The literacy skills of some 22 percent of adult Canadians are so limited that they are unable to determine the correct dosage from reading a medicine label. A further 26 percent can read — provided that materials are simple and presented in familiar contexts. Thus nearly half of Canadians have difficulty with reading materials encountered in everyday life. They avoid reading except for materials which are relatively simple and familiar to them.

As this paper has indicated, there is extensive evidence, from Canadian sources as well as from elsewhere, which consistently documents that literacy is one of the major factors influencing health status. However health is defined or measured, people with limited literacy skills are worse off than are others. Low literacy also is generally associated with greater use of health care resources.

Literacy affects health directly, for example when a failure to read or to understand instructions results in medication errors or accidents. The major impacts of literacy on health, however, occur indirectly. Literacy affects and interacts with almost all other determinants of health. It is a major determinant of poverty.

What can the health field do to address the impact of literacy on health? This paper has suggested that the first step is to acknowledge literacy as an important health issue. Literacy is closely related to practically all the major determinants of health which have been identified. There has been increasing recognition within the health sector of the importance of literacy. Indeed, Canada has been recognized for its efforts in this area. Nevertheless, there is still a long way to go.

Other steps which this paper has suggested include: placing more emphasis on enabling people to improve their literacy skills, developing partnerships between the health and literacy sectors, using alternatives to the written word to provide health information, and using a variety of strategies to make it possible for people with limited literacy to have more control over their lives. This paper has also identified areas for future research.

Finally, it is important that a population health approach give significant consideration to literacy issues. Improved communications, where health communities check to see whether or not people understand what they are saying, will benefit everyone, irrespective of literacy level. Addressing the needs of Canadians with low literacy levels benefits all Canadians.