Health Literacy and Noncommunicable Diseases

by

Sandra Vamos, Jim Frankish, Paul Yeung

• LAST REVIEWED: 15 December 2016
• LAST MODIFIED: 25 September 2023
• DOI: 10.1093/obo/9780199756797-0144

Introduction

Health literacy (HL) is an essential capacity for living a healthy life. Limited levels of HL are a significant public health issue because of its prevalence and its negative implications for health-care costs, health-care quality, and health outcomes. Given that chronic disease is the leading global cause of death and disability, having the necessary skills to make daily health-related decisions and the capacity to navigate the health-care system is paramount. HL 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 HL first appeared in the literature almost fifty years ago, the evolving concept has been informed by three main areas: (1) health care; (2) health promotion; and (3) education. It is important to note that the initial interest in HL in the United States was led by physicians with a medical perspective. However, over the past two decades interest in HL has grown in other countries, such as Canada, Australia, the United Kingdom, and the European Union as well as African and Asian countries, led by people with a background in the social sciences and health promotion. HL as an emerging field of research, practice, and policy has the potential to increase our understanding of both noncommunicable diseases (NCDs) and health promotion in the global context. This article provides a context for HL in relation to NCDs. It offers a collection of key resources (such as textbooks, journals, reports, websites, etc.) to provide insights into the concept of HL, the relevance and role of NCDs, and evidence of the effectiveness of HL interventions in relation to chronic disease prevention and management.

Definitions of Health Literacy

HL 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 important. Due to different perspectives (e.g., health care, health promotion, and education), different definitions of the concept have been developed over time. 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 HL using this WHO definition. Nielsen-Bohlman, et al. puts forth a definition in the landmark report, entitled Health Literacy: A Prescription to End Confusion (see Nielsen-Bohlman, et al. 2004, cited under Books), which is adopted in Healthy People 2010. US Department of Health and Human Services 2000 includes HL as a national health promotion objective and emphasizes individual skills in its definition. US Department 2023 expands the definition in Healthy People 2030 to underscore both people’s ability to use health information and acknowledge the important role that organizations play. Definitions that have been put forth by both organizations and individuals tend to vary in degree of emphasis regarding HL responsibility for individuals, patients, providers, policymakers, and communities. For example, Zarcadoolas, et al. 2006 views HL as a public health issue requiring a broad range of skills and core competencies from individuals. In contrast, in Europe, Kickbusch, et al. 2005 offers a definition that emphasizes the responsibility of HL by all parties. The most commonly cited Canadian operational definition (also underscores the importance of skills and abilities of all parties involved (e.g., public, patients, and providers) and takes into account that HL is an interaction between the individual in the system in different settings and highlights that it is a shared responsibility across the life-course (see Rootman and Gordon-El-Bihbety 2008, cited under Reports). The Calgary Charter on Health Literacy 2011 builds upon this milestone work explicitly stating five core HL domains or skills. Sørensen, et al. 2012, via the European Health Literacy Project Consortium, reviews international HL definitions and models in order to inform the development of the authors’ own applications within the health-care, disease prevention, and health promotion settings. While the different definitions of HL will continue to evolve, the following definitions highlight the importance of moving beyond an individual focus and encompass a broader view to consider HL as an interaction among the individual, providers, and systems. Key definitions are provided below.

• Calgary Charter on Health Literacy. 2011. The Calgary charter on health literacy: Rationale and core principles for the development of health literacy curricula.

  Participations from Canada, the United States, and the United Kingdom proposed a HL definition with five HL domains or skills and defined principles to support the development of curricula and evaluation tools to improve HL. HL is an individual’s capacity to “find, understand, evaluate, communicate, and use information” in order to make informed decisions for one’s health and well-being (p. 1).

• 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.

  The authors emphasize responsibility by all: “The ability to make sound health decisions in the context of everyday life – at home, in the community, at the workplace, in the health care system, the marketplace 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).

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

  DOI: 10.1093/heapro/13.4.349

  The WHO glossary on health promotion authored by Don Nutbeam proposes the following HL 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, is the same as the definition offered in Nutbeam 1998. HL “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 HL (i.e., functional, interactive, and critical).

• 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

  Sørensen and colleagues reviewed definitions and conceptual models of HL. Based on the content analysis, a new “all-inclusive” comprehensive definition capturing the essence of the seventeen definitions was put forth. The authors also developed an integrative conceptual model containing twelve dimensions referring to the knowledge, motivation, and competencies of accessing, understanding, appraising, and applying health-related information within the health-care, disease prevention, and health promotion setting, respectively.

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

  The US government’s national health objectives, titled Healthy People 2010 defines HL 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.” This definition, which reflects the health-care and education perspectives, has been adopted widely. It can be seen in Volume 1, Understanding and Improving Health, and Volume 2, Objectives for Improving Health.

• US Department of Health and Human Services. 2023. Healthy literacy in healthy people 2030. Washington, DC: US Department of Health and Human Services.

  Healthy People 2030 provides two definitions: “Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others” (para. 2).

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

  The authors define HL as “[t]he 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). Available online by purchase.