Van den Broucke Archives of Public Health 2014, 72:10

http://www.archpublichealth.com/content/72/1/10 ARCHIVES OF PUBLIC HEALTH

EDITORIAL Open Access

Health literacy: a critical concept for public health

Health literacy is gaining critical importance in public perspectives on health literacy, and accounts for the
health. Since its introduction in the 1970s, the scientific knowledge and competences that are required to meet
literature on this subject has grown exponentially. To the complex demands of modern society with regard to
date, already more than 3000 publications on the topic being ill, being at risk for illness, and staying healthy.
are listed in Pubmed, 75% of which have been published If health literacy can be considered as a critical determin-
in the last five years, and nearly 1000 have “health literacy” ant of public health, what is then its current status in the
as a major MeSH term. population? The available evidence suggests that more
Originally, the interest in health literacy was mainly people have limited health literacy than is often assumed.
focused on health care services, and had a limited focus According to population data from the US, nearly half of
on the ability to handle words and numbers in a medical the American adult population may have difficulties in act-
context. Yet over the years the concept gradually ex- ing on health information [7]. In Europe, findings from the
panded in meaning to also account for more complex recent European Health Literacy Survey [8] indicate that
and interconnected abilities, such as reading and acting 12% of the people surveyed have inadequate general health
upon written health information, communicating needs to literacy, and 35% have problematic health literacy. Although
health professionals, and understanding health instructions the prevalence of problematic health literacy varies widely
[1,2]. More recently, the concept of health literacy has also between countries (between 2% inadequate health literacy
found its way into public health. So, in addition to the in the Netherlands versus 27% in Bulgaria) and between
already significant body of literature linking low health liter- groups within populations, it is clear that health literacy is
acy to decreased medication adherence, poor knowledge of not just a problem of a small minority [9].
disease, poor adherence to self-care management, and poor To address this “health literacy epidemic” [10], action
treatment outcomes, there is now an increasing number of is needed to improve health literacy. A recent policy
studies attesting to the fact that people with lower health document issued by the European Regional Office of WHO
literacy are also less likely to engage in health promoting [9] calls for action at different levels: to ensure better health
behaviours [3], to participate in screening programs [4,5] communication through establishing health literacy guide-
or to use preventive services [6]. At the same time, the lines; to create and strengthen health literacy–friendly set-
meaning of the concept itself continues to expand and tings; and to develop policies for health literacy at the local,
now includes information seeking, decision making, prob- national and international level. These actions should be
lem solving, critical thinking, and communication, along integrated to empower and enable people to make sound
with a multitude of social, personal, and cognitive skills health decisions in the context of everyday life: at home, in
that are imperative to function in the health system. This the community, at the workplace, in the health care system,
expansion, both in scope and in meaning, is well captured in the educational system, in the marketplace, and in the
by the definition proposed by Sørensen et al. [1], which traditional and social media. While the health sector can
states that health literacy “entails people’s knowledge, lead by example through the creation of health care settings
motivation and competences to access, understand, appraise, that empower patients and promote and support health lit-
and apply health information in order to make judgments eracy, politicians, professionals, civil society and the private
and take decisions in everyday life concerning healthcare, sector should all contribute to addressing the health literacy
disease prevention and health promotion to maintain or challenges. International and regional agencies such as
improve quality of life during the life course”. The defin- WHO, the EU, and the UN Economic and Social Council
ition incorporates both the medical and public health can provide moral and political platforms for actions.
Such actions must build on research. While the growing
Correspondence: [email protected]
body of research on health literacy has expanded the scope
Psychological Sciences Research Institute, Université catholique de Louvain, and depth of the knowledge base about health literacy,
Place Cardinal Mercier 10, 1348 Louvain-la-Neuve, Belgium

© 2014 Van den Broucke; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public
Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this
article, unless otherwise stated.
Van den Broucke Archives of Public Health 2014, 72:10 Page 2 of 2
http://www.archpublichealth.com/content/72/1/10

produced a number of sophisticated and well-validated 12. Jordan JE, Buchbinder R, Briggs AM, Elsworth GR, Busija L, Batterham R,
measures of health literacy [11-13], and demonstrated Osborne RH: The health literacy management scale (HeLMS): a measure
of an individual’s capacity to seek, understand and use health
the links between poor health literacy and a variety of information within the healthcare setting. Patient Educ Couns 2013,
health outcomes, important knowledge gaps remain. 91:228–235.
For instance, the links between health literacy and doc- 13. Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R: The
grounded psychometric development and initial validation of the Health
umented health disparities among population groups is Literacy Questionnaire (HLQ). BMC Public Health 2013, 13:658.
not yet well understood. More comprehensive research 14. Nutbeam D: Health literacy as a public health goal: a challenge for
is also needed to understand the gap between individual contemporary health education and communication strategies into the
21st century. Health Promot Int 2000, 15(3):259–267.
capacities and demands posed by society and the health
care system, and to evaluate the impact on health literacy doi:10.1186/2049-3258-72-10
of novel communication techniques and devices, includ- Cite this article as: Van den Broucke: Health literacy: a critical concept
for public health. Archives of Public Health 2014 72:10.
ing ICT driven communication tools. Finally, the potential
of health literacy to serve as a proxy outcome measure of
health education could be further explored [14].
In a strategic document published ten years ago, the
American Medical Association [7] recommended four
areas for health literacy research: health literacy screen-
ing, improving communication with low-literacy pa-
tients, costs and outcomes of poor health literacy, and
causal pathways of how poor health literacy influences
health. All these topics remain very relevant to date. The
special series on health literacy of the Archives of Public
Health aims to contribute to the important and timely
task of providing research support to addressing low
health literacy in the population.
Received: 17 March 2014 Accepted: 17 March 2014
Published: 1 April 2014

References
1. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z,
Brand H: Health literacy and public health: a systematic review and
integration of definitions and models. BMC Public Health 2012, 12:80.
2. Peerson A, Saunders M: Health literacy revisited: what do we mean and
why does it matter? Health Promot Int 2009, 24(3):285–296.
3. Kaufman H, Skipper B, Small L, Terry T, McGrew M: Effect of literacy on
breast-feeding outcomes. South Med J 2001, 94(3):293–296.
4. Dolan NC, Ferreira MR, Davis TC, Fitzgibbon ML, Rademaker A, Liu D,
Schmitt BP, Gorby N, Wolf M, Bennett CL: Colorectal cancer screening
knowledge, attitudes, and beliefs among veterans: does literacy make a
difference? J Clin Oncol 2004, 22(13):2617–2622.
5. Lindau ST, Tomori C, Lyons T, Langseth L, Bennett CL, Garcia P: The
association of health literacy with cervical cancer prevention knowledge
and health behaviors in a multi-ethnic cohort of women. Am J Obstet
Gynecol 2002, 186(5):938–943.
6. Scott TL, Gazmararian JA, Williams MV, Baker DW: Health literacy and
preventive health care use among Medicare enrollees in a managed
care organization. Med Care 2002, 40(5):395–404.
7. Institute of Medicine: Health Literacy: A Prescription to end Confusion.
Washington DC: The National Academies; 2004. Submit your next manuscript to BioMed Central
8. Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, Fullam J, and take full advantage of:
Kondilis B, Agrafiotis D, Uiters E, Falcon M, Mensing M, Tchamov K, Van den
Broucke S, Brand H: Health literacy in Europe: comparative results of the
• Convenient online submission
European health literacy survey (HLS-EU). Eur J Public Health. in press.
9. Kickbusch I, Pelikan JM, Apfel F, Tsouros A: Health Literacy: The Solid Facts. • Thorough peer review
Copenhagen: World Health Organization (WHO); 2013. • No space constraints or color figure charges
10. Davis T, Wolf MS: Health literacy: implications for family medicine.
• Immediate publication on acceptance
Fam Med 2004, 36(8):595–598.
11. Sørensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, • Inclusion in PubMed, CAS, Scopus and Google Scholar
Kondilis B, Stoffels V, Osborne RH, Brand H: Measuring health literacy in • Research which is freely available for redistribution
populations: illuminating the design and development process of the
European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public
Health 2013, 13(1):948. Submit your manuscript at
www.biomedcentral.com/submit