Health literacy as an important social determinant of health: The need for an expanded understanding and comprehensive measurement tools

Just as the literacy component of health literacy is more than reading and writing, health is more than medicine and medical care. Health literacy is a concern for everyone, not only cultural and linguistic minorities. The rapidly evolving field of health literacy research and practice faces an increasingly well-recognized conceptualization and measurement problem on all three counts. Existing measures no longer reflect current definitions of health literacy that more precisely explicate this complex and multidimensional concept and identify health literacy as an issue for health professionals and the public alike. Current measures of health literacy are limited in their scope, validity, and ability to produce usable information to inform and evaluate public health interventions. This article builds on a critique and synthesis of existing definitions, empirical understandings, and theories of health literacy to propose a new and robust conceptual framework of health literacy. Future research can employ this framework in building a new, comprehensive, valid, and reliable measure of health literacy useful for outcomes research and needs assessments. Additionally, this framework can serve as a guide to evaluating public health interventions and creating new medical curriculum improving the health literacy skills of health professionals. Health literacy should be recognized as an important social determinant of health, a required component of medical and public health education through accreditation standards, a reimbursable indicator of quality care by physicians and health care facilities, and a primary tool to reach desired public health outcomes such as the UN Millennium Development goals.