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Reading Between the Lines to Improve Wellness

  • Health literacy is a stronger predictor of wellness than age, income, employment, education and race.
  • A 2013 report notes that communities and governments nationwide must become more aware and take action regarding health issues facing seniors.

Targeting and training enables smarter health choices

Health literacy is critical to making better health care decisions. Just how critical? According to the American Medical Association, health literacy is “a stronger predictor of an individual’s health status than income, employment status, education level, and racial or ethnic group.”

Health literacy allows people to take charge of their health and make steps toward chronic condition prevention. It also provides a way for people to improve ongoing disease management.

Health Literacy Programs for Seniors

According to the 2013 Senior Report, published by America’s Health Rankings®, communities and governments across the nation must become increasingly aware of issues facing America’s seniors and take action to help seniors improve their health and health literacy. Health literacy is one’s ability to read, understand and act on health information. However, there is cause for concern in the United States regarding the health of 93 million people1 because of some patients’ difficulty understanding and acting upon health information. Consider:

  • One in five American adults reads at the 5th grade level or below, and the average American reads at the 8th- to 9th-grade level — however, most health care materials are written above the 10th-grade level.2
  • Insufficient health literacy ups the imbalance in access to health care among particularly vulnerable populations, such as the elderly and minorities.
  • Minorities and immigrants are estimated to have literacy problems in disproportionate numbers — 50% of Hispanics, 40% of blacks and 33% of Asians, the Center for Health Care Strategies reports.2
  • 66% of adults 60 and older have deficient or borderline literacy skills.2

To address these problems, UnitedHealthcare is involved in a number of programs to help improve health and health literacy, including Heart Smart Sisters and Promotoras.

These programs seek to combat the negative impact of low health literacy, which is a huge cost burden on the American health care system. Annual health care costs for those with low literacy skills, for example, are four times higher than those with higher skills.2

In addition:

  • A poor understanding of health care information might cause problems with patient compliance and medical errors. Only about half of patients take medications as directed.2
  • Those with chronic diseases, such as diabetes, hypertension or asthma, who have low health literacy know less about their disease and treatment and know fewer proper self-management skills.3
  • There was a 50% increased risk of hospitalization for patients with low literacy skills, compared with patients with adequate skills.4


Heart Smart Sisters

Launched in 2010, Heart Smart Sisters is designed to educate women about the risk factors for developing heart disease and empower them to make the necessary lifestyle changes to improve their individual health status and reduce the overall incidence of heart disease in their communities.

“We wanted to target women because they are generally the caretakers and make the health care and meal decisions for the family,” says Charlisa Watson, vice president of Community Development for UnitedHealthcare Community & State, Southeast Region. “If the women are healthy, the entire family will be healthy.”

Women who attend a Heart Smart Sisters event participate in a health screening to determine baseline levels for blood pressure, glucose, BMI, etc. Then they learn heart-healthy exercises and are encouraged to take small steps to increase their activity and eat in a more healthy way. The ultimate goal is for them to “know their numbers” and work toward improving them.

In addition, the bilingual program — a cardiovascular risk screening, prevention education and outreach initiative — allows members to complete health risk assessments and allows providers in the community to partake in the health screening events.

Watson was inspired to develop the program because her father died suddenly from a heart attack at age 54 while jogging. She immediately changed to a more heart healthy lifestyle. “My father was retired from the Air Force, and he always had access to great health care and led an active lifestyle. We later discovered that he had complained of indigestion earlier in the day, which was obviously a warning sign. That experience makes it all the more special to be able to educate our members and potential members about how to be heart healthy," she says.

Watson has worked with underserved populations for more than 20 years and is committed to ensuring they receive targeted education in their communities where they feel most comfortable.

“This education must include actually demonstrating to them what they need to do, not just telling them,” she says. “This program heightens awareness among members of the benefits that UnitedHealthcare offers, facilitates member retention and growth and complies with the health disparity initiatives noted in many of our state contracts.”


In 2012, a partnership between the Arizona Community Plan and the San Luis Walk-In Clinic was one of four Community & State programs to win an Innovation Award. The program involved training community health care educators, or promotoras, to use an electronic registry to identify and track down high-risk patients who had not been seen by a primary care physician. The promotoras encouraged the patients to re-engage, see their doctors and get needed care.

“The partnership was created with a goal of improving the health of individual members, improving the overall health of the population and lowering health care costs,” said Anna Scott, vice president of Accountable Care in Community & State, a program that involves partnering with practices and helping them proactively manage high-risk patients using a Web-based registry.

The registry gives the practice team access to information about the care members have received and gives them greater responsibility for continuous care.

“The goal of the program is to improve access to care, reduce nonemergency use of the emergency room, reduce avoidable hospital admission/re-admissions and have a greater focus on management of high-risk groups of patients,” Scott says.

The clinic’s CEO, Amanda Aguirre, is a nutritionist, former state senator and leader in rural health care issues and has been successfully working with promotoras for a long time, Scott says.

“The promotoras live in the community and share the same culture as our members, so they are in a good position to help understand why the member has not been receiving care and help find a solution,” Scott says. “The member could be homeless or transient or there might be an issue with transportation or child care. There are a lot of reasons that this population doesn't put their health care first.”

The San Luis project has already resulted in significantly improved outcomes and decreased health care costs for members assigned to the clinic. “It’s a model that we encourage other practices to follow,” Scott says.

For More Information

UnitedHealthcare Community & State is your partner when it comes to health literacy. Its mission is to partner with states and communities to drive programs that improve health and health literacy.

For more information on senior health and health literacy, visit: This site provides all of the rankings of seniors’ chronic conditions, as well as methods for helping seniors take charge of their health.


1. Centre for Educational Research and Innovation, United States – Country Background Report.

2. The National Patient Safety Foundation, Health Literacy: Statistics At A Glance

3. Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998; 114: 1008-1015.

4. Baker DW, Parker RM, Williams MV, Clark WS. Health literacy and the risk of hospital admission. J Gen Intern Med. 1998; 13: 791-798.