Does Health Literacy Trump Health Care Reform In Terms Of Importance?

Thursday, July 20, 2017 | Larry Sobal

Does Health Literacy Trump Health Care Reform In Terms Of Importance?


The health care debate rages on in Washington with seemingly no end in sight. Here’s an idea that could potentially break the partisan impasse: what if we focused our national energy on health literacy instead of continuing to argue about insurance reform?

Before you dismiss my idea, consider the following. Health literacy—defined as the ability to obtain, process, and understand basic health information and services to make appropriate health decisions—is essential to promoting healthy people and communities. We can repeal or replace the Affordable Care Act, we can begin paying for health care in Alternative Payment Models, we can build all kinds of physician compensation plans linked to quality, and quadruple the number of ACOs, and none of it will matter very much if patients can’t understand treatment plans enough to be compliant.

Two decades of research indicate that today’s health information is presented in a way that isn’t usable by most Americans. Nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely made available by physicians and other providers, and handed out in our health care facilities, retail outlets, media, and communities, or accessed online. According to the report, Low Health Literacy: Implications for National Policy, low health literacy is estimated to cost the U.S. economy between $106 billion and $238 billion each year. This equates to between 7 percent and 17 percent of all personal health care costs.

Without clear information or an understanding of prevention and self-management of conditions, people are more likely to skip necessary medical tests, not take prescribed medications, go to the emergency room more often, and have a hard time managing chronic diseases.

Health literacy affects people's ability to:

  • Navigate the health care system, including filling out complex forms and locating providers and services
  • Share personal information, such as health history, with providers so that an effective dialogue takes place and accurate diagnoses and treatment plans are made
  • Engage in self-care and chronic disease management, and know when to seek medical care versus not, or what type of medical care is appropriate
  • Understand basic mathematical concepts such as probability and risk when making critical health care decisions

Yes, health literacy includes numeracy skills: calculating cholesterol and blood sugar levels; measuring medications; understanding nutrition labels; choosing between health plans; comparing prescription drug coverage; and calculating premiums, co-pays, and deductibles.

In addition to basic literacy skills, health literacy requires knowledge of health topics. People with limited health literacy often lack knowledge or have misinformation about the body as well as the nature and causes of disease. Without this knowledge, they may not understand the relationship between lifestyle factors such as diet and exercise and various health outcomes.

Health information can overwhelm even persons with advanced literacy skills. Since medical science progresses rapidly, what people may have learned about health or biology during their school years often becomes outdated or forgotten, or is incomplete. Moreover, health information, often provided in a stressful or unfamiliar situation, is unlikely to be retained.

Low health literacy is estimated to cost the U.S. economy between $106 billion and $238 billion each year.

But is there a clear correlation between health literacy and health status? Fourteen percent of adults (30 million people) have low health literacy. These adults are more likely to report their health as poor (42 percent) and are more likely to lack health insurance (28 percent) than adults with proficient health literacy. Furthermore, low literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services (see Fact Sheet: Health Literacy and Health Outcomes). Both of these outcomes are associated with higher health care costs.

It’s important to note that the definition of health literacy is moving away from a sole focus on clinical risk to include empowerment or “social and environmental factors that enable individuals to have greater control over health.” This shift helps us focus on how social and economic factors work in tandem to impact population level health. 

So, where would we start? Drawing upon the initial health literacy research and involving the community in programs and projects may be the best formula for success in improving health literacy. Health care organizations and their clinicians are encouraged to develop interdisciplinary teams that include communication experts, marketing professionals, visual designers, health information technology experts, and librarians to deliver oral, visual, print, and Internet-based information. Developing these materials will require teams to consider the specific needs of the populations they serve. This practice will result in clear, tailored health information that will best serve each population.

A very specific area for improvement is with the communication style health care professionals, who have their own culture and language. Many adopt the “culture of medicine” and the language of their specialty as a result of their training and work environment. This can affect how physicians and other health professionals communicate with the public, and can negatively impact patient understanding. Whether you say “hypertension” as opposed to “high blood pressure” is just one small example of how clinical language can contribute to poor health literacy.

One exercise I recommend is to print out your various forms of patient education and tape them all up on a wall. You may find the following:

  • Some have been photocopied so many times they are barely legible
  • Some are outdated, and not current with your existing processes or do not follow current evidenced-based practice
  • Some use old logos and formats, causing patients to wonder which organization they actually came from
  • Some contradict themselves or offer confusing instructions
  • Some have lengthy written descriptions of processes that are better explained with pictures or video

At a time when political health care rhetoric seems to be focused on insurance reform and not on how to fundamentally create higher quality care at a lower cost, maybe health literacy is the type of effort that can motivate significant bipartisan thinking and collaboration. At least it seems to be a better alternative to what we are spending time on right now. What do you think? 


Illustration: Lee Sauer


Larry SobalLarry Sobal is Executive Vice President and a Senior Consultant at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and health insurance. Larry consults, writes and presents on topics relevant to transforming physician practices and health systems. His weekly blog post comes out on Thursdays and can be accessed at


About the Author
Larry Sobal

Larry Sobal, MBA, MHA, is CEO of a yet-to-be-named cardiology practice which is transitioning from employment to an independent physician group effective January 1, 2019. He has a 37-year background as a senior executive in physician practices, consulting, medical group leadership, hospital leadership and health insurance.

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