The 2024 Nation's Report Card delivers a sobering message: U.S. 12th graders are entering college less prepared to read, write and comprehend complex material than any generation before them.
For higher education, and especially health care programs that depend on dense, technical reading, this is not just a K-12 problem. It is a workforce problem.
A Shrinking Literacy Pipeline
According to the National Assessment of Educational Progress (NAEP), the average reading score for 12th graders fell three points since 2019 and 10 points since 1992. Only 35% of students scored at or above the proficient level, while 32% fell below basic, meaning they struggled to locate or interpret key details in a text.
Confidence in reading also declined, with 71% of students describing themselves as confident readers, down from 73% in 2019.
While headlines may focus on test scores, the deeper concern is the long-term impact on academic and professional readiness. The Nation's Report Card highlights widening gaps between high- and low-performing students, a divide that has persisted for more than a decade.
The lowest-performing students now score about 100 points below the top performers on NAEP's 500-point scale.
"These declines reflect more than temporary learning loss," said Dr. Melissa Randazzo, EIM’s academic officer for speech-language pathology. " They are the product of decades of instructional practices that assumed students would intuit how written language works, without enough explicit, structured teaching in phonics and word structure."
Why It Matters for Health Care Programs
The consequences of this literacy erosion reach far beyond the general education classroom. Students who lack foundational decoding skills enter college with inefficient reading strategies.
They may recognize words by sight but struggle to unpack unfamiliar academic or medical vocabulary.
"For programs that rely heavily on independent learning and complex text, like anatomy, physiology and clinical documentation, those gaps quickly become barriers," Dr. Randazzo said.
"We often assume students can self-manage reading-heavy coursework, but when they can't, faculty end up reteaching content instead of building higher-level skills."
How Reading Deficits Affect Clinical and Academic Performance
When reading and writing are the primary modes of instruction, decoding and comprehension deficits can lead to disengagement, surface-level understanding and even attrition.
"Without targeted supports, we risk losing capable students simply because the cognitive load of reading graduate-level material becomes overwhelming," Dr. Randazzo added.
The implications ripple into the workforce pipeline. Health care employers already face critical shortages in fields like physical therapy, occupational therapy, nursing, physician assistant and speech-language pathology.
If students struggle to master the language of their professions and to pass licensing exams that demand deep comprehension, the bottleneck will only tighten.
Rethinking "College-Ready" for the Modern Student
Addressing this issue requires higher education to redefine what it means to be college-ready. Reading fluency and vocabulary flexibility are essential prerequisites for success in any rigorous program.
"Institutions should embed vocabulary and morphology instruction into early coursework," Dr. Randazzo said. "Teaching students how to analyze words through prefixes, suffixes and roots helps them learn new words more quickly and fosters long-term comprehension."
Faculty development is also essential. Instructors who understand cognitive load can better design materials that meet students where they are through scaffolded text, integrated vocabulary supports and intentional pacing.
In hybrid environments, where students navigate much of their learning independently, course design becomes a key determinant of literacy success.
A Call for Action and Collaboration
The 2024 NAEP results call for proactive leadership. Higher education cannot control K-12 instruction, but it can respond to its downstream effects.
Dr. Randazzo encourages universities to take a systems-level approach:
- Integrate language and reading support into the curriculum, not as an add-on, but as part of program design.
- Equip faculty to recognize literacy barriers and to structure assignments that strengthen comprehension and vocabulary skills.
- Partner with K-12 schools and community literacy organizations to align expectations and strengthen the academic pipeline.
Partnering Beyond Campus to Strengthen the Pipeline
"This is a moment for health care educators to lead," Dr. Randazzo said. "We cannot assume students arrive ready to engage with academic and scientific texts. But with awareness, intentional design and collaboration, we can ensure literacy gaps do not become barriers to entry or to the future of the health care workforce."
The Nation's Report Card underscores what higher education leaders already know: Student readiness is shifting, and adaptation is not optional.
The institutions that respond strategically by embedding literacy into the fabric of their health care curricula will be the ones that sustain enrollment, improve outcomes and ultimately graduate professionals prepared to meet the complex demands of patient care.