Health literacy in Aotearoa New Zealand

Here is a recent article written for New Zealand Medical Student Journal explaining health literacy and what those working in health can do to provide health literacy services and care Health literacy in Aotearoa New Zealand – what every medical student needs to do | Published in New Zealand Medical Student Journal (

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

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.

Health literacy review - a guide

While at Workbase we developed Health Literacy Review - A Guide for the Ministry of Health. The Guide shows large healthcare organisations how to review their services from a health literacy perspective, identify what they are doing well, and develop Health Literacy Action Plans for service improvement. Dr Rima Rudd from the Harvard School of Public Health provided peer review for the Guide.

The Guide describes the characteristics of a health literate organisation and uses a system-wide approach to review health services, taking into account:
  • strategic direction and leadership support
  • service and process design
  • communication mechanisms
  • workforce capability
  • access to support and services,
  • the experiences of consumers and families.
Using this approach enables organisations to identify the changes they can make within and across services 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.This is part of the journey to become a health literate organisation.

To develop the Guide we worked with three District Health Boards to trial and amend the health literacy review process in different contexts. We produced supporting material, such as the videos and observation tools, which accompany the Guide and can be found on the Ministry's website. Each review looked at how services and care were planned, structured and delivered as well as how consumers, whānau and families experienced these services.
More information on the Guide is available at

NZMJ Digest

Here is an article we wrote for the New Zealand Medical Association, describing how health literacy needs to be seen as an ever-changing state created by the health challenges we face and the complexity of the health system, rather than as a patient trait.  The phrase “people with low health literacy” only tells one side of the story, published in the February 2020 edition of the NZMJ Digest

International Handbook of Health Literacy 2019

We were honoured to be asked to contribute a chapter about the history of health literacy in New Zealand to the International Handbook of Health Literacy - Research, Practice and Policy across the Life-Span edited by Orkan Okan, Ullrich Bauer, Diane Levin-Zamir, Paulo Pinheiro and Kristine Sørensen (2019).  Here is our chapter, Health literacy in New Zealand: A tale of serendipity and indigenous health, as well as the link to the handbook.

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.

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