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Health Literacy

Health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”.1 It informs or limits an individual’s ability to search for and use health information, adopt healthy behaviors, follow prescribed treatment plans, and act on important public health alerts. Limited health literacy is associated with worse health outcomes and higher costs2 and in the collegiate population can also lead to impaired student success. Health literacy is not only about individuals’ skills; in the United States, health literacy reflects the efforts of health systems and professionals to make health information and services understandable and actionable. Interventions across multiple sectors need to focus on improving individual skills and making health service, education, and information systems more health literate.2

Key Facts

  • Nearly 9 of 10 adults have difficulty using the everyday health information that is routinely available in our healthcare facilities, retail outlets, media, and communities.1,3,4
  • The average annual healthcare costs of those with low health literacy levels are 4 times greater than that of the general population.5,6,7
  • Poor health literacy costs the U.S. healthcare system $30-$73 billion annually.5,6
  • 90 million Americans lack the skills needed to understand and act on health information.9
  • Individuals with low health literacy are less likely to participate actively in healthcare decision making and more likely to struggle with health management tasks and to face significant challenges navigating the health system. 9
  • Approximately 9 of 10 U.S. adults (88%) cannot calculate an employee's share of health insurance costs using a table based on income and family size.3
  • Health literacy is a better predictor of one’s health status than: age, income, employment, ethnicity, or education level.10,11
  • In 2006, 3 million Americans reported being seriously harmed or knowing someone who has been seriously harmed by following health advice or information found online.1
health literacy indicators


  1. Increase students’ ability to appropriately utilize health and mental health services, both on and off campus.
    Multiple factors determine how much healthcare people use, the types of healthcare they use, and the timing of that care.13 With its numerous layers of bureaucracy, procedures, and processes, the U.S. healthcare system can be difficult for many people to understand, to know how to access, or when to utilize its services.1 Individuals must choose a provider, make decisions about treatment depending upon the severity of illness, and assess the ease and quality of various treatment options.1 A student’s ability or inability to make these decisions and navigate healthcare systems is a reflection of systemic complexity and individual skill level. The consequences include lack of understanding and use of preventive services, poorer compliance rates with treatment modalities, and poorer health status.1,14

  2. Strengthen students’ understanding of their health-related financial resources and responsibilities.
    The ability to value, comprehend the options of, choose, and implement a personal healthcare financing plan is critically important to an individual’s wellbeing.15 Health insurance is associated with higher utilization of primary and preventive care, lower out-of-pocket medical expenditures and medical debt, and better self-reported physical and mental health.16 NYU requires all students to maintain adequate health insurance;17 however, students – like other healthcare consumers in the U.S. – often do not know what type of health plan they are currently enrolled in or how their healthcare will be affected by the type of plan they have chosen.18-22 Health insurance information for plan enrollment, use of benefits, coverage, and out-of-pocket costs is complicated and often unfamiliar for even highly literate individuals.2 Effective education and communication are important factors influencing consumer acceptance of healthcare benefits and program utilization23,24 and web-based tools can provide health plan members with information, self-service transactions, and decision support.25, 26
  3. Increase the proportion of students who use electronic personal health management tools.
    Since 1999, NYU Student Health Center has used an electronic health record system and currently offers personal health management tools such as secure messaging between patients and providers, online scheduling, and online refills of prescription medication. Increasing the use of electronic personal health management tools, such as a personal health record, is a national priority from Healthy People 2020;22 therefore, NYU will continue to expand its portfolio of tools to promote active, ongoing patient collaboration in care delivery and decision making. Personal health management tools improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; and ensure portability of medical records and other personal health information.27

  4. Increase students’ ability to identify reliable health information.
    Health information is critically important for empowering individuals to be active participants in personal health actions and decisions.2 The Internet is the primary source of information for the majority of NYU students,28-30 yet students can and do obtain health information from a variety of sources including healthcare professionals, magazines, brochures, family, friends, news/media, and peers, among other sources.29 Students often lack the skills to locate and evaluate effectively the information for credibility and quality, analyze the risks and benefits, and use high quality health information; therefore, they can suffer adverse consequences from using unreliable information.2,31,32 A tremendous opportunity exists for colleges and universities, including NYU, to provide high-quality health information and to teach students how to select and use credible information.

  5. Increase stakeholder engagement in developing communication strategies.
    Involving members of the target audience in the design, implementation, and evaluation of communication strategies is one of the most effective methods associated with the success of such interventions.2,33 Involvement can and should occur during different phases of a project;34-36 iterative and interactive processes help to improve understanding of the unique needs of the target population, garner necessary buy-in, create content or strategies that are relevant, identify appropriate modalities for dissemination, and assess whether information has been conveyed effectively.37 From conducting one-time focus groups to actually producing communication products, levels of participation can vary depending on the type of project and available resources.34,35 Finding the right combination of approaches to involve target populations is necessary to promote and enable action.36

  6. Strengthen students’ ability to engage in appropriate prevention, self-care, and/or self-management measures.
    Recent changes in the healthcare system necessitate that healthcare consumers, including college students, be informed and proactive in managing their own health.2 Individuals with low health literacy participate less in self-care and use preventive health care to a lesser extent, which results in the utilization of higher-level care.38 While the majority of NYU students are healthy,30 all students should engage in self-care for personal health maintenance and receive recommended preventive healthcare.  NYU has the opportunity to build a foundation of self-care models and practices among its students, developing the skills for long-term health maintenance and responsibility.

a) Provision of health education by NYU Student Health Center during patient visits

  • Data Source: Customer Satisfaction Survey #20
  • Survey Question: I received information during my visit that I will use to improve my health
  • Definition:

b) Students who incurred unexpected charges after receiving medical or mental services

  • Data Source: ACHA – custom question
  • Survey Question: True or False: In the last 12 months, when I received medical or mental health services (whether at the NYU Student Health Center or elsewhere), the charges I incurred were always what I expected.
  • Definition: of those who received services, proportion who responded “false” (does not includes N/A in denominator)

c)  Confused by online health information

  •  Data Source: ACHA – custom question
  • Survey Question: At any point in your last search for health information online did you feel any of the following things? (Select ALL that apply)
  • Definition: proportion who endorsed “Confused by the information you found online”

  1. Nielsen-Bohlman, L., Panzer, A.M., & Kindig, D.A. (2004). Health Literacy: A Prescription to End Confusion. Washington, DC: Committee on Health Literacy. Board on Neuroscience and Behavioral Health. Institute of Medicine of the National Academies.
  2.  U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Retrieved 7/15/2011, from:
  3. 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 (NCES 2006-483). Washington, DC: U.S. Department of Education.
  4.  Rudd, R. E., Anderson, J. E., Oppenheimer, S., & Nath, C., (2007). Health literacy: An update of public health and medical literature. In J. P. Comings, B. Garner, & C. Smith. (Eds.), Review of adult learning and literacy, 7, 175–204. Mahwah, NJ: Lawrence Erlbaum Associates.
  5. Friedland, R.B, & Summer, L. (1999). Demography Is Not Destiny. Washington, DC: National Academy on an Aging Society.
  6. Friedland, R.B. (1998). Life expectancy in the future: A summary of a discussion among experts. North American Actuarial Journal, 2(4), 1-14.
  7. Weiss, B.D. (1999). 20 Common Problems in Primary Care. New York: McGraw Hill, 468-481.
  8. Center for Health Care Strategies, Inc. (2005). Health Literacy Fact Sheet. The Commonwealth Fund and Pfizer Inc. Retrieved 10/25/11, from
  9. Martin, L.T., & Parker, R.M. (2011). Insurance expansion and health literacy. Journal of the American Medical Association. Published online August 9, 2011. Retrieved 10/25/11, from
  10. American Medical Association. (2004). Health Literacy. AMA-MSS Community Service Committee. Retrieved 10/25/11, from
  11. Weiss, B.D. (2003). Health Literacy: A Manual for Clinicians. American Medical Association/American Medical Association Foundation, 7.
  12. Fox, S. (2006). Online Health Search 2006. Washington, DC: Pew Internet and American Life Project.
  13. Bernstein, A.B., Hing, E., Moss, A.J., Allen, K.F., Siller, A.B., & Tiggle, R.B. (2003). Health care in America: Trends in utilization. Hyattsville, Maryland: National Center for Health Statistics.
  14. Pawlak, R. (2005). Economic considerations of health literacy. Nursing Economics, 23, 170–180.
  15. Vitt, L.A., Siegenthaler, J.K., Siegenthaler, L., Lyter, D.M., & Kent, J. (2002). Consumer Health Care Finance and Education: Matters of Values (EBRI Issue Brief 241). Institute for Socio-Financial Studies, Employee Benefit Research Institute.
  16. Finkelstein, A., Taubman, S., Wright B, Bernstein M, Gruber J, Newhouse JP, & Allen, H., Baicker, K. (2011). The Oregon Health Insurance Experiment: Evidence from the First Year (NBER Working Paper No 17190). The Oregon Health Study Group.
  17. Student Health Insurance Services. (2011). Guide to Student Health Insurance and Healthcare at New York University, 2011-2012. New York University. Retrieved 10/25/11, from
  18. Cunningham, P.J., Denk, C., & Sinclair, M. (2001). Do consumers know how their health plan works? Consumers tend to overestimate plan restrictions, especially regarding access to medical specialists. Health Affairs, 20(2), 159-166.
  19. Hibbard, J.H., & Jewett, J.J. (1997). Will quality report cards help consumers? Health Affairs, 16(3), 218-28.
  20. Isaacs, S. (1996). Consumers’ information needs: Results of a national survey. Health Affairs, 15(4), 31-41.
  21. Korcyk, S., & Witte, H. (2000). C.I.G. to managed health care. Upper Saddle River: NJ: Prentice Hall.
  22. Healthy People 2020. Health Communication and Information. Washington, DC: U.S. Department of Health and Human Services.
  23. Finkel, M.L. (1997). Evaluate and communicate health care benefits. Employee Benefits Journal, 22(4), 29-34.
  24. Jerussi, M, Savan, J. (2000). Educating employees on defined contribution health care: The time is eight for an employee-empowering approach. Benefits Quarterly, 16(4), 63-68.
  25. Emery, J, Cather, C. (2000.) Finally. Employers provide a focus to help health plans fashion full-scale e-strategies. Health Plan Advisor, 1-7.
  26. Goff, V. (2001). Consumer health care decision support: State of the art. Executive Brief. Washington, DC: National Health Care Purchasing Institute.
  27. Detmer, D., Bloomrosen, M., Raymond, B., & Tang, P. (2008). Integrated personal health records: Transformative tools for consumer-centric care. BMC Medical Informatics and Decision Making, 8, 45.
  28. New York University. (2010). Wellness expo evaluation.
  29. American College Health Association. American College Health Association - National College Health Assessment II: New York University Executive Summary Spring 2009. (2009). Hanover, MD: Author.
  30. American College Health Association. (2011). American College Health Association - National College Health Assessment II: New York University Executive Summary Spring 2011. Hanover, MD: Author.
  31. Rieh, S.Y., & Hilligoss, B. (2008). College students’ credibility judgments in the information-seeking process. Digital Media, Youth, and Credibility. The John D. and Catherine T. MacArthur Foundation Series on Digital Media and Learning. Cambridge, MA: The MIT Press, 49–72.
  32. Banas, J. (2008). A tailored approach to identifying and addressing college students’ online health information literacy. American Journal of Health Education, 39, 228–236.
  33. Neuhauser, L. (2001). Participatory Design for Better Interactive Health Communication: A Statewide Model in the U.S.A. The Electronic Journal of Communication. 11(3-4).
  34. U.S. Department of Health and Human Services. National Partnership for Action to End Health Disparities. Office of Minority Health. (2011, April). National stakeholder strategy for achieving health equity. Washington, DC: Author.
  35. Kimery, K.M., & Rinehart, S.M. (1998). Markets and constituencies: An alternative view of the marketing concept. Journal of Business Research, 43 (3), 117-24.
  36. U.S. Agency for International Development. (2002). Behavior change communication for HIV/AIDS: A strategic framework. Family Health International Institute for HIV/AIDS. Implementing Prevention and Care (IMPACT) Project.
  37. Centers for Disease Control and Prevention. (2009). What we know about health literacy. Health Communication and Marketing. National Center for Health Marketing. Washington, DC: U.S. Department of Health and Human Services.
  38. Adams, R.J., Stocks, N.P., Wilson, D.H., & Hill, C.L. (2009). Health literacy-a new concept for general practice. Australian Family Physician. 38 (3), 144-147.

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