University of Wisconsin–Madison Medical College of Wisconsin

Health Illiteracy: The Crisis in Rural America

Mario Duwe; Megan Lechleitner

WMJ. 2022;121(3):171

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Health literacy is defined as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”1 Despite the gravity of these essential skills, the health literacy competency rate in the United States is only 12%.2 It is no secret that rural America disproportionately suffers from low health literacy, as evidenced by its high rates of poor health and chronic disease. There are many factors attributed to these disparities; however, health literacy is our primary focus in that it is a fundamental and rooted explanation for health trends across rural America.

Literacy is commonly conceptualized as reading and writing; however, literacy embodies numerous aspects of life. As aspiring physicians and recent graduates of the Community Health Internship Program through the Area Health Education Center in Wisconsin, we developed and transformed our understanding of rural medicine. We witnessed the struggles many people endure to obtain adequate health care in a rural setting, including transportation issues, lack of access and understanding of health insurance, and the absence of urgency for regular doctor visits. Our initial first-hand experiences with Afghan refugees revealed the desperate need for health literacy. Each week of our program, we tutored refugees navigating their new environment and quickly discovered they were entirely uneducated regarding matters of our health care system.

We further learned from several local nonprofit organizations and involved community leaders of the hardships associated with rural health. We found that there is a health professional workforce shortage, limitations of rural health training opportunities, population health challenges, delay of care, and low health literacy prevalent in rural health care. We discovered that most patients gravitate toward emergency department or short-stay models of care. Additionally, the patients tend to be older, sicker, and less well-insured.

The solutions for addressing these concerns rely both on the individual health consumer and major community structures, such as health care systems, educational institutions, and the media. A starting point to improve this problem is to make health information easier to understand (print, oral, or electronic), improve education on these literacy skills, and reform health care delivery to a more patient-centered focus.

To help expand health care knowledge in rural communities, we created a handbook that includes step-by-step instructions on how to schedule a medical appointment, how to establish a provider, easy health insurance information, and many other resources in and around the community of Wausau, Wisconsin. This handbook can be accessed at the Marathon County Literacy Council or online at It is our hope that with similar resources many rural residents will better understand health care.

Conquering these challenges will require determination and a willingness to create solutions. Rural health illiteracy is a public health crisis, and it is time to address it.

  1. What is health literacy? Centers for Disease Control and Prevention. Reviewed February 2, 2022. Accessed August 15, 2022.
  2. Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). US Department of Education, National Center for Education Statistics; 2006.

Author Affiliations: Marathon County Literacy Council, Wausau, Wisconsin (Duwe, Lechleitner).
Corresponding Author: Megan Lechleitner,
Funding/Support: None declared.
Financial Disclosures: None declared.
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