Press Release Date: March 28, 2011

Low health literacy in older Americans is linked to poorer health status and a higher risk of death, according to a new evidence report by HHS’ Agency for Healthcare Research and Quality (AHRQ). More than 75 million English-speaking adults in the United States have limited health literacy, making it difficult for them to understand and use basic health information.

The report, an update of a 2004 literature review featuring findings from more than 100 new studies, also found an association between low health literacy in all adults, regardless of age, and more frequent use of hospital emergency rooms and inpatient care, compared with other adults.

The report’s authors also found a link between low health literacy and a lower likelihood of getting flu shots and of understanding medical labels and instructions and a greater likelihood of taking medicines incorrectly compared with adults with higher health literacy. They also found evidence linking poor health literacy among adult women and underuse of mammograms.

Furthermore, evidence from a small but growing body of studies suggests that differences in health literacy levels are related to racial and ethnic disparities. For example, flu shot rates among seniors, enrollment of children in health insurance programs and taking medications as instructed by a health care professional are lower among minorities.

“Ensuring that people understand health care information is critical to a high-quality, safe health care system,” said AHRQ Director Carolyn M. Clancy, M.D. “Improving health literacy will be a major step in the nation’s efforts to enhance health care quality and safety.”

In addition, the authors, who were led by Nancy D. Berkman, Ph.D., and Stacey Sheridan, M.D., M.P.H, of the AHRQ-supported RTI International-University of North Carolina Evidence-based Practice Center, concluded that intensive self and/or disease management programs appear to reduce disease severity, emergency room visits and hospital admissions among patients with limited health literacy.

In May 2010, the U.S. Department of Health and Human Services (HHS) launched the National Action Plan to Improve Health Literacy to engage organizations, professionals, policymakers, communities, individuals and families in a linked, multi-sector effort to improve health literacy.

The plan calls for improving the jargon-filled language, dense writing, and complex explanations that often fill patient handouts, medical forms, health web sites and recommendations to the public. Among the other objectives of the plan are promoting changes in the health care system that improve health care information, as well as improving patient-provider communication, low health literacy individual’s ability to make health care decisions based on evidence, and access to health care. Information on the plan is available at

The report, Health Literacy Interventions and Outcomes: An Update of the Literacy and Health Outcomes Systematic Review of the Literature is available on the AHRQ Web site at For more information on AHRQ funding, studies, tools and other resources related to health literacy and cultural competency, go to

For more information, please contact AHRQ Public Affairs: (301) 427-1539 or (301) 427-1859.

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Low Health Literacy Linked to Higher Risk of Death and More Emergency Room Visits and Hospitalizations. Press Release, March 28, 2011. Agency for Healthcare Research and Quality, Rockville, MD.