Adults with low literacy skills are four times more likely to report poor to fair health than adults with higher skills. This is two times the international average according to recent data from the Survey of Adult Skills (October, 2013), which is part of the Organization for Economic Cooperation and Development’s (OECD) Program for the International Assessment of Adult Competencies (PIAAC).
This correlation between skills and health presents great challenges to both the individual and his or her healthcare providers to communicate and address the prevention, management, and treatment of disease and healthy behaviors. Poor literacy, numeracy, and problem solving skills adversely affect health care, health information access, health outcomes, and appear to limit engagement in positive, preventative behaviors. At a time when the U.S. is spending more than $2 trillion a year on healthcare ($2.5 trillion in 2009, according to the Surgeon General’s National Prevention Strategy), even a fraction of improved outcomes could save millions of dollars. As a reference, the U.S. federal investment in the Adult Education and Family Literacy Act (AEFLA), which funds adult basic education and English proficiency classes, is $563 million.
U.S. adults ages 16-65 performed poorly on all measures of the Survey of Adult Skills, with average scores below international averages in literacy, numeracy, and problem solving in a technology-rich environment. While there are high performers in each domain, the U.S. population has a greater proportion of adults of working age with low skills (defined as below Level 2 on a five level scale) than the comparison countries (see more about the findings here).
The relationship between skills and health provides a strong case for investing in upskilling adults. The economic returns to skill development are clearly demonstrated in the Survey through the correlation of skills to higher wages, more permanent employment, and greater use of skills on the job. The returns to improved health are likely to be at least as important. A healthier workforce is more productive with fewer days lost to illness. The healthcare costs of poor health literacy is demonstrated through higher costs for service, more emergency room visits, and fewer preventative services accessed.
There is a great opportunity to think about addressing skills and health simultaneously in a more holistic approach, as called for in the National Action Plan to Improve Health Literacy, issued by the U.S. Department of Health and Human Services in 2010. Embedding opportunities for skill development and practice in community health efforts is an underutilized approach. While contextualizing literacy in the context of health has been a promising practice, see resources at the LINCS Health Literacy Collection, too little has been done to use community-based health interventions as the anchor for literacy and numeracy interventions.
Community health workers – whether in hospitals, health centers, private primary care practices or as part of home health care or visiting nurse services – can help low-skilled adults apply the skills they do have to the immediate situation. Health professionals can use plain language and teach back methods of communication, and work closely with local educational service providers to make referrals more seamless and less stigmatized. Similarly, adult education workers can assist individuals with accessing health care, finding insurance, following treatment instructions, applying literacy and numeracy skills to everyday practices, and providing navigation assistance to services that can enhance healthy behavior. Services could be co-located for greater coordination and impact. Cross-training or shared training and professional development within a community could strengthen relationships and referral networks.
The Survey of Adult Skills (OECD, 2013) is clear that skills and quality of life issues are deeply interrelated, especially in the United States. The findings echo a recent report from the Institute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health. Communities need to address these challenges as related, not separate issues, and find the means to take a holistic view of the quality of life issues faced by low-skilled, low-income, and low-English proficient populations when proposing solutions. Conducting a local health needs assessment and asset map of existing challenges, resources, and future growth projections can be a way to engage the community. Prevention and health safety campaigns are ideal opportunities to involve the full range of family-serving organizations in a community.
In November 2013, the U.S. Department of Education launched a national engagement effort to explore ways to increase our national capacity to improve the foundation skills of adults in the United States. Regional events have been held through the winter and communities are being asked to provide input and feedback from their own locally-hosted roundtable discussions to inform a national action plan.
In order to assist communities in hosting roundtable discussions, the Department created a set of resources and an online submission form. See www.TimetoReskill.org for the following tools:
- Consultation Paper, a 10-page paper that can be shared in advance of an event to provide background on the skills issue and the framework for the national action plan.
- Toolkit, a step-by-step guide to running a local roundtable from types of people to invite to the questions to pose.
- Online feedback form for submitting feedback. (Please submit comments by March 14 to be considered in the Plan.)
We hope community health partners will be part of the solution! Consider hosting a roundtable discussion in your area and contributing to the national action plan.
Johan Uvin is the Deputy Assistant Secretary for Policy and Strategic Initiatives at the U.S. Department of Education, Office of Career, Technical, and Adult Education