the only significant independent predictor of nonadherence. Those two very different results would lead to different types of interventions.
In a second study, patients were asked their preference regarding end-of-life care if they developed advanced dementia (Volandes et al., 2008). In an analysis that did not consider health literacy, African-American subjects appeared to be much more likely to want more aggressive care at the end of life. A handful of other studies support this conclusion. But the studies typically do not control for socioeconomic factors, and certainly not literacy. When controlling for health literacy in the study by Volandes and colleagues (2008), the race finding evaporated, and health literacy was found to be the dominant predictor of wanting more aggressive care at the end of life. Finally, when subjects were shown an educational video, differences by race as well as health literacy dropped. The preference for