Health Literacy

The concept of health literacy initially emerged and continues to gain strength as an approach to improving health status and health systems because numerous research studies clearly link low levels of education and literacy with poor health and early death around the world.

Health literacy is a key component of the complex relationship between knowledge, attitudes, behavior, and health outcomes from the individual to the societal level. For example, a health literate person is able to improve individual health decision [Page 354]making and reap benefits from healthier lifestyle choices. In addition, a health literate individual is more aware of the social, economic, and environmental determinants of health and is more prepared to engage in individual and collective actions that can improve the status of those determinants.

Health literacy is increasingly applicable and relevant to practice within health care and health research systems around the world. Most of the major advances in health since the beginning of the 20th century are due to the application of new knowledge and technologies such as immunizations and preventive medicine. Health literacy is the fundamental skills and abilities that allow health systems and health care professionals to promote those new advances and allow individuals to receive, understand, and use that information in their daily lives.

The evidence base on health literacy includes significant findings that people with lower health literacy often experience the following:

• Poorer adherence to medical regimes
• Poorer understanding of their own health
• Less knowledge about medical care and conditions
• Poorer understanding of medical information
• Lower understanding and use of preventive services
• Being less likely to seek health care early
• Being less likely to ask questions of a health care professional
• Poorer self-reported health
• Increased hospitalization
• Increased health care costs
• Poorer health status
• Being less likely to receive needed kidney transplants
• Earlier death

The ongoing shift in the global burden of disease away from infectious diseases and toward chronic diseases and illness further increases the importance of health literacy. That shift requires increased patient self-management as well as behavior and lifestyle changes. Thus, there is an increasing need for an active and informed public with the health literacy skills to ensure, for example, that people maintain their prevention and treatment plans, including proper self-care that promotes good health. A continuing emergence of self-care and long-term care protocols as basic treatment, combined with cutbacks in health services (furthering the need for self-care) and increasing complexity in routes to access care, compound the need and utility of a fully engaged health literate public.

Further, as nations (in particular the United States) grapple with the ongoing need for health care system reform—in part driven by the shift in the burden of disease—health literacy is beginning to play a strong role in providing a conceptual basis and direction for health care reform. For instance, at the September 2009 U.S. Institute of Medicine workshop on health literacy and prevention, the argument was advanced that a complete understanding of health literacy leads to key recommendations that urge transitioning away from the current sick care system and moving toward a true health care system that embraces prevention. The recommendations included the

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