Risks associated with low functional health literacy in an Australian population

To the Editor: The comments about health literacy by Adams and colleagues1 and Nutbeam2 are timely, given findings that 60% of Australians lack basic health literacy skills.2 Despite attention given to health literacy by the National Health and Hospitals Reform Commission, current discussions remain worryingly limited.

In the 1990s, Nutbeam was prominent among those who recognised both the individual and the larger environmental settings of health literacy, as well as its relevance to prevention. “Health literacy and health skills” was included as a category in a landmark health goals and targets framework, as “personal health knowledge and positive attitudes towards changing behaviour demonstrably influence people’s ability to adopt healthy lifestyles”.3 Significantly, the goals of improving health literacy were expressed as enabling people to make more informed choices about their health and to take an active role in bringing about changes in environments that influence health.

Since then, surprisingly scant attention has been given to health literacy in the context of coping with everyday life, including new situations4 — surprisingly, given that “nearly every choice we make throughout the day is relevant to health in some way — what we eat, how much we move, what products we buy”.5 Most discussions focus on the skills and knowledge individuals need to navigate the health system. Studies of health literacy in broader health contexts remain comparatively rare and frustratingly dispersed throughout numerous disciplines.6

It is time for greater recognition of health literacy as both a consumer issue and a public health issue relevant to disease prevention. (It is perhaps no coincidence that the Newest Vital Sign test for health literacy involves the comprehension of nutrition information about ice cream.)

Nutbeam’s suggestions for building health literacy and consumer engagement in health services could easily be expanded. Why not, for example, develop a national plan with specific objectives and approaches, and definitions and indicators to measure health literacy progress? There are obvious tie-ins with the “prevention agenda” and with Australia’s new national policies on men’s and women’s health, and just bringing together the scattered articles on health literacy and gender would be a major task.7

Australian health initiatives aimed at reducing the burden of chronic and preventable disease should consider the role and challenges of health literacy beyond its application to health services use. Our growing understanding of the complex behavioural, social, systemic, and ecological forces that influence health and wellbeing should help guide these efforts.