The mandate for health literacy
Defining health literacy
Health literacy refers, broadly, to the ability of individuals to “gain access to, understand and use information in ways which promote and maintain good health”1 for themselves, their families and their communities. While different definitions are used2 and health literacy is an evolving concept, there is 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.3
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.4
An important factor in improving health outcomes
The United Nations ECOSOC Ministerial Declaration of 2009 provided a clear mandate for action: “We stress that health literacy is an important factor in ensuring significant health outcomes and in this regard, call for the development of appropriate action plans to promote health literacy.”3 Indeed, knowledge and understanding remain powerful tools in health promotion.
Improving health literacy in populations provides the foundation on which citizens are enabled to play an active role in improving their own health, engage successfully with community action for health, and push governments to meet their responsibilities in addressing health and health equity. Meeting the health literacy needs of the most disadvantaged and marginalized societies will particularly accelerate progress in reducing inequities in health and beyond.
While there is no specific target on health literacy within the Sustainable Development Goals (SDGs), efforts to raise health literacy will be crucial in whether the social, economic and environmental ambitions of the 2030 Agenda for Sustainable Development are fully realized. As Table 1 demonstrates, increased health literacy gained through health education and various forms of communication, as well as actions taken through health systems and other policies, have the potential to support achievement of targets related to SDG 3 on health while advancing a wide range of other SDGs.
Reducing health inequities
Health inequities are endemic to every region of the world, with rates of disease significantly higher amongst the poorest and most excluded groups. As a result, the populations least able to withstand the multidimensional costs of illness are also those most likely to endure them. This injustice is not mere coincidence – the poor are more likely to live, work, study and play in environments that are harmful to health. Health literacy efforts can uniquely reduce inequities in health and beyond, as the case studies in these pages illustrate.
From Ottawa to Shanghai & the sustainable development agenda
Thirty years ago, the Ottawa Charter for Health Promotion recognized the need to enable people to increase control over and to improve their health and well-being by ensuring healthier, sustainable environments where people live, work, study and play. Social justice and equity were highlighted as core foundations for health, and there was agreement that health promotion is not simply the responsibility of the health sector.
Subsequent WHO global health promotion conferences have reiterated these elements as key for health promotion.
The 2030 Agenda for Sustainable Development, the world’s ambitious and universal “plan of action for people, planet and prosperity”, includes 17 Goals, 169 targets and 231 initial indicators. The Agenda offers a new opportunity to involve multiple stakeholders to ensure that all people can fulfil their potential – to live in health and with dignity and equality.
With this in mind, the theme of the 9th Global Conference on Health Promotion, “Health Promotion in the Sustainable Development Goals” is both timely and necessary to ensure policy coherence and alignment of agendas for action. The slogan: “Health for All and All for Health” captures the commitment to leave no one behind and to involve all actors in a new global partnership to achieve this transformative Agenda.
1. Nutbeam, Don. 1998. “Health promotion glossary.” Health Promot. Int., 13 (4): 349-364. doi: 10.1093/heapro/13.4.349
2. Sørensen, Kristine, et al. 2012. “Health literacy and public health: A systematic review and integration of definitions and models.” BMC Public Health, 12:80. doi: 10.1186/1471-2458-12-80
3. ECOSOC. 2009. “MINISTERIAL DECLARATION – 2009 HIGH-LEVEL SEGMENT: Implementing the internationally agreed goals and commitments in regard to global public health.”
4. Rudd, Rima E. 2015. “The evolving concept of Health literacy: New directions for health literacy studies.” Journal of Communication in Healthcare, 8 (1): 7-9.