Black and Hispanic adults are substantially over-represented in the low-skilled population. In the United States, the odds of being in poor health are four times greater for low-skilled adults than for those with the highest proficiency - double the average across participating countries. The results show that, overall, there is a reasonably close correlation between countries' performance across the successive PISA assessments and the proficiency of the corresponding age cohorts in literacy and numeracy in the Survey of Adult Skills.