As Ruth Parker, M.D., of the American university Emory in Atlanta, Georgia, says, "Health literacy is a very functional capability. It's really the body of knowledge and understanding people need in order to read, interpret and comprehend all material on bottles, slips, written and oral material and oral instructions and multiple forms of printed material" (Illiteracy may...1997, pg.4).

The American Robert Wood Johnson Foundation conducted a study on the issue of health literacy. Conducted by Ruth Parker, M.D. and Mark V. Williams, M.D., both of Emory University, along with David W. Baker, M.D., the study measured the ability of patients to perform health-related tasks that require reading and computational skills. Using the Test of Functional Health Literacy in Adults, a tool they developed, the researchers examined the impact of literacy skills on hospitalisation of 1008 patients at Grade Memorial Hospital in Atlanta, Georgia, over a period of 2 years. The researchers found a 52% increase in the risk of hospitalisation in patients with inadequate literacy compared with patients with adequate literacy (Marwick, 1997).

Within the American medical system, the study estimated that the increase in hospitalisation of illiterate persons alone could translate into excess hospital costs of U.S.$8 billion to $15 billion.

There are a number of important issues arising from the state of illiteracy. As demonstrated in the International Adult Literacy Survey, illiteracy is a global problem. Projections of the state of illiteracy show that although some progress is being made, illiteracy will continue to be a dramatic problem.

Michael F. Bloom, PhD., president of Bloom Forecasting, has developed scenarios for the world in 2020. Trends projection by the United States Bureau of the Census show that world illiteracy, in percentage terms, will decline, from 25.7% in 1990 to 18.9% in 2020. However, the world population will continue to expand strongly, increasing the number of illiterate people from 683 in 1990 to 780 million in 2020.

This means that the information age 20 years on, will have 780 million people in it who cannot receive, use or create information, are unable to read how to improve farming methods, unable to read instructions to install an appliance, unable to read instructions on a medicine bottle or over-the-counter medication. Most importantly, this enormous group of people will be denied access to the critical tool of our time: the computer (Bloom, 1995).

This future shows starkly the importance of approaching illiteracy both with the intention of eradication and also with the intention of communicating effectively with those who do not read and write.