Focus on: Health Literacy

To find out what’s going on in the growing field of health literacy, NLM in Focus spoke with resident expert Rob Logan, PhD, in the Office of Communication and Public Liaison at NLM. Logan is the co-editor of a new book on health literacy research and practice.

What are the main points you want the public to know about health literacy?

Health literacy has an impact on your health and life expectancy as well as your ability to cope with and navigate the health care delivery system.

Yet few people are “proficient”—that’s the actual term—or are health literate. The last US national assessment suggests only about 12 percent of the population is health literate, or proficient.

What about the rest of the world?

It’s about the same in the countries in the world where health literacy has been measured.

Sadly, I suspect health literacy may be low everywhere.

Did that surprise you?

Talking with a pharmacist

Better health literacy helps you navigate the health care system.

It saddened me.

Poor health literacy is a global concern.

Health literacy is important to you—whoever you are.

Better health literacy helps you use the health care delivery system. It improves your ability to communicate with a physician or health care provider. It improves your ability to cope. And it very much improves your ability to understand the directions that you’re given, or to demand an explanation when they aren’t clear. It even gives you self-confidence.

Better health literacy also can motivate you to get well. That seems to be the case for people who have acute and chronic illnesses. Recent research suggests improved health literacy therapeutically impacts both.

Who are your heroes in the field of health literacy?

Ceci and Leonard Doak, whom many consider to be the founders of contemporary health literacy, studied the reading skills of adults and hospitalized patients. The Doaks, along with Jane Root, co-authored the landmark book Teaching Patients with Low Literacy Skills, first published in 1985.

The Doaks’ compiled many observational studies based on their health educational practices. They visited NLM in the 1970s to go through the stacks, seeking then-very-hard-to-find prior research, information, and guidance.

I’m pleased the Doaks’ papers now are part of NLM’s History of Medicine collection.

Although retired, Ceci Doak still coaches me on health literacy issues and remains an inspiration to many other health literacy practitioners.

What’s your favorite definition of health literacy?

That’s a good question.

There are a lot of health literacy definitions.

My favorite, called the Calgary Charter, is a long one, but it’s more multidimensional than other definitions. The Calgary Charter defines health literacy this way:

Health literacy allows the public and personnel working in all health-related contexts to find, understand, evaluate, communicate, and use information.

Health literacy is the use of a wide range of skills that improve the ability of people to act on information in order to live healthier lives.

These skills include reading, writing, listening, speaking, numeracy, and critical analysis, as well as communication and interaction skills.

What makes the field of health literacy so unique?

Health literacy is both a social and a structural determinant of health. Social determinants refer to the demographic influences on health status, such as gender, race, income, and education. Structural determinants reflect the areas within the health care system that impact health and patients, such as errors in hospital care.

While there are many social and structural determinants of health, health literacy straddles both dimensions. It is the only health determinant that does so. As a result, health literacy’s impact on life expectancy and overall health is distinctive and robust.

What’s the health literacy roundtable?

The Institute of Medicine started a health literacy roundtable in 2006. Today, the roundtable is called the National Academies of Sciences, Engineering, and Medicine Roundtable on Health Literacy.

Its goals are to provide leadership in understanding health literacy as well as encourage innovative health literacy research and practice. A chapter in the book reports some of the Roundtable’s initiatives.

I’m an occasional participant in the Roundtable’s activities and several Roundtable members are authors in the new health literacy book. It’s fair to say that the Roundtable’s initiatives and leadership helped inspire the book.

What’s going on internationally?

Cross-borders health literacy research is funded by the European Union and is active in Europe. There is a chapter in the book that summarizes some of the findings.

A doctor discusses test results with her patient

Health literacy supports integrative health care.

The International Health Literacy Association (IHLA) was founded in October 2016 in Geneva, Switzerland. I was a happy participant and now understand why so many relish attending international meetings there.

IHLA is the first international academic and professional association devoted to health literacy research and practice.

Currently, IHLA has about 350 members from North America, the Middle East, Western Europe, Asia, and Africa. IHLA also collaborates with existing health literacy organizations in several nations as well as similar professional societies.

While I hope IHLA’s conferences bring together global health literacy practitioners and researchers in the future, right now the association is in its formative stage.

How can we better respond to health literacy needs in the future?

First, there is no question that the fields of health education and health literacy need to work together.

Initially, I suggest we need to focus on improving the health education of students from K-12 as well as undergraduate students in colleges and universities in the US and other nations.

A doctor consults with his patient and her spouse

Health literacy efforts need to be encouraged.

Next, we need to encourage the use of an evidence base to provide better health and medical information to the public. This means outreach efforts with health journalists, the news media, as well as the public information officers (who represent pharmaceutical, health product companies, universities, as well as medical organizations). In this regard,’s criteria to improve health news releases and medical news reporting represent a highly constructive step.

In addition, health literacy efforts need to be encouraged within local clinics, hospitals, medical centers, and governmental as well as non-governmental agencies.

And, of course, there’s a key role for pharmaceutical companies, the medical products industry, and insurers. Commendably, some pharmaceutical and medical products companies, as well as insurers, recently enhanced their patient materials. In some cases, these improvements were part of a collaboration with leading health literacy researchers, such as Ruth Parker, MD, of Emory University School of Medicine, and Professor Rima Rudd of the T.H. Chan School of Public Health at Harvard University.

Still, all of health’s stakeholders have a responsibility to improve the public’s health literacy.

On another front, we need better research about health literacy’s impact on medical outcomes and the utilization of the health care delivery system. Currently, it is difficult to determine the comparative degree that health literacy contributes to the structural and social determinants of health within the US and other countries.

Is health literacy a robust predictor of health outcomes and quality of life compared to other demographic and structural variables? More specifically, does health literacy predict an adult’s health status better than his or her educational level, income, and access to health insurance?

At the moment, while researchers have an array of mixed findings regarding these and related research questions, there is a dearth of definitive evidence.

What else do you want to add?

Book cover for Health Literacy: New Directions in Research, Theory, and PracticeThe only thing I’d add is health literacy is a key part of a movement toward more integrative health care in the US and abroad. I’m inspired by health care organizations and public health agencies that elevate both the health and quality of life of individuals, families, and surrounding communities. I suggest better health literacy is one of the elements that contributes to their success and trust the book helps students, health professionals, and others who wish to participate.

Robert A. Logan of NLM and Elliot Siegel, former director of NLM’s Office of Health Information Programs Development, are co-editors of the book Health Literacy: New Directions in Research, Theory and Practice, which was published in 2017 by IOS Press.

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