A new report from the Institute of Medicine of the National Academies states that 90 million adults — nearly half of all American adults — have low health literacy and may lack the functional reading and math skills needed to properly use the healthcare system in the United States.

A video produced by The Academy for Educational Development for the Institute of Medicine defines health literacy as the ability to find, understand and use health information and services. It defines reading, writing and the ability to calculate basic math as tools necessary for patients to participate in their own healthcare. For physicians, learning to listen, speaking clearly and bridging cultural barriers that cause misunderstandings and mistakes is a must, the video says.

In addition to healthcare providers and patients, health literacy is also the responsibility of family members, health communication advocates, advertisers, marketers, government and the public health community, the video says.

The report, titled “Health Literacy: A Prescription to End Confusion,” details what health literacy is and offers a sobering example of the problems that can arise from poor communication between patient and doctor.

The report describes a 29-year-old black woman who, after several days of stomach pain and fever, was taken to an emergency room by her family and became agitated when she was initially seen and told she would need an exploratory laparotomy, a procedure involving a small incision into the abdominal wall.

“I came in here in pain and all you want is to do an exploratory on me! You will not make me a guinea pig!” the report quoted the woman as saying.

She refused all treatment and later died of appendicitis.

The problem of low health literacy ranks above problems with health care costs, quality of care and emerging diseases, the video says. It is the most insidious challenge inhibiting health-care providers and how American society in general meets the needs of patients.

The video cites two recent studies reporting that Americans with poor health literacy use the emergency room and hospital services more than other Americans, which contributes to increasing health-care costs. Other studies have found that health-related materials such as consent forms, written instructions and information on pharmaceutical drugs, are written above the average reading ability of American adults.

“Clearly, the first step is that there needs to be awareness that there is the problem of health literacy,” said Cathy Meade, who served on the Health Literacy Panel that published the report. Meade, a professor in the Department of Interdisciplinary Oncology, Division of Cancer Control at USF’s College of Medicine, and director of the Education Program at the H. Lee Moffitt Cancer Center & Research Institute, said students going into the medical profession must be taught to communicate effectively with their patients.

“We need to look at the type of information that we are developing and how to make it easier to understand,” Meade said. “Professional schools of medicine and nursing should incorporate basic principles into the curriculum regarding communication, whether orally, visually or in a written manner.”

Other steps toward a health-literate America include: setting aside enough time for discussions between patients and healthcare providers, having health practitioners communicate clearly during all interactions with their patients, using everyday vocabulary and having informed consent documents regarding healthcare developed so that all people can give or withhold consent based on information they need and understand, the report said.

“It affects people on an everyday basis, whether you’re picking up a prescription, reading a food label or filling out some kind of consent form, we are being asked to do something,” Meade said. “I think health literacy is everyone’s business and everyone can have a role in tackling this particular issue.”