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Patients’ health literacy

BMJ 2009; 338 doi: https://doi.org/10.1136/sbmj.b2394 (Published 17 June 2009) Cite this as: BMJ 2009;338:b2394
  1. Sukhpal S Gill, final year medical student,
  2. John Skelton, professor of clinical communication and director of Medical Education Unit
  1. 1University of Birmingham

Better health literacy is a means to tackle health inequalities

Although the term “health literacy” has been around since 1974, its meaning has evolved: it now means much more than the ability to read and comprehend medical information.1 “Health literacy” is defined as the ability to make sound health decisions in the context of everyday life—at home, in the community, at the workplace, in the healthcare system, in the marketplace, and in the political arena—and so it is related to the general concept of “literacy.”

Poor health, higher rates of hospital admissions, and poor adherence to medical advice are common in health illiterate populations.2 In addition, patients with low health literacy underuse preventive services and experience more drug related problems. Achieving better health literacy is therefore a means of tackling health inequalities.

The financial costs of low health literacy are disturbing. Direct attributable annual costs to the US economy have been reported as high as $236bn (£144bn; €167bn).3 No such data are available for other countries, but for government run health systems, such as the UK National Health Service, the burden on resources is presumably considerable.

Health literacy may be categorised into three levels—functional, critical, and a more advanced cognitive form, known as interactive (box 1).

Box 1: Categories of health literacy1

  • Functional—Able to read and comprehend basic health information

  • Critical—Able to assess the information

  • Interactive—Able to apply the information and actively participate in health care

Better public health literacy

Health literacy is complex and depends on individual and social processes. Interventions should be targeted in three broad areas—education systems, culture and society, and health systems.1 Incorporating health literacy into school curriculums—for example, citizenship classes—may instigate positive health behaviours from an early age. But bringing about real change in culture and society is difficult, with initiatives aimed at low literacy groups yielding mixed …

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