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Introduction

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

The roots of health literacy can be traced back to the national literacy movement in India under Gandhi and to aid groups working in Africa to promote education and health. The term health literacy was first used in 1974 and described as “health education meeting minimal standards for all school grade levels” (Ratzan, 2001). From that first use the definition of health literacy evolved during the next 30 years with official definitions promulgated by government agencies and large programs. Despite differences among these definitions, they all hold in common the idea that health literacy involves the need for people to understand information that helps them maintain good health.

With the expansion of health literacy research and programs in the 1990s, health literacy has taken two different approaches, one oriented to clinical care and the other to public health (Pleasant and Kuruvilla, 2008). The clinical approach often involves a patient–provider interaction and is the focus of much of the health literacy efforts in the United States and Europe (Brand and Sørensen, 2010; Pleasant and Kuruvilla, 2008). The public health approach to health literacy is more prominent in developing nations, where organizations not only work to improve health for large groups of people but also provide educational opportunities to the same groups.

Although the United States produces a majority of the research on health literacy (Kondilis et al., 2008), Europe has strong multinational programs as well as research efforts (Brand and Sørensen, 2010), and health literacy experts in developing countries have created successful programs



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1 Introduction Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health care decisions. (Ratzan and Parker, 2000) The roots of health literacy can be traced back to the national literacy movement in India under Gandhi and to aid groups working in Africa to promote education and health. The term health literacy was first used in 1974 and described as “health education meeting minimal standards for all school grade levels” (Ratzan, 2001). From that first use the definition of health literacy evolved during the next 30 years with official definitions promulgated by government agencies and large programs. Despite dif- ferences among these definitions, they all hold in common the idea that health literacy involves the need for people to understand information that helps them maintain good health. With the expansion of health literacy research and programs in the 1990s, health literacy has taken two different approaches, one oriented to clinical care and the other to public health (Pleasant and Kuruvilla, 2008). The clinical approach often involves a patient–provider interaction and is the focus of much of the health literacy efforts in the United States and Europe (Brand and Sørensen, 2010; Pleasant and Kuruvilla, 2008). The public health approach to health literacy is more prominent in developing nations, where organizations not only work to improve health for large groups of people but also provide educational opportunities to the same groups. Although the United States produces a majority of the research on health literacy (Kondilis et al., 2008), Europe has strong multinational pro- grams as well as research efforts (Brand and Sørensen, 2010), and health literacy experts in developing countries have created successful programs 1

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2 HEALTH LITERACY AROUND THE WORLD implemented on a community level (UN ECOSOC, 2010). Given these distinct strengths of efforts worldwide, there are many opportunities for collaboration. International collaboration can harness the United States’ research power, Europe’s multilingual and multinational experience, and developing nations’ community-based programs to create robust p ­ rograms and research that reach people—not based on language or nationality but on need and value. The Institute of Medicine Roundtable on Health Literacy decided to hold a workshop focused on international health literacy efforts that would feature presentations and discussion about health literacy inter- ventions from various countries as well as other topics related to inter- national health literacy. As background for the workshop, a paper was commissioned to explore and report on health literacy policies and prac- tices outside the United States (see Appendix A). The workshop was organized by an independent planning committee in accordance with the procedures of the National Academy of Sciences. The planning commit- tee members were Debbie Fritz, Margaret Loveland, Clarence Pearson, Andrew Pleasant, Scott C. Ratzan, Will Ross, and Rima Rudd. The role of the workshop planning committee was limited to planning the work- shop. Unlike a consensus committee report, a workshop summary may not contain conclusions and recommendations, except as expressed by and attributed to individual presenters and participants. Therefore, this summary has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. The workshop was moderated by Roundtable chair George Isham and featured presentations from invited speakers. These presentations make up the chapters that follow. Each topic (chapter) includes one or more presentations that are followed by a group discussion. Chapter 2 includes two presentations that set the stage for a discussion of interna- tional health literacy efforts. The presentations in Chapter 3 detail dif- ferent health literacy perspectives and a discussion of public–private partnerships for health literacy. Chapter 4 presentations address national policies and programs promoting health literacy. Chapter 5 presentations focus on local innovations in health literacy. Chapter 6 discusses future directions, including conceptualizing health literacy, research and mea- sures, and translating what is known in order to improve health literacy programs and policies. REFERENCES Brand, H., and K. Sørensen. 2011. Measuring health literacy in Europe: The development of the HLS-EU tool. http://inthealth.eu/app/download/3310881502/Measuring+Health+ Literacy+in+Europe+-+Stockholm+9+3+2010.pdf (accessed October 19, 2011).

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INTRODUCTION 3 Kondilis, B. K., I. J. Kiriaze, A. P. Athanasoulia, and M. E. Falagas. 2008. Mapping health literacy research in the European Union: A bibliometric analysis. PLoS ONE 3(6):e2519. Pleasant, A., and S. Kuruvilla. 2008. A tale of two health literacies: Public health and clinical approaches to health literacy. Health Promotion International 23(2):152-159. Ratzan, S. C. 2001. Health literacy: Communication for the public good. Health Promotion International 16(2):207-214. Ratzan, S. C., and R. M. Parker. 2000. Introduction. In National Library of Medicine current bib- liographies in medicine: Health literacy, edited by C. R. Selden, M. Zorn, S. C. Ratzan, and R. M. Parker. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health. UN ECOSOC (United Nations Economic and Social Council). 2010. Health literacy and the Millennium Development Goals: United Nations Economic and Social Council (ECOSOC) regional meeting background paper (abstracted). Journal of Health Commu- nication 15(Supp 2):211-223.

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