Health disparities: Numeracy and literacy

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, blood pressure 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 is asked to complete several forms. Embarrassed that he is 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 blood pressure 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 is unsure how often to take his medication, what his target blood pressure should be, or when he should seek medical attention. Rather than admitting he is confused, he leaves.

Several weeks later, Isaiah returns for a follow-up appointment. His blood pressure remains elevated. It becomes clear that he has been taking his medication inconsistently and has not made the recommended lifestyle changes, not because he was unwilling, but because he did not 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 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.

Recognizing 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.