The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Ratzan and Parker, 2000).

The capacity of the individual is a substantial contributor to health literacy. The term “capacity” refers to both the innate potential of the individual, as well as his or her skills. An individual’s health literacy capacity is mediated by education, and its adequacy is affected by culture, language, and the characteristics of health-related settings. In this report, the committee has captured the range of environments and situations related to health in the term “health context”. The health context includes the media, the marketplace, and government agencies, as well as those individuals and materials a person interacts with regarding health—all must be able to provide basic health information in an appropriate manner (Rudd, 2003). This health context is of equal importance to individuals’ health literacy skills, as the impact of health literacy arises from the interaction of the individual and the health context (Rudd, 2003; Rudd et al., 2003). Health literacy, then, is a shared function of cultural, social, and individual factors. Both the causes and the remedies for limited health literacy rest with our cultural and social framework, the health and education systems that serve it, and the interactions between these factors.

A Conceptual Framework for Health Literacy

Figures 2-1 and 2-2 provide visual frameworks for considering health literacy. Figure 2-1 places literacy as the foundation of health literacy and health literacy as the active mediator between individuals and health contexts. Individuals bring specific sets of factors to the health context, including cognitive abilities, social skills, emotional state, and physical conditions such as visual and auditory acuity. Literacy provides the skills that enable individuals to understand and communicate health information and concerns. Literacy is defined as a set of reading, writing, basic mathematics, speech, and speech comprehension skills (Kirsch, 2001a). Health literacy is the bridge between the literacy (and other) skills and abilities of the individual and the health context. This interaction is explored in Chapter 3, where associations between health literacy and health-related outcomes are discussed in detail.

Figure 2-2 illustrates the three key sectors that should assume responsibility for health literacy, and within which health literacy skills can be built. The sectors that constitute the contexts of health literacy are culture and society, the health system, and the education system. These sectors also provide intervention points that are both challenges and opportunities for improving health literacy.

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