Low Health Literacy: A Major Blow to Patient Outcomes

According to Shahid et al., more than 43 million Americans have inadequate health literacy. Another study, by the Milken Institute, found that at least 88 percent of adults living in the US have health literacy inadequate to navigate the healthcare system and promote their well-being. Health literacy, which is a stronger predictor of poor health than age, race, income, employment status, or education level, is defined by Shahid et al. as “personal knowledge and competencies which enable people to access, understand, appraise, and use information and services in ways which promote and maintain good health and wellbeing for themselves and those around them”. They also estimated that patients with low health literacy add an additional $106-238 billion cost to the US healthcare system, which may represent over 15% of all personal healthcare expenditures. 

The authors above throughout their research followed patients with inadequate health literacy, marginal health literacy, and adequate health literacy. They found that patients lacking adequate health literacy were significantly more likely to revisit the emergency room within 90 days of discharge from the hospital. See table 2 below. According to the World Health Organization, since health literacy is built up in individuals via a variety of societal factors, it is not the sole responsibility of individuals to develop and maintain. They advocate for honest, trustworthy, and understandable materials to be disseminated from the governments, national health services, and civil society. 

The World Health Organization suggests the following four steps to improve health literacy rates: First, improve organizational health literacy by improving training to strengthen communication, informed decision-making, and increase access to culturally and linguistically appropriate health information. Secondly, increase professionals’ health literacy through more regular, continued training of healthcare professionals. Third, improving personal health literacy through implementing educational programs at an early age (even before school), all throughout school from kindergarten up, throughout college curricula, and even into adult educational programs. Lastly, they would like to see more assessment of health literacy in communities, since there won’t be relevant policy changes unless the problem is addressed.

I think that the WHO’s sentiment here is great, but they don’t give any solid plans of how to achieve these goals. We’ve talked so much about how emergency room visits are a big indicator of healthcare expenditure and the system in general, because it shows difficulty in seeing a provider regularly. When dealing with low health literacy, this could be for a variety of reasons, but the fact stands that having low health literacy leads to worse, and oftentimes, more expensive outcomes for patients and health systems. I think their idea of education at all levels is great, as I only had maybe two years of a health class while in grade school, and it was spent mostly discussing mental health. Ensuring general public adults continue education is an impossible task, though. Healthcare is changing so rapidly that it’s impossible to keep up, and I don’t see a way to require education beyond grade school. In addition, I don’t see a guaranteed way to ensure that all information being disseminated by and to the general public is accurate, trustworthy, safe knowledge. Social media complicates this issue infinitely, but also simplifies it if people know how to use it. 

Table 2: Impact of low health literacy on patients’ health outcomes: a multicenter cohort study

Outcomes of interest according to health literacy of the study participants

Outcomes of Interest

N (%)

167

Inadequate %

Marginal %

Adequate %

P value

ER Revisit





< 0.05

 No revisit

129 (77)

27.9

16.3

55.8


 1 or more than re-visit

38 (23)

47.4

21.1

31.6


Hospital Readmission





> 0.05

 No readmission

117 (70)

29.1

15.4

55.6


 1 or more readmission

50 (30)

40.0

22.0

38.0


Length of Stay in Days (mean, SD)

17.45 (23.01)

19.63 (21.32)

20.24 (27.95)

15.03 (22.20)

> 0.05

Length of Stay in Days (median, IQR)

9.00 (15.00)

12.50 (17.50)

13.00 (18.00)

7.5 (12.00)

> 0.05

Comments

  1. Emily HerumApril 2, 2026 at 5:51 AM

    https://www.amjmed.com/article/S0002-9343(23)00035-9/fulltext
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9465902/
    https://www.who.int/news-room/fact-sheets/detail/health-literacy

    ReplyDelete

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