Health disparities: Numeracy and literacy

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Literacy and numeracy play an important role in health outcomes and health disparities. People with lower literacy and numeracy skills are more likely to have trouble understanding health information, navigating healthcare systems, and managing medical conditions.
Understanding literacy and numeracy begins with recognizing what these skills are, how they influence health, and why some populations face greater barriers than others.
Recognizing these challenges also highlights practical ways healthcare professionals can improve communication, support patient understanding, and promote more equitable care.
Let's begin by defining these two concepts. Literacy is the ability to read, understand, and use written information.
Numeracy is the ability to understand and use numbers and mathematical concepts in everyday life. In healthcare, these skills are applied through health literacy and health numeracy.
Health literacy is the ability to obtain, understand, and use health information and services to make informed decisions about health.
Health numeracy is the ability to understand and use numerical information in healthcare, such as medication schedules, BP readings, laboratory values, and risk information.
Together these skills help patients understand medical instructions, navigate the healthcare system, make informed decisions, and manage their health more effectively.
When literacy or numeracy is limited, these tasks become much more difficult. Let's go over a case to see why these skills are so important.
Isaiah is a middle-aged man with a family history of hypertension. He has limited literacy and numeracy skills, making it difficult for him to read and understand written health information.
Isaiah visits his primary care clinic for a routine health evaluation. At registration, he's asked to complete several forms.
Embarrassed that he's unable to read them, he spends several minutes pretending to fill them out before asking a staff member for help.
The delay makes him increasingly anxious and results in a more rushed office visit. During the visit, his BP is found to be consistently elevated on repeat measurements, and he is diagnosed with hypertension.
Before discharge, he receives a prescription for medications along with written information about his condition, lifestyle changes, and instructions for taking his medication.
Isaiah thanks the healthcare team but never reads the educational materials. He's unsure how often to take his medication, what his target BP should be, or when he should seek medical attention.
Rather than admitting he's confused, he leaves. Several weeks later, Isaiah returns for a follow-up appointment.
His BP remains elevated. It becomes clear that he's been taking his medication inconsistently and has not made the recommended lifestyle changes, not because he was unwilling, but because he didn't fully understand the information he had been given.
At first glance, it might be easy to assume that Isaiah simply chose not to follow his treatment plan. However, his experience highlights how a limited literacy and numeracy can create barriers to understanding health information, navigating the healthcare system, and managing disease.
Understanding literacy and numeracy also involves thinking about the broader factors that influence these skills and shape a person's ability to interpret and use health information.
Educational opportunity is one of the strongest influences here. People who have limited access to high quality education, including those growing up in under-resourced communities, may have fewer opportunities to develop reading, writing, and numerical skills.
These differences can persist throughout adulthood and influence many aspects of health and healthcare. Socioeconomic status also plays an important role.
People experiencing socioeconomic disadvantage may have reduced access to educational opportunities, healthcare, transportation, technology, and other resources that support learning.
In turn, limited literacy and numeracy may reduce employment opportunities and earning potential, reinforcing a cycle that can be difficult to break.
The relationship is bidirectional. Poor health during childhood may disrupt learning through frequent school absences, disability, or untreated vision or hearing problems.
These barriers can affect educational attainment and literacy and future socioeconomic opportunities. Finally, the language itself is very important.
People with limited proficiency in the primary language used by the healthcare system may have difficulty understanding health information, completing forms, following medical instructions, or navigating care.
This challenge is distinct from literacy, but the two often overlap. Recognising the impact of literacy and numeracy on health has led to important efforts to improve education, communication, and access to health information.
Because these disparities are influenced by educational, social, and economic factors, meaningful solutions require action beyond individual patient encounters.
One important approach is improving access to high quality education throughout life. Early childhood education, strong public schools, adult literacy programs, and continuing education can help build the reading, writing, and numerical skills needed to make informed health decisions.
Healthcare systems have also begun adopting organizational health literacy practices. These include using plain language patient education materials, improving language access services, developing easier to navigate healthcare systems, and creating written and visual resources that are accessible to people with a wide range of literacy and numeracy skills.
Lastly, community organizations play an important role by providing health education, literacy programs, and support services that help people better understand and use health information.
Although these system level efforts are essential, healthcare professionals should support patients during everyday clinical encounters.
Difficulties with literacy and numeracy are not always obvious during a clinical encounter. Many patients develop strategies to compensate for or even hide difficulties with reading, writing, or understanding health information because they feel embarrassed, fear being judged, or have just always managed on their own.
For this reason, many healthcare organizations recommend using universal precautions for health literacy. This means healthcare professionals should assume that every patient may have difficulty understanding health information and communicating clearly with everyone, rather than trying to identify who might struggle.
At the same time, healthcare professionals should remain alert for observational cues that a patient may need additional support.
Patients may leave forms incomplete, say they forgot their glasses, ask a family member to read written materials, or have difficulty explaining how they take their medications.
These observations should prompt supportive communication, not assumptions about a patient's intelligence, motivation, or educational background.
When additional assessment is needed, validated screening tools such as the brief health literacy screen or the newest vital sign can help identify patients who may benefit from extra support.
Screening should always be performed respectfully and with a plan to address identified needs. Open-ended non-judgmental questions can help identify barriers rather than asking, do you understand?
Clinicians could ask, what questions do you have about what we've discussed today? or what concerns do you have about following this plan.
These questions encourage patients to share areas of uncertainty without feeling embarrassed or judged. Alright, recognizing barriers is only the first step.
The next one is communicating in ways that support every patient's understanding. Effective communication is an essential part of patient-centered care and benefits every patient regardless of their literacy or numeracy skills.
Several communication strategies can improve understanding and support informed decision making. One of the most effective strategies is plain language.
Plain language presents information using simple, familiar words rather than unnecessary medical jargon, with emphasis placed on a few key messages instead of large amounts of information.
Another important strategy is the teachback method. During teachback, patients explain the information in their own words or describe how they'll take their medication.
Teachback helps identify misunderstandings and provides an opportunity to clarify information before the patient leaves.
Visual aids can also improve understanding. Pictures, diagrams, medication schedules with symbols, and other visual tools often communicate complex information more effectively than written text alone, particularly for patients with limited literacy and numeracy.
Communication is also most effective when it's culturally and linguistically appropriate. Patient education materials should be available in commonly spoken languages whenever possible, and professional interpreters should be used when language barriers exist.
Beyond individual patient encounters, healthcare professionals can also advocate for clearer communication within their organizations by supporting accessible patient education materials, and helping create healthcare systems that are easier for everyone to understand and navigate.
Now in Isaiah's case, the healthcare team could have recognized his literacy and numeracy challenges, confirmed his understanding using Teachback, and provided information in a way he could understand.
This way he might have been better prepared to manage his BP after leaving the clinic. Although communication alone cannot eliminate every barrier, it can significantly improve patient understanding, engagement, and health outcomes.
All right, as a quick recap. Literacy and numeracy, and their application in healthcare through health literacy and health numeracy, influence a person's ability to obtain, understand and use health information to make informed decisions about their care.
These skills are closely linked with educational opportunity, socioeconomic circumstances, health, and language. Together they contribute to important health disparities.
Healthcare professionals can help reduce these disparities by using universal health literacy precautions and communicating clearly with every patient.
Plain language, teachback, visual aids, culturally and linguistically appropriate materials, and professional interpreters all help improve understanding and support safer, more equitable care.