Public Health Health Literacy and Non-Communicable Diseases
Sandra Vamos, Jim Frankish
  • LAST REVIEWED: 15 December 2016
  • LAST MODIFIED: 30 September 2013
  • DOI: 10.1093/obo/9780199756797-0144


Health literacy is an essential capacity for living a healthy life. Limited levels of health literacy are a significant public health issue because of its prevalence and its negative implications for health outcomes, health-care quality, and health-care costs. Given that chronic ill health is the leading global cause of death, having the necessary skills to make daily health-related decisions and the capacity to navigate the health-care system is paramount. Health literacy refers not only to the abilities of individuals but also to the health-related systems and providers of information within those systems. While the concept of health literacy first appeared in the literature more than thirty-five years ago, interest in it has increased dramatically. Until recently, interest in health literacy was concentrated in the United States, led by physicians. However, over the past decade interest in it has grown in other developed countries such as Canada, Australia, and the United Kingdom as well as other European Union countries, led by people with a background in the social sciences and health promotion. Health literacy as an emerging field of research and practice has the potential to increase our understanding of both noncommunicable diseases and health promotion in the global context. This bibliography provides a context for health literacy in relation to noncommunicable diseases (NCDs). It offers a collection of key resources (textbooks, journals, reports, websites, etc.) to provide insight to the concept of health literacy, the relevance and role of NCDs, and evidence of the effectiveness of health literacy interventions in relation to chronic disease prevention and management.

Definitions of Health Literacy

Health literacy involves a broad range of skills needed for everyday life, whereby communication and decision-making skills coupled with an understanding of health and medical concepts and contexts across the life-course are all important. Health literacy can be viewed in many ways in relation to NCDs. Partly as a result of different perspectives (e.g., health care, health promotion, education), different definitions of the concept have been developed. Internationally, the World Health Organization (WHO) introduced the concept in its glossary of health promotion terms (Nutbeam 1998). Nutbeam 2000 further differentiates among three levels of health literacy using this WHO definition. US Department of Health and Human Services 2000 (Healthy People 2010) includes health literacy as a national health promotion objective and includes a definition of health literacy emphasizing individual skills. Nielsen-Bohlman, et al. 2004 puts forth a definition in the US Institute of Medicine landmark report titled Health Literacy: A Prescription to End Confusion, which is seen later in Healthy People 2010. Definitions have been put forth by both organizations and individuals and tend to vary in degree of emphasis regarding health literacy responsibility for individuals, patients, providers, policymakers, and communities. For example, critiques of the commonly cited US Department of Health and Human Services 2000 definition note that public responsibility is highlighted. Zarcadoolas, et al. 2006 views health literacy as a public health issue requiring a broad range of skills and core competencies from individuals. On the other hand, in the European Union, Kickbusch, et al. 2005 offers a definition that emphasizes the responsibility of health literacy by all parties. The most commonly cited Canadian operational definition (Rootman and Gordon-El-Bihbety 2008) also underscores the importance of skills and abilities of all parties involved (e.g., public, patients, providers) and takes into account that health literacy is an interaction between the individual in the system in different settings and highlights that it is a shared responsibility across the life-course. It is likely that the debate on the health literacy definition will continue. This lack of international consensus related to the variety of definitions in existence offers ongoing opportunities for exploration and dialogue related to the complex area of study and application to NCDs. Sorenson and colleagues (Sørensen, et al. 2012), via the European Health Literacy Project Consortium, recently conducted a systematic literature review to identify definitions and conceptual frameworks for health literacy. The review resulted in seventeen definitions and twelve conceptual models. A shared characteristic of earlier definitions is a focus on individual skills to access, process, and understand health information. The following definitions highlight the importance of moving beyond an individual focus and encompass a broader view to consider health literacy as an interaction between the individual and the health system. Key definitions are provided below.

  • Kickbusch, I., S. Wait, and D. Maag. 2005. Navigating health: The role of health literacy. London: Alliance for Health and the Future, International Longevity Centre.

    Authors emphasize responsibility by all: “The ability to make sound health decision(s) in the context of everyday life—at home, in the community, at the workplace, the health-care system, the market place, and the political arena. It is a critical empowerment strategy to increase people’s control over their health, their ability to seek out information, and their ability to take responsibility” (p. 8).

  • Nielsen-Bohlman, L., A. Panzer, and D. A. Kindig, eds. 2004. Health literacy: A prescription to end confusion. Washington, DC: National Academies.

    The Institute of Medicine’s definition is the same as the definition seen in the US government’s statement of national health objectives Healthy People 2010. Health literacy is “the individual’s capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions” (p. 37). The text of the report clearly indicates that health literacy is an “interactive” concept.

  • Nutbeam, D. 1998. Health promotion glossary. Geneva, Switzerland: World Health Organization.

    The WHO glossary on health promotion authored by Don Nutbeam proposes the following health literacy definition: “The cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health” (p. 10).

  • Nutbeam, D. 2000. Health literacy as a public goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International 15.3: 259–267.

    DOI: 10.1093/heapro/15.3.259

    Nutbeam’s definition, which reflects a health promotion perspective, was the same as the definition offered in the WHO Health Promotion Glossary. “Health literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information to promote and maintain good health” (p. 264). This paper also identified three types of health literacy (functional, interactive, and critical). Available online for purchase or by subscription.

  • Rootman, I., and D. Gordon-El-Bihbety. 2008. A vision for a health literate Canada: Report of the Expert Panel on Health Literacy. Ottawa: Canadian Public Health Association.

    This definition encompasses four domains and was the first to note that health literacy (and related information needs and processing) vary across the life-course. Health literacy is “the ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in a variety of settings across the life course” (p. 11).

  • Sørensen, K., S. Van den Broucke, J. Fullam, et al. 2012. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health 12.1: 80.

    DOI: 10.1186/1471-2458-12-80

    The authors conducted a systematic review of seventeen health literacy definitions and suggest their own “all-inclusive” definition. Health literacy is “linked to literacy and entails people’s knowledge, motivation, and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course” (p. 3).

  • US Department of Health and Human Services. 2000. Healthy people 2010. 2 vols. Washington, DC: US Department of Health and Human Services.

    The US government’s national health objectives titled Healthy People 2010 defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (pp. 11–20). This definition, which reflects the health-care and education perspectives, has been adopted widely. Includes Volume 1, Understanding and Improving Health, and Volume 2, Objectives for Improving Health.

  • Zarcadoolas, C., A. Pleasant, and D. S. Greer. 2006. Advancing health literacy: A framework for understanding and action. San Francisco: Wiley.

    The authors define health literacy as “The wide range of skills and competencies that people develop to seek out, comprehend, evaluate and use health information and concepts to make informed choices, reduce health risks and increase quality of life” (p. 55).

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