Health Literacy and Equity Principles Can Bring True Reform to US Healthcare

This blog post was originally posted on the Horowitz Center for Health Literacy website on April 1, 2019

Written by Dr. Cynthia Baur, Director of the Horowitz Center for Health Literacy

Photo of Cynthia Baur

Health literacy and health equity principles embody a health system many Americans would choose, if they could. A system based on health literacy and equity would be designed and implemented so that everyone can understand, use, and access (including afford) the information, products, and services they need for health and well-being.

The UMD Center for Health Literacy is sponsoring this blog to begin a public conversation about the contribution health literacy and equity principles can make to a truly inclusive and health and well-being-promoting system in the US. We have invited several UMD School of Public Health faculty to offer their perspectives, and we welcome comments and suggestions for future topics and bloggers.

According to Healthy People 2030, the nation’s health goals and objectives, health literacy occurs when a society provides accurate health information and services that people can easily find, understand, and use to inform their decisions and actions. Health equity means that everyone has a fair and just opportunity to be healthier, which requires removing obstacles to health such as poverty, discrimination, and their consequences.

Arguably, the most significant US health literacy issue is the gap between the general perception that health care is excellent/good and affordable1 and the large volume of data and policy reports that shows otherwise. The US ranks poorly in health care costs, quality measures, and health outcomes against its own measures and in country comparisons.2  Health system errors have been documented when culture and language are not considered, as well as evidence-based protocols are not followed.3

Many reasons could explain this perception-data gap, including dense, jargon-filled policy documents understandable primarily by “insiders” and periodic public communication campaigns to generate fear and spread misinformation about health policy changes.4

If policymaking began with people’s health and well-being needs instead of the healthcare sector’s interests as the policy cornerstone, then a system based on health literacy and equity is an obvious starting point. More than a decade ago, the National Academies of Sciences, Engineering and Medicine named health literacy as one of two cross-cutting priorities to transform healthcare quality.

No shortcut to a healthy society exists when so many people are excluded from understanding and accessing necessary information, products, and services to pursue a healthy life. We hope this blog stimulates the long-overdue focus on health literacy and equity as the essential pieces of healthcare reform in the service of a healthy society.



1 Patients’ Perspectives on Health Care in the United States. Poll conducted September 8—November 9, 2015 by the Harvard T.H. Chan School of Public Health in partnership with the Robert Wood Johnson Foundation and NPR.

2 AHRQ National Healthcare Quality and Disparities ReportsHealthy People 2020; It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt. Anderson GF, Hussey P, Petrosyan V. Jan. 2019 Health Affairs

3 The National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division. Crossing the Quality Chasm: The IOM Health Care Quality Initiative. Accessed March 6, 2019.

4 Plain Writing Act of 2010; Why the “Death Panel” Myth Wouldn’t Die: Misinformation in the Health Care Reform Debate. Nyhan B. 2010. The Forum.


Dr. Cynthia Baur became the Director of the Horowitz Center for Health Literacy in January 2017. Prior to coming to UMD, Dr. Baur worked for 17 years in communication leadership roles with the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and the U.S. Department of Health and Human Services (HHS) in Washington, D.C. Most recently, she served as the Senior Advisor for Health Literacy in the CDC Office of the Associate Director for Communication and CDC’s Senior Official for the Plain Writing Act implementation. 

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