The Scope of Health Literacy

If people who promote health care, create policy, and develop health materials have a clear understanding of the problem of health literacy, procedures, policies, and programs can be developed to meet the health literacy needs of the average American adult. A clear understanding of health literacy can guide the health system of public health practitioners, care providers, insurers, and community agencies toward adopting definitions and policies that resolve incompatibilities between the needs of individuals and the demands of health systems. The committee believes that both a commonly accepted definition and a conceptual framework will contribute to the clear understanding of health literacy. In choosing the definition and developing the framework in this report the committee examined the existing definitions and concepts of health literacy. The committee believes the definition and framework in this report incorporate aspects essential to the understanding of health literacy, and allow for a flexibility of response within the framework of a widely accepted definition.

Health literacy is a newly emerging concept and field of inquiry, so it is not surprising that the scope of health literacy varies according to how it is defined. For example, in 1999, the Ad Hoc Committee on Health Literacy of the American Medical Association defined health literacy as the “constellation of skills, including the ability to perform basic reading and numerical tasks required to function in the health care environment,” and included everyday health functions such as the “ability to read and comprehend prescription bottles, appointment slips, and other essential health-related materials” (American Medical Association, 1999). This definition captures important components of health care, but confines the scope of health literacy to the health-care sector. This committee extends the concept of health literacy beyond health-care settings to include the variety of contexts (such as in the community and at work) in which individuals make health-related decisions.

Another concept of health literacy is found in the definition used by the Joint Committee on National Health Education Standards: “the capacity of individuals to obtain, interpret and understand basic health information and services and the competence to use such information and services in ways which enhance health” (Joint Committee on National Health Education Standards, 1995). This definition does move beyond the health-care setting; however, this and similar definitions (e.g., Kickbusch, 1997) maintain a focus on the capacity of individuals and emphasize the characteristics, knowledge, and skills of individuals without attention to the complexity of various health contexts, the tasks involved, or the materials in use.

The committee chose to adopt the definition used in Healthy People 2010 for purposes of measurement and clarity in this report. As previously

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