Illiteracy as a public health issue.

Epidemiology: Residents of Ontario learned recently that 29% of the province's grade 10 students had failed either the reading or writing component of a standardized literacy test, 1 calling into question the quality of high school education in the province as well as the validity of the standardized test used to measure this performance. Undoubtedly , postmortem debate will identify a few fatal flaws in this newly administered instrument that will need to be corrected before the next exam, but the estimate that 29% of 15-year-olds lack literacy skills is consistent with estimates from the 1994 International Adult Literacy Survey (IALS). 2 It indicated that 22% of Canadian adults, the bulk of whom were older than 50 years, fell into the lowest level of literacy, which means that they may have difficulty identifying the correct amount of medicine to give a child from the information found on the packaging. 2 The IALS researchers were careful not to call these adults illiterate; the notion that individuals are either literate or illiterate has been replaced by the recognition that literacy skills fall along a continuum, running from quite limited to very high. There are several types of literacy. Prose literacy is the ability to understand and use information from texts such as news stories and fiction, whereas document literacy is the ability to locate and use information from documents such as job applications and transportation schedules. Numerical literacy is the ability to balance a chequebook or complete an order form. To package these varied skills into the binary outcome of " pass or fail, " as the provincial test has done, too starkly paints the shades of literacy in black and white, and knocks the self-esteem of many Ontario teenagers in the process. Self-esteem is intrinsically tied to illiteracy. A recent qualitative study of the perspectives of adults with low literacy skills 3 revealed how much patients feared that their poor reading skills would be exposed. " I don't tell anybody or say anything [about my il-literacy], " said one. " They might think I'm a bad person. " 3 However, the consequence of nondisclosure in a health care setting is uninformed consent. " A lot of times I thought, 'My God, I am signing my life away,' " said another study participant. 3 The participants felt that doctors and nurses should be aware of patients' reading ability and use that knowledge …