The Key to Improving Health Literacy

Dr Gill Rowlands

What is health literacy?

Health literacy skills are those needed to gain access to, understand, and use information to promote and maintain health. At its most basic, health literacy involves functional literacy, numeracy, and ICT skills for understanding health information, but also includes skills to evaluate and apply health information in changing contexts. In addition, patients with these skills can use the information to take control over environmental and social factors affecting health (critical health literacy).

How big is health literacy a problem in England?

We know that levels of functional health literacy are low in England. Health information in current circulation is written at too complex a level for 43% of working age adults (16 to 65 years), this figure rises to 61% if the health information includes numeracy. We do not know how many people are additionally burdened by low interactive and critical health literacy skills, but numbers are likely to be even higher.

We also know that low health literacy has real effects on health and illness. In England, older people with low health literacy have higher mortality. Research from the US and Europe shows people with low health literacy are more likely to have a long-term health condition, and this is more likely to limit their activities. People with low health literacy rate their health as lower than people with higher health literacy levels, and people with low health literacy and lower educational levels are more likely to have unhealthy lifestyles.

Health literacy as a social determinant of health is strongly linked with other social determinants such as poverty, unemployment and membership of a minority ethnic group. Where health literacy differs from these other social determinants is that it is, potentially, open to change through improving health systems and building patient and public awareness and skills.

Why is health literacy important for GPs?

General practitioners are the 'front-line' of the NHS. Over 90% of NHS appointments occur in general practice, and patients will often see GPs after consultations and contact specialist care for explanation and support. GP awareness of, and sensitivity to, low health literacy means that patients can be supported to find clear information that is relevant and useful for them. GPs can take time to explain health information and check understanding of key issues, especially when numeracy is involved, such as assessing risks and benefits of screening tests or treatment options.

Following NHS reorganisation, GPs have a key role in commissioning, and hence shaping, specialist health services. GPs can work with specialist colleagues to ensure that services are 'health literate' and accessible to all regardless of health literacy level.

RCGP and NHS England Call for Action

In view of the importance of health literacy, and the central role of GPs in addressing the issue, NHS England sponsored an RCGP-led workshop on the issue.

This has resulted in the following:

  • A Call for Action for the College and NHS England to work together to improve GP training in health literacy.
  • Work with CCGs to consider health literacy when commissioning health services.
  • Develop pilot projects where GPs can refer patients for skills courses.
  • Develop national guidelines for the literacy and numeracy aspects of health information.

The 2014 RCGP conference workshop

Dr Rowlands, together with Dr Joanne Protheroe (Health Literacy Group UK Chair) and Euan Lawson (Deputy Editor BJGP) ran a workshop on Friday 3 October. The aims of the workshop were to develop concrete plans for action including practical suggestions for rolling out ideas for raising awareness of, and addressing, health literacy across the UK, and developing personal development plans for appraisal / revalidation that include health literacy actions.

More information and resources

This is the third of four articles focusing on health literacy in general practice. Click here to view the three other articles.

Health Literacy: Report from an RCGP-led workshop

Health Literacy Group UK

NHS Digital Inclusion Project

The Community Health and Learning Foundation


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