The Adult Literacy Survey also confirmed the effects of literacy on health care. Since 1974, when health officials became aware of the effects of low literacy on health, literacy problems have grown. A more complex health-care system requires better reading skills to negotiate the system and take more responsibility for self-care.

Using a nationally representative sample of the U.S. adult population age 16 and older, the National Academy (2002) on an Aging Society examined the impact of literacy on the use of health care services. The study found that people with low health-literacy skills use more health care services.

Among adults who stayed overnight in a hospital in 1994, those with low health literacy skills averaged 6 percent more hospital visits, and stayed in the hospital nearly 2 days longer than adults with higher health literacy skills. The added health-care costs of low literacy are estimated at $73 billion in 1998 dollars. This includes $30 billion for the Level 2 population plus $43 billion for the Level 1 population. The total is about what Medicare pays for doctor services, dental services, home health care, prescription drugs, and nursing-home care combined.

Low literacy is not chiefly the problem of immigrants, the elderly, high school dropouts, or people whose first language is not English. Low literacy is a problem that knows no age, education, income levels, or national origins. Most people with low literacy skills were born in this country and have English as their first language.

One solution to the problem of low literacy of adults is more government and corporate support for adult literacy programs. Workplace literacy programs have cost-effective and lasting results. Another solution is to produce more texts that are written for people of diverse reading skills.

Challenges for technical communicators

The lessons of the literacy studies for technical communicators are obvious:

• Low and intermediate literacy skills are a big problem for large numbers of users of technical documents. Providing technical documents at their levels will advance both their technical and reading skills.
• The larger the audience, the more it will include the average reading habits and skills of the public as determined by the literacy surveys.
• The more critical the information is for safety and health, the greater is the need for increased readability.

The finding that the great majority of adult readers are mid-range, intermediate readers brings to us in technical communication new opportunities and challenges.

Intermediate readers represent a large audience that technical documents have been missing. Go into any library or bookstore, and you will find few technical or scientific publications in the "Young Adult" section, or elsewhere written at the 7^th to 9^th-grade level. On the Internet, there is the same scarcity of intermediate technical materials.

For example, a small sampling of the author's shows that the support sections of the Apple and Microsoft Web sites are written at advanced level of 10^th grade and up. The technical books for Dummies and Idiots, while written in a casual style, are often at the 10^th-grade level and up. Like the car-safety seat instructions, these technical documents are too difficult for 80 percent of adult readers in the U.S. Ironically, the user manual that comes with the CorelDraw program is written at the 7^th-grade level, making it fit for a much larger audience than its Dummies counterpart.