woman reading the instructions together on the back of the packaging of medication

woman reading the instructions together on the back of the packaging of medication

Health literacy: more than being able to read pamphlets, make appointments and understand food labels?

Published 06/12/2023   |   Last Updated 06/12/2023   |   Reading Time minutes

The Minister for Health and Social Services, Eluned Morgan MS, has said she wants to see the Welsh public take greater responsibility for their own health to support the NHS.

The Minister has emphasised the importance of individual choices, like engaging in exercise, not smoking, and eating healthier, to foster a healthier population. She says promoting personal responsibility for health will, in turn, alleviate the strain on the healthcare system. Health literacy is closely linked to this.

In a report to the Senedd’s Health and Social Care Committee, published today, academics from Swansea University, Dr Emily Marchant and Professor Tom Crick, call for improved health literacy. They point to a link between low health literacy and poorer self-reported health status. The report was commissioned as part of an Area of Research Interest.

This article looks at what is meant by health literacy and strategies for improving it.

Defining health literacy

The World Health Organisation (WHO), references Professor Don Nutbeam’s ‘Health promotion glossary’, first published in 1998, and defines health literacy as:

…the ability of individuals to “gain access to, understand and use information in ways which promote and maintain good health”… for themselves, their families and their communities.

However, the WHO acknowledges that health literacy is an evolving concept and that different definitions are used. It says there is general agreement that:

…health literacy means more than simply being able to "read pamphlets", "make appointments", "understand food labels" or "comply with prescribed actions" from a doctor.

In their report, Marchant and Crick define health literacy as:

…the ability and motivation level of an individual to access, understand, communicate and evaluate both narrative and numeric information to promote, manage, and improve their health status throughout their lifetime.

They say it encompasses various aspects of health, including behaviours, information, services, prevention, care and disease management. Marchant and Crick argue that health literacy is about people understanding health information, which can help them to make informed decisions and navigate healthcare systems. This can lead to increased awareness of preventive measures, better adherence to medical advice, and a proactive approach to managing their own health and well-being.

Strategies for improving health literacy

The Welsh Government has taken some action on health literacy, most notably through the Welsh Value in Health Centre. Health literacy is aligned with the government’s value-based healthcare and person-centred care approach. The Welsh Government’s approach has predominantly focused on improving patient education to support healthy lifestyle choices and on improving digital literacy.

Marchant and Crick propose several recommendations to build on this. They include:

  • a clear focus on building health literate citizens;
  • strengthening research efforts;
  • mentioning health literacy explicitly in policies;
  • monitoring child health literacy; and,
  • and developing national health literacy action plans.

The full set of recommendations are available in Marchant and Crick’s report.

National health literacy action plans

Marchant and Crick recommend the Welsh Government develops a national health literacy action plan to promote health literacy. They say it should, among other things, focus on actions that foster individual empowerment, improve communication and address the root causes of health disparities.

Their report notes some countries, such as Germany, Austria, Australia, and Scotland have introduced health literacy action plans.

Marchant and Crick make the case that investing in health literacy pays off in the long term, as for example, individuals are better equipped to manage chronic conditions and maintain overall well-being.

The WHO also says that better health literacy can lead to a more productive workforce, reducing the economic burden associated with preventable diseases.

Public Health Wales says that supporting individuals to make healthy choices can:

…reduce the burden of disease and help narrow the gap in health inequalities arising from long term conditions such as obesity, cancers, heart conditions, stroke, respiratory disease and dementia.

Its focus is on reducing smoking prevalence, promoting a healthy weight, and preventing harm from a range of behaviours such as substance misuse.

Public Health England published early years guidance in May 2021 aimed at improving health literacy to help families manage minor illnesses and reduce unintentional accidents among children. It points to the importance of ensuring health information is clear and easily accessible. It also outlines that it needs to be available in multiple languages to reach diverse populations.

Marchant and Crick note the importance of early education to build health literacy. They point to the Curriculum for Wales as having a crucial role in shaping this agenda.

The King’s Fund says that health inequities are endemic, with rates of disease significantly higher amongst the poorest and most excluded groups. It says targeted health literacy efforts can help address disparities, ensuring that all segments of the population have equal access to and understanding of health information.

A call to action?

The WHO states:

Health literacy is also not just a personal resource; higher levels of health literacy within populations yield social benefits, too, for example by mobilizing communities to address the social, economic and environmental determinants of health. This understanding, in part, fuels the growing calls to ensure that health literacy not be framed as the sole responsibility of individuals, but that equal attention be given to ensure that governments and health systems present clear, accurate, appropriate and accessible information for diverse audiences.

It adds:

Those with higher levels of health literacy are empowered to hold their governments accountable, whether for access to essential medicines, universal health coverage, removing environmental air pollutants or tearing down discriminatory laws and practices.

Marchant and Crick’s report outlines that empowering individuals in health decisions goes beyond lifestyle choices like smoking, exercise, or alcohol consumption. They agree with the Health Minister that health literacy involves individuals actively improving their health, through improved self-care and preventive practices. But add, governments and health systems must fulfil their responsibilities by supporting people with knowledge to become “health literate citizens”.

Article by Sarah Hatherley, Senedd Research, Welsh Parliament