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Health Literacy

Health LiteracyWhat is health literacy?

Health literacy is the ability and motivation level of an individual to access, understand, communicate and evaluate both narrative and numeric information to promote, manage and improve their health status throughout their life time.
It is an important public health topic which has grown to considerable status across the globe in recent years.
Health literacy is more than just the ability to read and understand health related information; it also includes the motivation, ability and confidence to make informed decisions to help manage and improve health.
As such it is relevant to the whole population, including those who may not be currently in receipt of care.
Although health literacy is reliant on basic literacy skills, people with advanced literacy skills in normal life circumstances (home/work environment for example) may still have insufficient health literacy to effectively navigate the healthcare system. They may be unable to evaluate competently the vast and sometimes conflicting information required to manage or improve their health status.
Although inadequate health literacy levels can affect all segments of society, it is more common amongst the most disadvantaged and hard to reach.
Research has identified the following “high risk” groups: the elderly, those with limited education, ethnic minority groups, and those whose first language is not that of the resident country (Weiss, 2007). People with a lower socio-economic status are also at risk of limited health literacy skills.
People who are visually impaired and those who have learning disabilities are also identified as at risk populations, although they may not be as prominent as the previously mentioned groups (Weiss, 2007).

Impact of poor health literacy

Research indicates that low health literacy results in poorer health status (Nielsen-Bohlman et al. 2004).
Previous studies suggest that people with “inadequate or marginal health literacy skills have a 50 per cent higher mortality rate over a five year period than those with adequate skills” (Rootman & Gordon-El-Bihebety, 2008).
Studies in the USA have found that “medication errors, excess hospitalizations, longer hospital stays, more use of emergency departments, and a generally higher levels of illness (all attributable to limited health literacy) are estimated to result in excess cost for the US health care system of between $50 billion and $73 billion a year” (Weiss, 2007).

The scale of the problem in Wales

The true scale of the problem in Wales is not yet known as there are no available “off the shelf” measures specifically related to health literacy currently accessible in Wales.
The 2005 National Survey of Adult Basic Skills in Wales (Williams & Kinnaird, 2005) shows that literacy levels for parts of Wales are very limited.  The survey identified that 25 per cent of the people surveyed had literacy skills equivalent to a seven year old.  In a healthcare setting, this would be a considerable disadvantage.
The proportion of the population with equivalent numeracy levels (of a seven year old) is an estimated 53 per cent.
The survey does not however include questions relating to health literacy for the population (Williams & Kinnaird, 2005).
A national survey into how patients with chronic conditions experience care was performed by the All Wales Alliance for Research and Development for Health and Social Care (AWARD, 2009).
The survey reported that 11 per cent of respondents were unable to understand their role in their own healthcare. These respondents were significantly more likely to have attended hospital than respondents with higher levels of knowledge about their condition and confidence for self-management (AWARD 2009).
The survey highlighted an information gap between what is provided to the patient and what the patient requires to help understand and manage their condition.

What is being done?

The development of the Welsh Government framework ‘Our Healthy Future’ in 2009 highlighted the importance of developing health literacy in Wales.
The subsequent Welsh Government action plan ‘Fairer outcomes for all’, focuses one of the seven action areas on the development of health literacy in Wales.
To support this action plan, Public Health Wales undertook a scoping exercise on Health Literacy in Wales. This involved repeated consultation with stakeholders including Welsh Government, third sector, academic and NHS organisations, national and international experts and members of the public.
The aims of this work were to:
  • identify a Welsh definition
  • explore implications for Wales
  • provide an overview of current activities
  • consider measurement opportunities
  • offer evidence-based recommendations
This work was completed in 2011 and is available at:  Health Literacy in Wales: A scoping document for Wales [Pdf, 1Mb]
The report suggests improved health literacy empowers staff and patients to engage in a more balanced and effective relationship.  This would subsequently lead to better managed, more cost effective and sustainable care.
The report indicates that by measuring the health literacy level of our Welsh population we will gain a better understanding of the impact of health literacy on the Welsh population.
This knowledge can be used to develop interventions aimed at reducing the health inequity gap in Wales.

Future steps

The scoping report makes 24 recommendations for consideration by the Welsh Government.  The recommendations cover the following areas:
  • Research and development
  • Communicating good practice
  • Awareness-raising
  • Increase health literacy levels in the general population/patient education
  • Better access to health information
  • Patient communication
  • Professional development
The Welsh Government and Public Health Wales will now work together to consider these recommendations.  They will work with other partners to explore a rigorous and systematic approach to measuring health literacy levels in Wales.


  • Weiss BD. (2007). Health literacy and patient safety. Help patients understand. Manual for Clinicians. 2nd Ed. Chicago, IL: American Medical Association Foundation and American Medical Association.
  • Nielsen-Bohlman L et al. (2004). Health Literacy: a prescription to end confusion.  National Academy of Sciences. [Online] Available at: http://www.nap.edu/catalog/10883.html.  
  • Rootman I & Gordon-El-Bihebety D. (2008). A vision for a health literate Canada. Report of the Expert Panel on Health Literacy. Canadian Public Health Association, p. 20.
  • Williams J & Kinnaird R. (2005). The national survey of adult basic skills in Wales. Basic Skills Agency.
  • All Wales Alliance for Research and Development for Health and Social Care (AWARD). (2009). How do patients with chronic conditions experience care in Wales? A baseline study.


For more information about the health literacy work or scoping report please contact:
Sarah Puntoni, Healthcare Improvement Lead Officer, Public Health Wales
Telephone: 02920 827649
Hilary Jones, Public Health Practitioner, Public Health Wales
Telephone: 01352 803290

Information resources

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Last updated: 29 July 2011