Health literacy: an update

Literacy, the foundation of education, sheds light on the well-established pathway between education and health outcomes. However, literacy had not been a consideration in most health studies, programs, or practices in industrialized nations until recently because literacy concerns were generally associated with developing nations. In the early 1990s, findings from international surveys of adult literacy conducted in 22 industrialized nations indicated that literacy is problematic in these technologically sophisticated nations with consequences for the economy, daily life, and civic engagement.1 These findings inspired health researchers to examine the influence of literacy on health outcomes. Within the first decade of research, links between the literacy skills of patients and their health outcomes were firmly established.2 As a result, health literacy emerged as a new variable for health studies—offering insight into health outcomes and health disparities and generating interest among health researchers, practitioners, and policy makers.
Over the past two decades, the definition of health literacy has evolved, new component factors have emerged, and new measures have been developed. Studies indicate that health literacy considerations can improve strategic efforts in clinical care by improving dialogue and discussion between and among health professionals and between health professionals and patients with concrete implications for health outcomes. Health literacy in the public health arena is informing programs and evaluation studies in health communication, health promotion, disease prevention, care management, environmental health, and preparedness. Examination of institutional and system level characteristics that support or impede health literacy are informing health policy initiatives in many countries.