Patients are often confused. Health care providers often don’t know it.
Many people are not aware of the problem of marginal literacy, which means being able to read, but not with real skill. Individuals fall into poor health for many reasons. There also are many reasons why people fail to follow through on what their health care providers ask them to do. One main reason for both of these issues can be linked to reading skills. More people than we think do not read well. In recent years, researchers have shown that reading skills make a difference when it comes to staying healthy. This has been proven in a number of health conditions. Diabetes is one. Asthma is another.

The issue affects Americans of all races.
In 2003, the U.S. Department of Education released the results of its National Assessment of Adult Literacy (NAAL). The NAAL measured reading and math skills of thousands of adults in the U.S. The results showed that 43 percent of adults in the U.S. are performing at the two lowest levels of literacy. This figure includes people of all races and ages, white and black, young and old. Many adults in the U.S. are not at ease dealing with words and numbers in print.

But this is a special issue for African Americans.
The NAAL also looked at reading skills by race and ethnic group. It showed that an even greater percentage of African Americans — 67 percent — were performing at the two lowest levels of literacy. Now, this is not something that African Americans want to hear. Who wants to be labeled as not being able to do well in skills such as reading or math? To understand this, we need to take a look back in time.

For African Americans, history may tell us why.
If reading skills have been a concern, this should come as no surprise. According to Cecelia McCall, a noted professor of English, African Americans are “the only Americans who were deliberately, legally and systematically prevented from having access to the book.” They are “the only Americans who had to litigate for what other Americans took for granted — decent schools.” In fact, she reminds us that during slavery, many African Americans risked punishment and even death by learning to read.

But there’s also good news: Reading scores for blacks have gone up in the 10 years since the last national survey was conducted. So the gap is closing.

Shame can get in the way of good health care.
People go out of their way to hide from their doctors that they can’t read well. This is true no matter what a person’s age or race. Researchers have shown that “because of the shame that they hold, some patients may be intimidated and less likely to ask questions or admit they do not understand.”

Confusion and shame should not be mistaken for lack of interest.
Sometimes patients don’t do what they agree to do. And some health care providers assume this is because patients don’t care. But, many such people do care. They simply struggle in silence. So, casting blame is not helpful. Providers can begin to look more closely for signs of confusion.

Staying healthy can be hard. It often calls for strong reading skills.
People have to do many things to manage their health. They need to fill out forms to get care. They need to read complex instructions before tests can be done. They need to take the correct amount of medication at the correct time. Yet, many instructions and forms are written for very strong readers. This makes it hard for the thousands of people who are not strong readers to manage their health care.

When people don’t read with ease, the health results can be serious.
People who do not have strong reading skills are more likely to end up in the hospital. They are more likely to need treatment for illnesses that could have been prevented. They also are more likely to die sooner because of their health problems.

Even people with strong reading skills often need special attention.
A person can have strong general literacy skills and still have low health literacy skills. Why? Because even people with strong literacy skills can find health information confusing. Providers should not assume that people who are good readers also are clear about how to manage their health care. People often are confused by medical words and concepts. They may be unclear about what to do and why to do it. They read well. But, they are just not familiar with complex health care issues and systems. They have low health literacy.

Steps can be taken to address the issue.
Marginal health literacy is a serious problem. Steps can be taken to correct it:

• Expand awareness across the nation about this issue.
• Create policies to provide health care information that is easy to read, follow, understand and relate to.
• Support health care providers in communicating more clearly.
• Support efforts to improve the literacy skills of both children and adults.
• Push for more research and funding to find and apply more solutions.

The more we do together to address this issue, the healthier a society we will become. It just takes a little dose of understanding.