U.S. Literacy Woes Lead to Poorer Health

Published on
November 27, 2013

Last month the Wall Street Journal reported on a new study from the Organization for Economic Cooperation and Development that found the U.S. ranked 16th out of 23 industrialized nations when it came to literacy. That puts the U.S. just ahead of Poland and just behind Austria.

That unimpressive ranking isn’t made any less worrisome by looking at the raw numbers: an estimated 30 million U.S. adults, or about 14%, lack basic prose literacy, according to the most recently available national data.

Illiteracy isn’t just an inconvenience. Research has shown that a lack of basic reading skills lowers one’s chances of graduating high school, which in turn influences how much money a person makes, where they live, how healthy they are, and how long they live.

Some of the statistics from grade-schoolers are jaw dropping: According to 2011 figures, 68% of fourth-graders were “below proficient” in reading. (Definitions can be tricky, however: The figure for fourth-graders who are “below basic” in reading is a more modest 34%.)

For African American fourth-graders, the percentage of less-than-proficient readers jumps to 84%. The numbers are similarly high for Hispanic and American Indian students. Nor are the disparities limited to race. Among low-income fourth-graders, 82% lacked reading proficiency, compared to 52% of higher-income students.

Today’s struggling reader can easily become tomorrow’s drop out: Of those who lack basic prose literacy, 55 percent didn’t graduate high school. That’s compared to 15 percent of the overall population.

Not graduating from high school, as one might expect, has a big impact on everything from chronic disease rates to overall well-being. The correlation between higher levels of educational attainment and better health (and health care cost savings) is now supported by ample research.                                                                                           

Pointing to work done by Dr. Peter Muennig of Columbia University, a 2006 report lays it bare:

The consequences of educational disparities are striking: adults with low educational attainment are more likely to die precipitately from cardiovascular disease, cancer, infection, lung disease, and diabetes, for example.

It’s not hard to understand some of the reasons why. Less education lowers the chances that you have medical insurance, which translates into less medical care and worse health outcomes. Those with more education also tend to make more money, which affords healthier, safer neighborhoods, and are able to make better choices when it comes to diet and exercise. Money alone won’t make you healthy, but it makes it much more likely you will be.

But for those unable to read basic documents, many of the health risks are much more immediate than that. Prescription bottles and care instructions become ciphers, health insurance paperwork a meaningless maze.

In the New England Journal of Medicine, a doctor describes her astonishment at discovering the reason why one of his patients wasn’t taking his medications was because he couldn’t read.

We had tried to avoid jargon and to use simple language in explaining our instructions, and he had seemed to understand everything we had told him. He had seen scores of doctors, nurses, and social workers over the years without anyone's guessing he had a reading problem.

A recent NPR report on adult illiteracy features a health educator who explains the kinds of strategies she uses with patients who can’t read.

“We use illustrations for medicines — we would draw the sun and the moon as to when to take the medicine. Sometimes we help them put it in the pill boxes because they can't count either."

It’s not just medical labels and documents that pose a health challenge. Food packaging can be equally inscrutable for the illiterate. It’s hard to eat healthy when you can’t be sure what’s in what you’re buying.

The broader problem of health illiteracy results in huge costs for the U.S. health care system. A 2003 survey found that 36% of U.S. adults had either basic or below basic health literacy and estimated that low health literacy was costing the U.S. economy somewhere in the range of $106 billion to $238 billion dollars.

Adult education offers one obvious route for remedying illiteracy after students leave behind K-12. But as the NPR story notes, funding for adult education pales in comparison to other education programs. According to the National Coalition on Literacy, funding for adult literacy is less than one-eighth of the funding for Head Start and serves only about 3% of the adults who need it.

Funding isn’t the only problem. A 2009-10 survey found that three-quarters of adult education programs had a waiting list, with 160,000 student-hopefuls on the lists -- twice as many as in 2008.

In response to last month’s OECD report that found the U.S. languishing in literacy, numeracy and problem-solving, the New York Times editorial board argued that other nations have been far more pro-active in improving teacher training and expanding access to quality education.

“The United States, by contrast, has yet to take on a sense of urgency about this issue. If that does not happen soon, the country will pay a long-term price,” the editorial concluded.

While many argue that making sure children leave elementary school as proficient readers should be a first-order priority, it’s clearly not happening yet. Better funding would require political will, and illiterate children and adults aren’t exactly the loudest constituency.

Image by jepoirrier via Flickr