Personal health literacy is the “degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”1

Personal health literacy refers to the skills necessary for a person to participate in the health care system and maintain good health. These skills include reading and writing, calculating numbers, communicating with health care professionals, and using health technology.

But health literacy is a two-way street. The burden of limited health literacy should not lie solely on the individual. Health care organizations can adopt strategies to address health literacy and make it easier for people to use their services.2

Organizational health literacy is the “degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”3

Health Literacy Fact Sheet Series

This fact sheet is part of a series addressing the impact of limited health literacy and providing strategies for organizational improvement. For more information, visit

Who Has Limited Health Literacy?

Only about one in 10 English-speaking adults in the U.S. has “proficient” health literacy skills.4 Among the remaining nine, about half have “intermediate” health literacy skills and a little over one-third have “basic” or “below basic” health literacy skills.5

Limited health literacy disproportionately impacts Medicaid members. Sixty percent of people with Medicaid coverage are either at “below basic” or “basic” health literacy levels compared to only 24 percent of those with employer-sponsored coverage.6

Limited health literacy makes navigating health care systems difficult for some people and very difficult for others. This especially includes:

  • People ages 65 and older;
  • Those living at a low socioeconomic status, income level, or education level;
  • People who identify as Latino, Black, or American Indian/Alaska Native;
  • People with limited English proficiency and/or non-native speakers of English; and
  • Those insured by Medicaid or Medicare, or who are uninsured.7

Why is Health Literacy Important?

Health literacy is an everyday issue. People make choices about their health every day, including what to eat, when to see a doctor, and how to take their medicine. All these tasks, outlined below, rely on health literacy skills. Anyone can struggle with health literacy, even those who read and use numbers well.

  • Can you understand the labels on your medicine and food?
  • Can you locate and get to the nearest clinic or hospital?
  • Can you accurately and cohesively report your symptoms to health care professionals?
  • Can you understand and complete insurance paperwork?

An inability to complete these tasks indicates that a person may have limited health literacy skills — and their ability to manage and access health care is at risk.8

Health Literacy Snapshot

Sherry is a 65-year-old individual dually eligible for Medicare and Medicaid who did not graduate from high school and has limited reading skills. When she was discharged from a hospital stay, she received a printed list of medications. At her follow-up appointment, her doctor asked her how she was taking her medications. Sherry confessed she had not been taking them. She said she had been embarrassed to tell the hospital staff that she couldn’t read well and didn’t understand the instructions. No one at the hospital gave her the instructions verbally or checked with her to make sure she understood how to take her medicine.

Health literacy is also a health equity issue. Populations with limited health literacy skills disproportionately experience adverse health outcomes and poorer access to quality care. These inequities can reinforce one another. Factors such as race and ethnicity, age, primary language spoken, education level, and socioeconomic status all play a role in the prevalence of limited health literacy. One large systematic review found that patients who were non-white, older, non-English speaking, less educated, or lower earning faced greater challenges in effectively navigating the health care system, leading to increased costs, greater use of acute and emergency care, and poorer health outcomes.9

Health literacy is an organizational and health system issue. The Centers for Medicare & Medicaid Services and the Department of Health and Human Services both list improved health literacy as organizational priorities. Health care organizations that do not prioritize health literacy will face challenges providing high-quality, equitable care.10,11

Finally, health literacy is a costs issue. The growing complexity of health care systems, medicine, and health insurance leads to challenges for patients in effectively navigating and using health care services, often leading to increased costs and poorer outcomes.12

What is the Impact of Limited Health Literacy?

Limited health literacy can result in: 

  • Medication errors;
  • Difficulty understanding and following care plans;
  • Reduced use of preventive services;
  • Challenges managing the complexities of chronic conditions;
  • Longer hospital stays, increased hospital readmissions, and increased emergency department use;
  • Confusion about appropriate responses to public health emergencies; and
  • Higher mortality.13,14

Increased Costs

Limited health literacy, through all its impacts — medical errors, miscommunication, increased illness and disability, loss of wages, and compromised public health — is estimated to cost the U.S. economy up to $349 billion every year, when adjusted for inflation to 2023 dollars using the Bureau of Labor Statistics’ CPI Inflation Calculator.15

Additional Resources

The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy by the National Center for Education Statistics.

Health Literacy: A Prescription to End Confusion: Landmark report on health literacy from the Institute of Medicine.

Health Literacy Interventions and Outcomes: The Agency for Healthcare Research and Quality’s systematic review of health literacy interventions and outcomes.

IHA Health Literacy Solutions Center: Resources compiled by the Institute for Healthcare Advancement to help integrate health literacy in the health care system through professional practice and development.

AHRQ Health Literacy Portal: Resources about the basics of health literacy, patient education and education, research tools, and more from the Agency for Healthcare Research and Quality.

5 Things to Know about Health Literacy: Short video from U.S. Department of Health and Human Services explaining what health literacy is and why it’s important.

Ten Attributes of Health Literate Organizations: A 2012 discussion paper from the National Academy of Medicine outlines elements like leadership buy-in, workforce development, communications, and design as foundational factors for building organizational health literacy.

CHCS Health Literacy Fact Sheets: The full series of health literacy fact sheets produced by CHCS provide guidance in identifying and addressing limited health literacy.


  1. Healthy People 2030. History of health literacy definitions. (n.d.)U.S. Department of Health and Human Services.
  2. Brach, C., Dreyer, B., Schyve, P., Hernandez, L.M., Baur C., Lemerise, A.J. & Parker, R. (2012, January 12). Attributes of a health literate organization. NAM Perspectives [Discussion paper]. National Academy of Medicine.
  3. Centers for Disease Control and Prevention. (2020, August). What Is health literacy? U.S. Department of Health and Human Services.
  4. Kutner, M. Greenberg, E. Jin, Y. & Paulsen, C. (2006). The health literacy of America’s adults: Results from the 2003 national assessment of adult literacy. National Center for Education Statistics. U.S. Department of Education.
  5. Kutner, et al., 2006.
  6. Lopez, C. Kim, B., & Sacks, K. (2022, May). Health literacy in the United States: Enhancing assessments and reducing disparities. Milken Institute.
  7. Lopez, et al., 2022.
  8. Davis, T. (2015). Health literacy: Hidden barriers and practical strategies. Association of Health Care Research and Quality.
  9. Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., Viera, A., Crotty, K., Holland, A., Brasure, M., Lohr, K. N., Harden, E., Tant, E., Wallace, I., & Viswanathan, M. (2011). Health literacy interventions and outcomes: an updated systematic review. Evidence Report/Technology Assessment, (199), 1–941.
  10. Centers for Medicare & Medicaid Services. (2022, April). Framework for health equity, 2022-2032. U.S. Department of Health and Human Services.
  11. Healthy People 2030. Healthy people 2030 framework. (n.d.) U.S. Department of Health and Human Services.
  12. Kutner, et al., 2006.
  13. Berkman, N.D., Sheridan, S.L., Donahue, K.E., Halpern, D.J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2): 97–107.
  14. Baker, D. W., Wolf, M. S., Feinglass, J., Thompson, J. A., Gazmararian, J. A., & Huang, J. (2007). Health literacy and mortality among elderly persons. Archives of Internal Medicine, 167(14), 1503.
  15. Vernon, J., Trujillo, A., Rosenbaum, S., & DeBuono, B. (2007). Low health literacy: Implications for national health policy. University of Connecticut.