INTRODUCTION
In Australia and other developed countries, the burden of disease attributable to preventable diseases and conditions has resulted in an increasing focus on health promotion and chronic disease prevention on a population-wide and health system-wide basis (World Health Organization, 2004; Begg et al., 2007; Health Council Canada, 2007; National Health and Hospital Reform Commission, 2008a,b; National Preventative Health Taskforce, 2008). At the same time, ‘having the capacity to manage health and wellbeing, and demonstrating that self-efficacy and capacity, have become central components of citizenship in post-industrial societies’ [(Green et al., 2007), p. 21]. The issue of responsibility for modifiable risk factors has also reignited debates within both the political and the public health communities about disease prevention and the relative roles of individual responsibility, social determinants of health and ‘healthy public policy’. In this context, it is useful to revisit notions of health literacy and establish what we know and need to understand about its contribution to health outcomes.
The term ‘health literacy’ was first used, in 1974, in a discussion of health education as a policy issue affecting the health system (Simonds, 1974, cited in Ratzan, 2001, p. 21). Definitions of health literacy have evolved so that the concept commonly refers to people’s capacity to obtain, process and understand basic (written or oral) health information and services needed to make appropriate health decisions (Ratzan and Parker, 2000). There is a definitional split, however, in relation to the settings for those ‘health decisions’. Many studies purporting to discuss ‘health literacy’ are limited to information, knowledge and action within health care settings. In contrast, broader notions of ‘health literacy’ include the capacity to understand and act on messages that are central to making critical judgements and decisions not only in health-related settings, but also about health.
It was 10 years ago—in 1998—that Nutbeam described the broad concept of health literacy as ‘cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health’ (World Health Organization, 1998).
