What is health literacy?

In New Zealand, health literacy has been defined as 'the capacity to obtain, process and understand basic health information and services in order to make informed and appropriate health decisions' (Ministry of Health, 2010). This is one of the older definitions of health literacy and, on the face of it, has a consumer deficit focus. Reading between the lines, the roles of the health system, health care provider and health practitioners are crucial to health literacy. The health system is responsible for funding health services (and information about services). The health care provider is responsible for delivering services and communicating information. The health practitioners are responsible for making sure that appropriate information is provided to consumers in a way that makes sense to consumers. The health provider and health practitioners also need to identify and remove any barriers to a person taking action on the new health information they have obtained.

A similar concept is conveyed by the Institute of Medicine (2004) where health literacy is described as the interaction between the skills and knowledge of individuals and the demands of the health system (Institute of Medicine 2004). Because of the way health systems and services are designed and delivered, consumers face a series of demands on their health literacy. These demands impact on consumers' ability to access health information, care and services. In many health settings there is a significant mismatch between the skills and knowledge consumers need in order to meet the health literacy demands imposed by the health system, and consumers' actual health literacy skills and knowledge.

Why is health literacy important?

International research shows a strong link between consumers' level of health literacy and their health status (Canadian Council on Learning 2008; Kickbusch et al 2005; Institute of Medicine 2004; Nutbeam 2008). There are also links between health literacy and health inequalities (Chao et al 2009; Korhonen 2006). Health literacy affects all aspects of health care – prevention, acute care, long-term conditions and public health. Health literacy affects people of all ages and socioeconomic status.

Changes in the health system, such as the shift to patient-centred and shared care, and the recognition that the current health system is not financially sustainable, have put more emphasis on the need for consumers and their families to be responsible for their own health. For this to happen, consumers' health literacy knowledge and skills will need to be built so that consumers are not as reliant on the providers and health professionals to access to information and resources.

The focus on health literacy needs to extend far beyond improving the written materials given to consumers and their families. Health literacy involves changing the health care environment and how knowledge is shared.

A health literacy framework

In New Zealand, the Ministry of Health has recently published a Framework for Health Literacy. The Framework describes the characteristics of a health-literate health system - which includes building health literate health organisations and a health literate workforce to support individual and family health literacy. This is a system which reduces the literacy demands people face and builds the health literacy skills of the workforce, and the individuals and families who use its services. A health literate system provides quality services that are easy to access and gives clear and relevant health messages so that people can effectively manage their own health. More information on the framework is available at http://www.health.govt.nz/publication/framework-he...

What is a health literate organisation?

Health literate health organisations continually identify the improvements they can make to reduce the health literacy demands faced by consumers and families, and how to better work with consumers to build the health literacy skills and knowledge needed to effectively manage their health.

Research and brief history of health literacy

Health literacy as a concept started in the United States in the mid-1970s where individuals with low health literacy were regarded as "risks." The initial focus placed the responsibility for health literacy on individuals.

Over the years other models of health literacy were developed (Nutbeam, 2001 PPT presentation) which takes the view that the health sector needs to reduce the health literacy demands of its systems as well as develop the health literacy skills of individuals.

The "asset" model was endorsed in the 2004 publication "Health Literacy: A Prescription to End Confusion" by the highly regarded Institute of Medicine.

Health literacy statistics

New Zealand's health literacy statistics come from the Adult Literacy and Life Skills Survey (ALL)conducted in New Zealand in 2006, which tested the literacy, numeracy, and problem-solving skills of a large sample of New Zealanders aged 16-65 years. The Ministry of Health's report, Kōrero Mārama (published in February 2010), presented findings on health literacy by gender, location, age, level of education, labour force status, and household income.

Kōrero Mārama (2010) reported that:
  • 56.2% of adult New Zealanders have poor health literacy skills, scoring below the minimum required to meet the demands of everyday life and work;
  • Four out of five Māori males and three out of four Māori females have poor health literacy skills;
  • Māori who live in a rural location have on average the poorest health literacy skills, closely followed by Māori who live in an urban location;
  • Māori in the 50-65, 16-18, and 19-24 years of age groups have the poorest health literacy compared to the rest of the population. This is particularly concerning because over half of the Māori population (53%) was less than 25 years of age at the 2006 census. Also, older age groups have high levels of health need and are generally high users of health services;
  • Māori and non-Māori with a tertiary education are more likely to have good health literacy skills compared to those with lower levels of education. This is consistent with international evidence;
  • Māori across all labour force status types have poorer health literacy skills compared to non-Māori, but Māori who are unemployed or looking for work have the poorest health literacy skills of all groups;
  • Maori have poorer health literacy statistics across gender, age and location than non-Māori.
New Zealand's health literacy statistics are very similar to Australia and better than Canada and the U.S.A.

To see more about Australian health literacy statistics see here:
http://www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/73ED158C6B14BB5ECA2574720011AB83/$File/42330_2006.pdf

To see more about American health literacy statistics see here:
http://nces.ed.gov/pubs2006/2006483_1.pdf