15 May 2013 ~ 0 Comments

Aging Americans and Health Literacy

Author: admin

By Marilynn J. King, a graduate research assistant with MOHEC and the Center for Health Policy.

As we age, certain skills and abilities change – including physical and cognitive deterioration that can impact our health and sense of well-being. The challenges that can happen along with the aging process often find us unprepared to navigate the medical and health service systems necessary for treatment of the major illnesses, ailments, and diseases associated with growing older. Perhaps we have spent the majority of our lifetime relatively healthy and rarely needed to engage with doctors, hospitals, public health systems, pharmacies and medical insurance providers. For most of us, health treatment occurs sporadically and predictably throughout our lives, but that pattern can change dramatically as we age. For others, chronic or life-threatening illnesses occur earlier in life, and these individuals, too, must access and navigate health care systems. How they access and navigate care is related to health literacy. A person’s health literacy level directly affects how successful those engagements are and the quality of life that is available to them. Currently senior citizens in America, have the lowest health literacy levels of any age group (National Alliance for Caregiving, 2009).

What is Health Literacy?

The World Health Organization explains:

Health Literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to understand and use information in ways which promote and maintain good health. Health Literacy means more than being able to read pamphlets and successfully make appointments. By improving people’s access to health information and their capacity to use it effectively, health literacy is critical to empowerment. (WHO, 2013)

Many factors go into a person’s level of health literacy, but as health equity advocates, the term primarily concerns people’s ability to access, understand and use medical information and health care. The term was first used in 1974 by S.K. Simonds in the context of establishing health education in grade schools. The relationship between literacy, health behavior and outcomes gained attention following WWII as the health issues of returning soldiers became a national concern (Huber, Shapiroll & Gillaspy, 2012).

Two Approaches

Approaches to understanding and addressing low health literacy levels can broadly be divided into two areas of focus and orientation – the clinical and public health approaches (Pleasant & Kuruvilla, 2008). The clinical approach concerns efforts by those within the medical profession to increase patient’s understanding and compliance with their medical treatment. Recognizing the relationship between the health literacy levels of their patients and the ability to positively affect health care and outcomes is important. It enables health providers to adapt their patient practices, such as using plain language to give medical instructions and other communications. By communicating as clearly and as plainly as possible to patients, health care providers have been able to successfully overcome some of the barriers patients face.

The other approach to health literacy, the public health orientation, involves efforts to identify, understand and implement programs to increase health literacy levels. The main way of improving health literacy is through education, communication and health policy initiatives aimed at raising awareness about the connection between health outcomes and people’s ability to understand their health behavior and its consequences. The goal is to educate and empower people so they will make better health decisions throughout their lifecycle and not just around health crises and traumatic incidents.

Consequences and Costs

Low health literacy has consequences, on an individual level and on a societal level, as reflected in the increasing incidence of health care needs, as well as in the escalating costs associated with health care services. Low health literacy is prevalent across all sectors of society. Almost half of all Americans have difficulty understanding and acting on written and verbal health information. For American age 65 or older, one-third of them have below basic health literacy levels and the cost to the national economy has been estimated to be between $106 – 238 billion per year (Kutner, Greenberg, Jin & Paulsen, 2006). Due to deteriorating cognitive skills and the general decline in health that can happen through the aging process, seniors are particularly vulnerable to the effects of low health literacy.

It is projected that by 2030, twenty percent of Americans will be 65 years or older; the health literacy level of that population will have a profound effect on all aspects of our society and we are called to increase our efforts in understanding and improving health literacy interventions to meet those challenges. There are many useful resources available to help us gain a better understanding of the important issues facing us as an aging nation. The list provided below is a great place to start –

  • National Council on Aging Center for Healthy Aging


Huber, T., Shapiroll, R.M. & Gillaspy, M.L. (2012). Top down versus bottom up: The social construction of the health literacy movement. The Library Quarterly, University of Chicago Press, 82(4) 429 – 451.

Kutner, M., Greenberg, E., Jin, Y. & Paulsen, P. (2006). The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy. U.S. Department of Education, Institute of Education Sciences, national Center for Education Statistics. Accessed at http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483

National Alliance for Caregiving. (2009). Caregiving in the U.S., A focused look at those caring for someone age 50 or older, Executive Summary. In collaboration with the American Association of Retired Persons and MetLife Foundation. Accessed at www.caregiving.org

Pleasant, A. & Kuruvilla, S. (2008). A tale of two health literacies: public health and clinical approaches to health literacy. Health Promotion International, 23(2), 152 – 159. DOI: 10.1093/heapro/dan001

World Health Organization. (2013). Track 2: Health literacy and health behaviour. 7th Global Conference on Health Promotion. Accessed at http://www.who.int/healthpromotion/conferences/7gchp/track2/en/

The opinions and views expressed in this blog and/or comments are those of the author(s) and do not reflect any position of the Center or the University.

Marilynn J. King is a Graduate Research Assistant with MOHEC and the Center for Health Policy at the University of Missouri – Columbia.  She is enrolled in the Rural Sociology Master’s program at MU and has been actively involved over the past three years in assisting her aged parents navigate their health issues, including end-of-life care for her beloved, and greatly missed father last September.

Leave a Reply

You must be logged in to post a comment.