This paper examines the relationship between illiteracy and poor health outcomes in the United States, with a particular focus on elderly adults. Drawing on government literacy data and research published in The New England Journal of Medicine, the paper outlines three categories of literacy — prose, document, and quantitative — and reports alarming deficiency rates among the general population and seniors specifically. It then traces how low literacy discourages preventative healthcare, enables patients to conceal reading difficulties from providers, and results in medical instructions going unread and ignored, ultimately worsening health conditions.
Illiteracy is a significant issue in the United States, and unfortunately one that too often goes unrecognized. In a society increasingly dependent on information, illiteracy of any kind threatens to create a large underclass of citizens who are unable to interact with and process the basic information and data that surrounds them every day. The effects on society can be significant and range from serving as an indicator of poverty to a form of social isolation. By far one of the most pressing and dangerous consequences of illiteracy, however, is its effect on the health of a society.
Current estimates from the United States government identify three major kinds of literacy: prose literacy (the ability to function in a media-saturated society), document literacy (the ability to read and understand basic documents), and quantitative literacy (the ability to competently interpret and work with numbers). According to these estimates, illiteracy is rampant across all three categories. In the U.S., 14% of all adults have a below-basic level of prose literacy, 12% have a below-basic level of document literacy, and 22% have a below-basic level of quantitative literacy (Marcus, 2006).
These rates are considerably higher among the elderly. Of individuals older than 64, the percentages with below-basic levels of literacy are 23%, 27%, and 34%, respectively. Among elderly Americans, then, anywhere from one-fifth to one-third of all people are effectively illiterate. The scale of this problem among an age group already at elevated health risk makes the intersection of health literacy and aging a matter of serious public concern.
No matter how individuals might conceal this fact, or resist taking steps to address their own illiteracy, it is crucial to recognize that there will be consequences — social ones, but also serious consequences for their health. An illiterate senior citizen might not be able to read a bus schedule or might have trouble comparing the cost of two grocery store items. Far worse, however, these individuals face exceptional difficulty managing their own health. Many illiterate individuals avoid doctors' offices because they are intimidated by the seemingly endless paperwork. Rather than take preventative care of their own bodies, they prefer to visit the emergency room only when necessary, because there someone asks them questions and fills out the forms on their behalf (Marcus, 2006).
Because many illiterate patients are ashamed to admit their condition, they hide it from their healthcare practitioners. This tendency can severely worsen their health problems and make it more difficult for them to ever fully recover. Preventative medicine depends on patients being able to follow instructions, track symptoms, and engage with health information — none of which is easily possible for someone who cannot read.
"Concealed illiteracy leads to unread instructions and worsening health"
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