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Electronic Platform for Adult Learning in Europe



What is health literacy?

by David Mallows
Language: EN
Document available also in: LV NL

Literacy – more than just reading and writing

The English word ‘literacy’ has a simple definition – the ability to read and write – and yet its precise meaning is subject to endless debate. Such debates are common in European projects, as ‘literacy’ does not have a direct translation in many languages. This is also the case for other forms of the word such as 'literate' and 'literacy learning'.

A further complication for translators is that 'literacy' has another meaning in English. As well as being used to talk about the ability to read and write, it is common for literacy to be preceded by a term referring to a specialised field. Thus we have computer literacy, financial literacy, quantitative literacy, emotional literacy, and many others; I’ve just found 33 of them (including ocean literacy). While for each of these specialised areas the use of information mediated by text, often specialised text, plays an important role, the meaning of literacy here is not reading and writing, but competency – being able to engage competently in that area. And that is the case with health literacy.

What is health literacy?

Health literacy is usually defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. At its simplest, it means being competent in looking after your own health. It covers general health care, disease prevention and health promotion and focuses on ways in which adults access or obtain information relevant to their health from professionals, medical institutions, medical products and other sources; and how they understand, evaluate and use such information.

However, health literacy is not just about individuals. Improving societal levels of health literacy is also about understanding and lowering barriers created by healthcare personnel and systems. Societal levels of health literacy can be improved when documents and processes used within health encounters are designed with an understanding of the knowledge and understanding of all of those who will take part in them. Professionals within the health care system should be good communicators, aware of the need to support patients and carers in navigating the array of information that our health produces.

The importance of adult educators in increasing awareness of the concept of health literacy and in improving the ways in which the healthcare system communicated with its users was a central message of the Canadian Calgary Charter on Health Literacy:

The health literacy skills and abilities of individuals contribute to the health literacy of a health service system or organisation. For instance, one individual with a high level of health literacy can enhance a system's performance. However, a system or organisation that has low health literacy can overwhelm a health-literate individual or diminish the effect of a well-written document.

There is little individual or system-level data about the health literacy of European societies. The European Health Literacy Survey (HLS-EU) was an output of the European Health Literacy Project, lead by Maastricht University from 2009 to 2012. The survey measured health literacy in eight countries and found that poor health literacy was widespread in Europe, but that it differed substantially across countries. There were also "subgroups within each country with socioeconomic factors such as economic status, employment and education associated with poor health literacy, suggesting the presence of the type of social gradient that is familiar from surveys of other related issues, such as literacy itself".

Adult education and health literacy

Adult education can play a central role in improving societal levels of health literacy and thus of the long-term health of European populations. Health literacy, on an individual level (being competent in the management of your own health), and on a societal level (having a population able to competently manage its own health), is a useful concept and one that is rightly gaining policy makers' attention. As well as working with adults to support them in successfully managing their own health, public policy should encourage adult educators to engage with health professionals, and the systems they work in, about the way that healthcare information is communicated.


David Mallows has over 25 years experience in adult education as a teacher, teacher trainer, manager and researcher. He is currently Director of Research at the National Research and Development Centre for adult literacy and numeracy (NRDC) at the UCL Institute of Education, London and leads the adult education strand of European Commission’s literacy policy network, ELINET.

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  • Mārīte Peipiņa's picture
    Joprojām ir daudz cilvēku, kuri par veselību uzskata slimību trūkumu. Atgādināšu, ka veselība ir pilnīga fiziska, garīga un sociāla labklājība. Tas ir līdzsvars starp ķermeni un garu. Šādu stāvokli cilvēks var ietekmēt pats – ar savu dzīvesveidu. Te būtiska loma ir personīgajai atbildībai, fiziskajāmun sociālajām aktivitātēm, stresa vadībai kā arī vides kvalitātei. Mūsdienās informācijas bagātajā laikmetā būtu jāapzinās veselības riski un jāizvarās no tiem.  
  • Beāte Bernedīne Konstanta's picture
    It is very hard to educate someone who thinks that the health system takes responsibility for his health.  We should focus on/start with scholars- educate them about health management at teen/young adult age, when they already can make decisions about their lifestyle, not when they have already been living like that their whole life.  People should be educated that they are responsible for managing their own health and that health care professionals can give advice on how to do that, but they need to manage it for themselves. 
  • Laura Austen-Gray's picture
    Hi Beāte, 

    I agree with your point that there needs to be an emphasis on teaching basic health management and health literacy skills to young people. However, I think that efforts to increase health literacy should target adult learners as well as younger people (alongside training medical professionals to use techniques to aid those with lower literacy skills). 

    There appears to be a negative correlation between health literacy and age (as you probably see first hand as a nurse). Health literacy also appears to be correlated with levels of educational attainment, with socio-economic status and with health outcomes. Unfortunately efforts to improve health literacy among younger people may miss out some individuals, such as early school leavers. Therefore, I think it is also very important to offer adult learners an opportunity to improve their health literacy, particularly adult learners with lower socio-economic status and lower levels of educational attainment. 

  • Beāte Bernedīne Konstanta's picture
    Hello Laura, thank You for Your comment and I can only agree with You, this is the real situation- as you described and it is important to get societies attention and offer them possibilities to understand this information in a variety of ways that all people can understand why it is important to improve their own health literacy. And yes- we should target adults, but it is harder than it looks- it takes many skills to manage the right ways on how to do that on each of individual. From my experience- the older people are more organized and educated than those in the middle age because they are starting to get some ageing related issues and that motivates them to learn "why it is happening" and they start to understand how they "are functioning", but most of the people don`t pay attention to these things as long as their health is good, and yes- this needs to change. We should pay more attention to ourselves, our relatives, colleagues and talk more about these things- this is a good informal way on how to learn something new and exchange our experience and maybe even help someone to understand the importance on the need to improve his own health literacy. Thank You again for Your view on this topic!
  • MEHMET KAYA's picture
    Sağlık okur Yazarlığında Yetişkinin Hastalık öncesi önleyici tedbirler konusundaki yeterliliği ile Hastalık anında ve sonrasında Tedavi yol ve yöntemleri ne ulaşmadaki yeterliliği olarak netleşmeli.
  • David Mallows's picture

    Hi Rumen,

    There are actually two separate groups of words within the list. In one group literacy just means reading and writing with the words that precede it describing a type, or a level, of reading and writing (1, 6, 9, 13, 20, 24, 25). The others use the second meaning of literacy - competence. So, if you know when the Byzantine Empire ended and the Ottoman Empire began, then you are historically literate. 

    I'm sure there are others that we have not mentioned yet.



  • Rumen HALACHEV's picture

    Hi David,

    This is in fact a very interesting list!

    Following my instinct I'd put visual literacy in the same category as 9, 24, 25 and 26, as it is the ability to interpret information presented as an image. Although I wouldn't limit this set only to survey assessment.

    I came across this list of 26 types of literacy. In spite of some repititions, there are some new ones like historical and legal literacy.

  • David Mallows's picture

    I've listed below the 33 types of literacy that I mentioned in the text above. Can you add any more? And also, how would you categorise the 33? For example, 9, 24, 25 and 26 are from large scale survey assessments of literacy. What other 'sets' are there?


    Specialised or developed knowledge in a particular area or field, competency in a specified skill.

    1. Basic (Baseline)
    2. Bible (Biblical)
    3. Civic
    4. Computer
    5. Consumer
    6. Critical
    7. Cultural
    8. Digital
    9. Document
    10. Emotional
    11. Environmental (enviro)
    12. Financial
    13. Functional
    14. Geographic(al)
    15. Health
    16. Intercultural
    17. Media
    18. Medical
    19. Multimodal
    20. Multiple
    21. Musical
    22. Ocean
    23. Political
    24. Print
    25. Prose
    26. Quantitative
    27. Research
    28. Scientific
    29. Social
    30. Statistical
    31. Technological
    32. Workplace
    33. Visual