Background Document on Literacy and Health

Section 1. Overview of health literacy

1.1 Low literacy in Canada and the USA

The International Adult Literacy Survey (OECD, 1995) provides comparable data on the literacy skills of adults from eight Western countries including Canada. IALS represents the notion of literacy (please see definition in annex 1) as a skill continuum divided into five levels:

1. Level 1: Individuals have great difficulty reading; they are generally aware that they have a problem.
2. Level 2: Individuals can read, but not well. They can only deal with material that is simple and clearly laid out. They often do not recognize their limitations.
3. Level 3: Individuals can read well but have some problems with more complex tasks. In many countries, this is considered to be a basic skill level. Some occupations require higher skills.
4. Level 4/5: Individuals can meet most reading demands. This level is considered a high level of literacy.

The IALS determined literacy levels by using real examples of varying complexity drawn from everyday life. The adults tested had to understand and use information from texts (Prose scale; news story, editorial, etc.), from forms (Document scale: job application, maps, tables, etc.) and from numbers (Quantitative scale: balance a chequebook, calculate a tip, etc.). About 22% of adult Canadians fall into level 1 and a further 26% are at level 2. Thus, nearly half of Canadians (48%) have difficulty with reading materials encountered in everyday life.

The IALS also indicates that literacy skills generally increase from east to west, with Western provinces having the most literate population in Canada. For all three scales (prose, document and quantitative), Quebec has the highest percentage of adults at level 1 and the lowest percentage at level 5. Respondents took the test in the official language of their choice. Those who took the test in English had overall better results than those who took the test in French:

The differences between language groups strongly relate to differences in educational attainment. Quebec youth in particular showed strong results. There are a large number of older Canadians with low skills: 53% of adults over 65 are at level 1 and 27% are at level 2. However, few young people aged 16 to 24 are at level 1. A large number of immigrants in Canada are at the lowest and highest levels. Compared to other countries, a larger proportion of immigrants in Canada are at levels 4/5. The IALS indicates a close relationship between education and literacy. The higher the level of educational attainment, the higher the literacy level. The study also makes linkages between literacy and training, employment, income, economic change, social transfers. It demonstrates that lower-skilled adults spend more time per day watching television, their main source of information.

The results of Canadians are similar to those of its southern neighbour: 23% of adults in the United States scored at level 1, while another 28% are at level 2, for a total of 51%. In the United States, the average reading level is at the 8th to 9th grade levels (between levels 2 and 3). About one in five adults read at the 5th-grade level and below (at about level 1) (Doak, et al., 1996).

The IALS is not universally accepted; some researchers question its methodology. Thomas Sticht, an international consultant in Adult Education, raises the problem of how to determine on a continuum a point or points that divide the continuum into various amounts of literacy. The IALS set a criterion of having an 80 percent probability of getting the average item at a given literacy level correct to be assigned to that level of skill. According to Sticht, this criterion is arbitrary and denies the skills adults actually have in performing tasks above the level to which they have been assigned (Sticht, 2000). He argues that with a criterion of 65% or 50%, the percentage of adults scoring at level 1 and 2 would drop dramatically. Some researchers thus question the percentage of individuals assigned to each literacy level. There is considerable debate in the United States about which standards should be used for national assessments.

The IALS does, nevertheless, allow us to say that regardless of the actual percentage there are a significant number of Canadians who experience difficulty with everyday reading. One can however question the IALS finding that individuals at level #2 often do not recognize their limitations. An alternative interpretation might be that they have found ways around their "limitations". They are generally functional because they have developed strategies and support systems to help them work around their difficulties with reading and writing.