Leaders from around the world recently endorsed a need for health literacy action at governmental levels. Culminating a year of the United Nations Economic and Social Council focusing on “Implementing the internationally agreed goals and commitments in regard to global public health,” Ministers agreed in a declaration that: “We stress that health literacy is an important factor in ensuring significant health outcomes and in this regard call for the development of appropriate action plans to promote health literacy” (July 9, 2009).

In addition to dialogue at the United Nations, the European Union, OECD, United States, China, United Kingdom, and other countries have begun to address health literacy. In the United States, legislation has been introduced in the last Congress with a Senate Bill (National Health Literacy Act of 2007 (S. 2424)). HHS included health literacy as a Healthy People 2010 objective; and agencies including AHRQ, FDA, and CDC have some references to health literacy. Currently, health reform legislation includes references with health literacy and 12 states are developing legislation and/or coalitions related to health literacy.

Health literacy is a critically important, but often overlooked, determinant of health. Low health literacy skills are associated with less healthy choices, riskier behaviors, poorer health, more hospitalizations and higher healthcare costs (IOM, 2004).

Health literacy is “the capacity to obtain, interpret and understand basic health information and services and the competence to use such information and services to enhance health.” (IOM, 2004; Ratzan and Parker, 2000)

The purpose of this paper is to describe ways that health literacy can be effectively integrated into primary and secondary prevention in the United States. The most obvious strategy is to leverage any existing programs in health care and public health, and to reform health policy. There are many issues and challenges, but also many potential entry points, from direct to the individual to messages for broader society, through ethical health communication. Illustrative ideas are presented for policy-making consideration at the multiple levels—institutional, community, national and regional—that shape the social and structural factors which advance public health. This paper also presents a galvanizing opportunity to advance health literacy in relation to primary and secondary prevention to serve as a provocative challenge for the IOM Roundtable.

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