Simply stated, health literacy is the ability to obtain, understand, and effectively use health-related information. In a recent report entitled "Health Literacy: A Prescription to End Confusion," the Institute of Medicine estimated that 90 million adults may lack the needed literacy skills to effectively use the U.S. health care system. Extrapolating from the National Adult Literacy Survey, approximately 36 percent of New York City adults would not be able to identify the name of a hospital in a short article; an additional 27 percent would not be able to fill out a standard health insurance form. Health care providers and patients typically do not identify low health literacy as a major issue, but both groups are well aware of its consequences. Health care professionals know they need improved communication with their patients so that they can better understand patient concerns and priorities, engage them as active partners in their care, improve their grasp of protocols for care management and the need for preventive care and screening, and ensure that they know when and where to seek care and how to navigate the health care system. Conversely, adults with low literacy skills often feel intimidated by the complexity of the health care system, by the forms and instructions, and by medical terminology. To avoid appearing ignorant, they may be hesitant to ask questions or express concerns, thereby compounding the problem. All of these difficulties are exacerbated when patients do not speak English well and are unfamiliar with the U.S. health care system.