Education and health outcomes


Health Equity through Analytics (HExA): Literacy and numeracy

The ABC’s of education and health outcomes

Education is one of the drivers of health typically established early in life and often measured through assessments for literacy and numeracy. Our three-part education volume examines health equity data and offers actionable takeaways to better understand literacy and numeracy in relationship to chronic condition management, health behaviors, and health care utilization.

Data to inspire conversation and catalyze action

The Deloitte Health Equity Institute’s Health Equity through Analytics (HExA) series explores relationships between drivers of health—all the social, environmental, and economic factors that influence health—and health outcomes, identifying actionable trends through a quantitative lens. The main goals of the HExA series are to deepen our knowledge on drivers of health, detangle and segment analyses, and share knowledge broadly in order to inspire conversation and catalyze partnerships that ultimately address root causes.

We recognize that real-world health care issues are highly nuanced, complex, and multifactorial. So, we need additional real-world research to keep building the evidence base—and this series is just the first step.

Volume one focuses on education as a driver of health, with an emphasis on literacy and numeracy: two foundational skill sets established early in life with long-term implications. Download the full report to explore our main findings and learn more about the relationship between literacy, numeracy, and health.

Chapter 1: Numeracy, literacy, and chronic condition management

Numeracy is critical for appropriately acting on health information to manage chronic conditions effectively. Our research uncovered that counties with lower literacy and numeracy tend to experience higher rates of high cholesterol, diabetes, obesity, and high blood pressure.

The following conditions surveyed require general at-home management and a strong understanding of numeric values such as calorie count, blood cholesterol, sugar, and pressure levels for successful management.

Baseline differences in prevalence and numeracy across income groups

The prevalence, though decreasing in all income groups, is overall higher in the lower income group. Also, the proportion of counties that are low numeracy in the lower income group (30%) is greater than the proportion of counties that are low numeracy in the higher income group (1.5%). This points to the potential link between income and numeracy, and it helps to prioritize counties in the lowest third income and low literacy group for investment, resources, and research.

Consistent trends across and within income levels

The negative relationship between numeracy and chronic condition rates exists across the different income groups surveyed. This suggests that while numeracy is related to income, it may also play a role in chronic condition outcomes separate from income (i.e., an improvement in numeracy may lead to an improvement in the prevalence of these conditions in the lower income group).

Prevalence impacted more in lower income counties

The greatest decrease in chronic condition prevalence upon numeracy increase is in lower income communities.

Chapter 2: Numeracy, literacy, and health behaviors

Numeracy and literacy are important skill sets to empower adults in managing their own health behaviors. Our research uncovered that counties with lower numeracy and literacy tend to get less sleep and leisurely physical activity in all income groups. 

Consistent trends across income levels

Literacy appears to be positively associated with county-level sleep and physical activity across all income levels. This suggests that while literacy is related to income, it may also play a role in health behaviors separate from income (i.e., an improvement in literacy may lead to an improvement in sleep and activity).

Rates improve most for lower income counties

Improved literacy rates in lower income counties shows a greater improvement in sleep and physical activity compared with higher income counties. Lower income counties may present the greatest opportunity for impact and intervention.

Chapter 3: Numeracy, literacy, and health care utilization

Numeracy appears important for interpreting and appropriately acting on personal health information, which may inform site-of-service decisions. At a population level, average high numeracy may lead to more judicious health care utilization across all sites of service. 

Our findings on literacy reflect some of the prior ambiguity. However, the relationship between numeracy and health care utilization seems to be more consistent. Moreover, there may be a numeracy threshold (from medium to high) that helps to avoid inappropriate utilization. 

Numeracy inferences may be stronger than literacy

Numeracy levels, stratified into income groups, show more consistent patterns of association to health care utilization trends compared to literacy. Additionally, numeracy appears to be more strongly connected to income as all high numeracy counties are in the upper third of income. This creates a somewhat natural controlled environment that holds stable other factors associated with income, such as access and affordability of services. As a result, numeracy may be a better indicator of health care utilization.

Utilization trends change as numeracy increases

While the initial trend is greater total utilization from low to medium numeracy counties, there’s a decrease in all utilization from medium to high numeracy. On a population scale, there seems to be an inflection in trend when moving into the high numeracy range, which might signal more judicious utilization. However, this could also be influenced by other interacting and confounding factors, thus warranting additional analyses on the individual level.

Five conclusions to inspire strategic conversation


The county average literacy and numeracy across the United States is overwhelmingly low to moderate. In the context of the current health care environment, improving baseline literacy and numeracy may have great potential for improving long term outcomes.


Numeracy may be especially important and overlooked. Based on population data, high numeracy is more difficult to acquire and is mentioned less than literacy in the literature. However, our initial findings suggest that numeracy may provide greater visibility into health behaviors and outcomes.


The prevalence of numerically managed chronic conditions in lower income counties may potentially be reduced through prioritized resources and efforts on increasing baseline literacy and numeracy. All income groups could also benefit from improvements.


Improving literacy and numeracy may also impact health outcomes indirectly through influence on health behaviors like sleep and physical activity across all income groups.


Improved baseline numeracy may influence appropriate health care utilization to lessen some of the systemic and financial burden, and potentially improve provider burnout.

Next steps to take action

Each community is generally best positioned to develop and tailor programs and solutions relevant to their context. Going as far upstream as possible should catalyze the greatest impact. However, an important mindset is starting somewhere, grounded in data, community engagement, and a commitment to identifying and actioning on approachable gaps within the complexity. 
With some advanced planning, evidence can be generated using existing sources—any individual and organization can begin collecting information and measuring outcomes with openly available tools, resources, and collaborations. View our Framework for Generating Evidence with Existing Resources poster that was presented at the Academy Health 2023 Annual Research Meeting for more information

Finally, measurement and evaluation are critical and cannot be overemphasized. A better future relies on shared knowledge. If you’d like to talk more about education and health outcomes or the emerging opportunities they present for your organization, let’s have a conversation. Reach out to learn how Deloitte can help your company achieve its goals.

Get in touch

Elya Papoyan, MPH
Data and Analytics Manager
Deloitte Health Equity Institute
Deloitte Services LP


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