Health literacy

The young and multidisciplinary field of health literacy emerged from two expert groups; physicians and other health providers and health educators, and Adult Basic Education (ABE) and English as Second Language (ESL) practitioners. Physicians are a source of groundbreaking patient comprehension and compliance studies. Adult Basic Education / English for Speakers of Languages Other Than English (ABE/ESOL) specialists study and design interventions to help people develop reading, writing, and conversation skills and increasingly infuse curricula with health information to promote better health literacy. A range of approaches to adult education brings health literacy skills to people in traditional classroom settings, as well as where they work and live.

Health literacy involves both the context (or setting) in which health literacy demands are made (e.g., health care, media, Internet or fitness facility) and the skills that people bring to that situation.

The biomedical approach to health literacy that became dominant (in the U.S.) during the 1980s and 1990s often depicted individuals as lacking, or “suffering” from, low health literacy, assumed that recipients are passive in their possession and reception of health literacy, and believed that models of literacy and health literacy are politically neutral and universally applicable. This approach is found lacking when placed in the context of broader ecological, critical, and cultural approaches to health. This approach has produced, and continues to reproduce, numerous correlational studies.

A more robust view of health literacy includes the ability to understand scientific concepts, content, and health research; skills in spoken, written, and online communication; critical interpretation of mass media messages; navigating complex systems of health care and governance; and knowledge and use of community capital and resources, as well as using cultural and indigenous knowledge in health decision making (Nutbeam, 2000; Ratzan, 2001; Zarcadoolas, Pleasant, & Greer, 2002). This view sees health literacy as a social determinant of health that offers a powerful opportunity to reduce inequities in health.

This perspective defines health literacy as the wide range of skills, and competencies that people develop over their lifetimes to seek out, comprehend, evaluate, and use health information and concepts to make informed choices, reduce health risks, and increase quality of life (Zarcadoolas, Pleasant, & Greer, 2006). While definitions vary in wording, they all fall within the conceptual framework offered in this definition.

Defining health literacy in that manner builds the foundation for a multi-dimensional model of health literacy built around four central domains:
 * fundamental literacy,
 * scientific literacy,
 * civic literacy, and
 * cultural literacy.

Finally, it must be stressed that health literacy skills are not only a problem 'in' the public. Health care professionals (doctors, nurses, public health professionals) can also have poor health literacy skills; most often captured by a reduced ability to clearly explain health issues to patients and the public.