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The evolving concept of health literacy


  • Nutbeam, Don


The relationship between poor literacy skills and health status is now well recognized and better understood. Interest in this relationship has led to the emergence of the concept of health literacy. The concept has emerged from two different roots - in clinical care and in public health. This paper describes the two distinctive concepts that reflect health literacy, respectively, as a clinical "risk", or a personal "asset". In the former case a strong science is developing to support screening for poor literacy skills in clinical care and this is leading to a range of changes to clinical practice and organization. The conceptualization of health literacy as an asset has its roots in educational research into literacy, concepts of adult learning, and health promotion. The science to support this conceptualization is less well developed and is focused on the development of skills and capacities intended to enable people to exert greater control over their health and the factors that shape health. The paper concludes that both conceptualizations are important and are helping to stimulate a more sophisticated understanding of the process of health communication in both clinical and community settings, as well as highlighting factors impacting on its effectiveness. These include more personal forms of communication and community based educational outreach. It recommends improved interaction between researchers working within the two health literacy perspectives, and further research on the measurement of health literacy. The paper also emphasizes the importance of more general strategies to promote literacy, numeracy and language skills in populations.

Suggested Citation

  • Nutbeam, Don, 2008. "The evolving concept of health literacy," Social Science & Medicine, Elsevier, vol. 67(12), pages 2072-2078, December.
  • Handle: RePEc:eee:socmed:v:67:y:2008:i:12:p:2072-2078

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    References listed on IDEAS

    1. Cho, Young Ik & Lee, Shoou-Yih D. & Arozullah, Ahsan M. & Crittenden, Kathleen S., 2008. "Effects of health literacy on health status and health service utilization amongst the elderly," Social Science & Medicine, Elsevier, vol. 66(8), pages 1809-1816, April.
    2. Hayes, Michael & Ross, Ian E. & Gasher, Mike & Gutstein, Donald & Dunn, James R. & Hackett, Robert A., 2007. "Telling stories: News media, health literacy and public policy in Canada," Social Science & Medicine, Elsevier, vol. 64(9), pages 1842-1852, May.
    3. repec:aph:ajpbhl:2002:92:8:1278-1283_1 is not listed on IDEAS
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    Cited by:

    1. Glenngård, Anna H. & Anell, Anders & Beckman, Anders, 2011. "Choice of primary care provider: Results from a population survey in three Swedish counties," Health Policy, Elsevier, vol. 103(1), pages 31-37.
    2. Sabine Ackermann Rau & Sibel Sakarya & Thomas Abel, 2014. "When to see a doctor for common health problems: distribution patterns of functional health literacy across migrant populations in Switzerland," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(6), pages 967-974, December.
    3. Setti Rais Ali & Paul Dourgnon & Lise Rochaix, 2018. "Social Capital or Education: What Matters Most to Cut Time to Diagnosis?," PSE Working Papers halshs-01703170, HAL.
    4. repec:eee:hepoli:v:123:y:2019:i:1:p:11-20 is not listed on IDEAS
    5. repec:eee:joepsy:v:62:y:2017:i:c:p:98-119 is not listed on IDEAS
    6. Musharraf Cyan & Michael Price & Mark Rider, 2017. "A Health Literacy RCT toward Improvement of Programmatic Outcomes of Tuberculosis Control in the Tribal Areas of Pakistan Governance Support Program Post-Crisis," International Center for Public Policy Working Paper Series, at AYSPS, GSU paper1711, International Center for Public Policy, Andrew Young School of Policy Studies, Georgia State University.
    7. repec:spr:ijphth:v:63:y:2018:i:3:d:10.1007_s00038-017-1074-2 is not listed on IDEAS
    8. repec:eee:socmed:v:226:y:2019:i:c:p:1-8 is not listed on IDEAS
    9. repec:eee:tefoso:v:120:y:2017:i:c:p:240-251 is not listed on IDEAS
    10. Moon, Graham & Aitken, Grant & Roderick, Paul & Fraser, Simon & Rowlands, Gill, 2015. "Towards an understanding of the relationship of functional literacy and numeracy to geographical health inequalities," Social Science & Medicine, Elsevier, vol. 143(C), pages 185-193.
    11. repec:cog:meanco:v:7:y:2019:i:2:p:160-168 is not listed on IDEAS
    12. Smith, Sian K. & Dixon, Ann & Trevena, Lyndal & Nutbeam, Don & McCaffery, Kirsten J., 2009. "Exploring patient involvement in healthcare decision making across different education and functional health literacy groups," Social Science & Medicine, Elsevier, vol. 69(12), pages 1805-1812, December.
    13. Don Nutbeam, 2009. "Defining and measuring health literacy: what can we learn from literacy studies?," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 54(5), pages 303-305, October.
    14. Wouters, Edwin & Van Damme, Wim & Van Loon, Francis & van Rensburg, Dingie & Meulemans, Herman, 2009. "Public-sector ART in the Free State Province, South Africa: Community support as an important determinant of outcome," Social Science & Medicine, Elsevier, vol. 69(8), pages 1177-1185, October.
    15. Wyke, Sally & Adamson, Joy & Dixon, Diane & Hunt, Kate, 2013. "Consultation and illness behaviour in response to symptoms: A comparison of models from different disciplinary frameworks and suggestions for future research directions," Social Science & Medicine, Elsevier, vol. 86(C), pages 79-87.
    16. repec:adm:journl:v:2:y:2013:i:12:p:46-51 is not listed on IDEAS
    17. Chinn, Deborah, 2011. "Critical health literacy: A review and critical analysis," Social Science & Medicine, Elsevier, vol. 73(1), pages 60-67, July.
    18. Hendrik Jürges & Eberhard Kruk & Steffen Reinhold, 2013. "The effect of compulsory schooling on health—evidence from biomarkers," Journal of Population Economics, Springer;European Society for Population Economics, vol. 26(2), pages 645-672, April.
    19. Clarke, Andrew & Isphording, Ingo E., 2015. "Language Barriers and Immigrant Health Production," IZA Discussion Papers 8846, Institute of Labor Economics (IZA).
    20. Spinks, Jean & Mortimer, Duncan, 2015. "The effect of traffic lights and regulatory statements on the choice between complementary and conventional medicines in Australia: Results from a discrete choice experiment," Social Science & Medicine, Elsevier, vol. 124(C), pages 257-265.


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