Health literacy is a relatively new concept in health promotion. It is a composite term to describe a range of outcomes to health education and communication activities. From this perspective, health education is directed towards improving health literacy. This paper identifies the failings of past educational programs to address social and economic determinants of health, and traces the subsequent reduction in the role of health education in contemporary health promotion. These perceived failings may have led to significant underestimation of the potential role of health education in addressing the social determinants of health. A ‘health outcome model’ is presented. This model highlights health literacy as a key outcome from health education. Examination of the concept of health literacy identifies distinctions between functional health literacy, interactive health literacy and critical health literacy. Through this analysis, improving health literacy meant more than transmitting information, and developing skills to be able to read pamphlets and successfully make appointments. By improving people's access to health information and their capacity to use it effectively, it is argued that improved health literacy is critical to empowerment. The implications for the content and method of contemporary health education and communication are then considered. Emphasis is given to more personal forms of communication, and community-based educational outreach, as well as the political content of health education, focussed on better equipping people to overcome structural barriers to health.

Don Nutbeam; Health Promotion Glossary, Health Promotion International, Volume 13, Issue 4, 1 January 1998, Pages 349–364, https://doi.org/10.1093/heapro/13.4.

Evidence of a social gradient in health literacy has been found in all reported national population surveys. Health literacy is a midstream determinant of health but not a panacea for addressing health inequities created by the maldistribution of opportunity and resources. It is possible to optimize the contribution health literacy makes in mediating the causes and effects of established social determinants of health. Existing interventions demonstrate the feasibility of improving health literacy among higher-risk populations, but research remains underdeveloped and effects on health inequity are largely untested. Future health literacy intervention research should focus on ( a) improving the quality of health communication that reaches a diversity of populations, especially by improving frontline professional skills and support; ( b) enabling people to develop transferable skills in accessing, understanding, analyzing, and applying health information; and ( c) ensuring that priority is proportionate to need by reaching and engaging the population groups who are disproportionately affected by low health literacy.

Several issues of current debate in health promotion evaluation are examined. These include the definition and measurement of relevant outcomes to health promotion, and the use of evaluation methodologies which assess both the outcome achieved and the process by which it is achieved. Considerable progress is being made in understanding the complexity of health promotion activity, and in the corresponding need for sophisticated measures and evaluation research designs which reflect this complexity. The more powerful forms of health promotion action are those which are long term, and least easily predicted, controlled and measured by conventional means. Against this, important and valued advances in knowledge and credibility have come from more tightly defined and controlled interventions, which have been evaluated through the application of more traditional experimental designs. This tension between ‘scientific rigour’ and the perceived advantages (in longterm effectiveness and maintenance) coming from the less-well-defined content and methods of community controlled programmes continues to pose technical problems in evaluation. It is important to foster and develop evaluation designs which combine the advantages of different research methodologies, quantitative with qualitative, in ways which are relevant to the stage of development of a programme. The use of a diverse range of data and information sources will generally provide more illuminating, relevant and sensitive evidence of effects than a single ‘definitive’ study. Evaluations have to be tailored to suit the activity and circumstances of individual programmes—no single methodology is right for all programmes.

The WHO Health Promotion Glossary was written to facilitate understanding, communication and cooperation among those engaged in health promotion at the local, regional, national and global levels. Two editions of the Glossary have been released, the first in 1986 and the second in 1998, and continued revision of the document is necessary to promote consensus regarding meanings and to take account of developments in thinking and practice. In this update 10 new terms that are to be included in the Glossary are presented. Criteria for the inclusion of terms in the Glossary are that they differentiate health promotion from other health concepts, or have a specific application or meaning when used in relation to health promotion. The terms defined here are: burden of disease; capacity building; evidence-based health promotion; global health; health impact assessment; needs assessment; self-efficacy; social marketing; sustainable health promotion strategies, and; wellness. WHO will continue to periodically update the Health Promotion Glossary to ensure its relevance to the international health promotion community.