Health literacy then and now: Fifty years of conceptual evolution

Abstract

Health literacy was first mentioned in the context of health education and social policy by Simonds (1974), who emphasized students’ health literacy shouldn’t be neglected. Despite accidental use, health literacy has been recognized as an important health determinant, and its definition and conceptualization have changed considerably over the decades. This paper aims to outline health literacy conceptualizations development to better understand the debates shaping the field. Initially, health literacy was viewed as an individual characteristic, emphasizing the application of reading, writing, and numeracy skills in a health context. Nutbeam’s framework of functional, interactive, and critical health literacy (2000) shifted the focus from basic skills toward a broader range of cognitive and social competencies enabling individuals to actively participate in health decision-making. Health literacy thus evolved from being viewed as a clinical risk factor associated with poor health outcomes to a public health resource enabling successful health promotion. Building on this, Sørensen and colleagues (2012) proposed an integrated conceptual model that consolidated various definitions and established a framework based on the abilities to access, understand, appraise, and apply health information. By analyzing 250 definitions in MEDLINE, Malloy-Weir and colleagues (2016) confirmed the importance of these abilities. They also highlight concerns that most interpretations neglect health and contextual determinants. This underscores that health literacy is as a shared responsibility among individuals, organizations, and health systems. Although the core principles remain the same, the broadening of its concept has introduced new challenges for its definition, assessment, and implementation in research, policy, and practice.