This summer, the U.S. Department of Health and Human Services (HHS) released Healthy People 2030, the fifth iteration of the nation’s 10-year plan to improve the health of all Americans. For the first time, Healthy People features health literacy as part of its framework. Specifically, attaining health literacy for all is one of Healthy People 2030’s five overarching goals. Further, Healthy People 2030 has released an expanded definition of health literacy. Healthy People previously identified health literacy solely in terms of individuals’ capacities to understand health information. Now Healthy People’s definition includes a new organizational component that recognizes the essential role organizations that provide health-related information and services play in improving health literacy. Physicians, as both clinicians and organizational leaders, have key roles to play in helping their organizations become health literate.1
The below text box shows the two Healthy People 2030 definitions that together constitute health literacy.
Health People 2030 Health Literacy Definitions|
Personal Health Literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
Organizational Health Literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
Source: U.S. Department of Health and Human Services. Healthy People 2030 Health Literacy Definitions. 2020; https://health.gov/our-work/healthy-people/healthy-people-2030/health-literacy-healthy-people-2030.
This definition acknowledges that the level of difficulty and complexity of health information and health services play a crucial role in determining whether people will be able to make informed decisions and take informed actions.2 It is the culmination of a trend toward organizational accountability that began in the health literacy field’s early days.3, 4 Its inclusion of health equity as an imperative of a health literate organization is particularly timely. This definition encourages physicians and other health care leaders to take a systems approach to improving health literacy.5 For example, health care leaders could be instrumental in implementing and spreading the Health Literate Care Model6 that integrates health literacy universal precautions—by assuming that all patients may have difficulty comprehending health information and accessing health services—throughout their organizations. The Health Literate Care Model incorporates health literacy into the Expanded Chronic Care Model by showing how using tools from the AHRQ Health Literacy Universal Precautions Toolkit7 can promote the kind of productive interactions between health care teams and patients and their families that lead to improved health outcomes. Gratifyingly, health systems are increasingly realizing that being health literate is critical to engaging patients and meeting quality, prevention and self- management goals, especially in the advent of value-based payments.FormalPara Personal Health Literacy
Healthy People 2030 has retained an individual, skills-based definition of health literacy, similar to the one that was included in Healthy People 2010 and Healthy People 2020. It reminds physicians that patients’ vary in their abilities, and of the importance of confirming understanding with all patients and providing extra support to those who need it. It is also valuable for conducting both population studies and research on interventions aimed at ensuring equal access to information and services by those who face the greatest challenges.
Even patients with high levels of literacy have difficulty understanding health information and services, which argues for fundamental change. Redefining health literacy as the product of individual and organizational capabilities—both affecting whether people can find, understand and use health information and services—underscores the responsibility of organizations to create and deliver health literate information and services.
Along with other clinicians and others that interact with patients, physicians have a clear impact on the aspect of organizational health literacy that relates to interpersonal communication and confirming understanding. Healthy People 2030 has three measurable objectives with 10-year targets for increasing health literate provider-patient encounters. Progress over the decade on these objectives is tracked using patients’ reports of whether their provider: (1) checked that they understood instructions they had been given, (2) explained things in a way that was easy to understand, and (3) involved them in decisions about their health care as much as they wanted. Physicians can help achieve health literacy for all by adopting health literacy strategies7 so they can align with their patients’ abilities.
Physicians’ opportunities to support health literacy goals, however, do not stop with the acquisition of skills to deliver health literate clinical care. Physicians are in a powerful position to advocate for health literacy within their organizations; they are frequently organizational leaders and managers and, equally important, can engage with administrators, nursing leadership, and others whose involvement is essential. We hope that physicians will use their positions of authority in organizations to champion and implement systematic changes to make their organizations more health literate. Health literacy champions can use the ten attributes of health literate health care organizations5 as their guide to integrating health literacy into every aspect of their organization—from strategic planning and workforce development to providing navigational assistance and including members of the community with limited health literacy on governing and advisory bodies. Our hope is that Healthy People 2030 and its new health literacy definitions will encourage physicians to partner with personnel at every level to accelerate their organizations’ efforts to meet the needs of all of their patients.
Brach C, Dreyer B, Schillinger D. Physicians’ roles in creating health literate organizations: a call to action. J Gen Intern Med. 2014;29(2):273-275.
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U.S. Department of Health and Human Services. Communicating health: priorities and strategies for progress: Action plans to achieve the health communication objectives in Healthy People 2010. Washington, DC; 2003.
Nielsen-Bohlman L, Panzer AM, Kindig DA, eds. Health literacy: a prescription to end confusion. Washington, DC: The National Academies Press; 2004. Institute of Medicine of the National Academies, ed.
Brach C, Keller D, Hernandez LM, et al. Ten attributes of health literate health care organizations. Washington, DC: Institute of Medicine; 2012.
Koh HK, Brach C, Harris LM, Parchman ML. A proposed ‘health literate care model’ would constitute a systems approach to improving patients’ engagement in care. Health Aff. 2013;32(2):357-367.
Brega A, Barnard J, Mabachi NM, et al. AHRQ health literacy universal precautions toolkit, 2nd edition. Rockville, MD: Agency for Healthcare Research and Quality; 2015. 15-0023-EF.
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Brach, C., Harris, L.M. Healthy People 2030 Health Literacy Definition Tells Organizations: Make Information and Services Easy to Find, Understand, and Use. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-020-06384-y