2: Health Literacy: Definition and Background

In order to adequately place the concept of health literacy within the ‘new normal’ of health care, it makes sense to examine its history. First used by Simonds in 1974 in a paper titled ‘Health education as social policy’ (Simonds, 1974), he asked for minimal standards for health literacy at all school grade levels in health education as a policy involving the health care system, the educational system and mass communication. Starting from this health education basis, health literacy gained clinical relevance in the 1990s, when it was understood as a patient's ability to understand medical instructions, package leaflets and patient information. It was seen as a part of general literacy, i.e. the ability to read, write and possess basic numerical skills in a medical context. In 1998 the concept was gradually extended beyond basic cognitive capabilities (so-called functional health literacy) to a wider range of skills in finding medical information from various different sources, evaluating the information and applying it to one's personal situation, as well as to communicate relevant information (e.g. in conversation with one's physician; now termed interactive/communicative health literacy) and to distinguish between and critically appraise health issues (now called critical health literacy) (Bitzer & Sørensen, 2018).