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Journal of Health Communication:

International Perspectives
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Elaborating a Definition of Health

Literacy: A Commentary
a b
CHRISTINA ZARCADOOLAS , ANDREW PLEASANT & DAVID S. GREER
c

a
Center for Environmental Studies, Brown University, USA
b
Department of Communications, Cornell University, Ithaca, New
York, USA
c
Dean of Medicine Emeritus, Brown University School of Medicine,
USA
Published online: 15 Dec 2010.

To cite this article: CHRISTINA ZARCADOOLAS , ANDREW PLEASANT & DAVID S. GREER (2003)
Elaborating a Definition of Health Literacy: A Commentary, Journal of Health Communication:
International Perspectives, 8:S1, 119-120, DOI: 10.1080/713851982

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 Journal of Health Communication, 8: 119–120, 2003
Copyright # Taylor & Francis Inc.
ISSN: 1081-0730 print/1087-0415 online
DOI: 10.1080/10810730390224965

Elaborating a Definition of Health Literacy:

A Commentary

CHRISTINA ZARCADOOLAS
Center for Environmental Studies, Brown University, USA

ANDREW PLEASANT
Downloaded by [University of Miami] at 06:58 03 January 2015

Department of Communications, Cornell University, Ithaca, New York, USA

DAVID S. GREER
Dean of Medicine Emeritus, Brown University School of Medicine, USA

If you were on the World Wide Web looking for anthrax information in November 2001,
you might have come to the Centers for Disease Control and Prevention website1 and read
the following definition: ‘‘Bacillus anthracis, the etiologic agent of anthrax, is a large,
gram-positive, non-motile, spore-forming bacterial rod. The three virulence factors of
B. anthracis are edema toxin, lethal toxin, and a capsular antigen . . . .’’ If you turned on
the nightly news, you were first presented with the scientific certainty that anthrax spores
couldn’t spread through envelopes and then the discovery that they could, and indeed
had. If you read a newspaper, you might have been judging for yourself whether or not
U.S. Postal Service workers at the Brentwood facility had been treated unfairly when it
came to precautions taken against anthrax exposure at work. And if you were like some 8
million others around the country, you asked your doctor for a prescription for Cipro or
another antibiotic, just in case you were exposed to anthrax.
Communicating breaking news and evolving health recommendations about anthrax
presented opportunities to put available facts simply, teach basic medical concepts such
as drug resistance, and raise the level of public sophistication about the issue of scientific
uncertainty. Many of these opportunities were missed, in part because of a lack of an
adequate, widely shared definition of health literacy.
Our research has lead us to define health literacy as the evolving skills and com-
petencies needed to find, comprehend, evaluate, and use health information and concepts
to make educated choices, reduce health risks, and improve quality of life. A health
literate person is able to apply health concepts and information to novel situations. A
health literate person is able to participate in ongoing public and private dialogues about
health, medicine, scientific knowledge, and cultural beliefs. This dialogue, in turn,
advances health literacy, individually and collectively.

Address correspondence to Christina Zarcadoolas, Center for Environmental Studies, Brown

University, Box 1943, Providence, RI 02912, USA. E-mail: christina_zarcadoolas@brown.edu

119
 120 C. Zarcadoolas et al.

Powerful aspects of people’s language abilities; their understanding of science,

media, and society; and their understanding and use of cultural and community systems
require that we place our understanding of health literacy into an equally diverse and
multi-layered framework. In our forthcoming book—Health Literacy: Can the Public Be
Healthy Without It?—we propose a model for understanding and studying health literacy
in terms of four domains:
1. Fundamental literacy/numeracy—competence in comprehending and using printed
and spoken language, numerals, and basic mathematical symbols and terms. Funda-
mental literacy affects a wide range of cognitive, behavioral, and social skills and
abilities.
2. Science and technology literacy—knowledge of fundamental health and scientific
concepts, ability to comprehend technical complexity, understanding of common
technology, and an understanding that scientific uncertainty is to be expected and that
rapid change in the accepted science is possible.
Downloaded by [University of Miami] at 06:58 03 January 2015

3. Community/civic literacy—knowledge about sources of information, and about

agendas and how to interpret them, that enables citizens to engage in dialogue and
decision-making. This domain includes media literacy skills and knowledge of civic
and governmental processes.
4. Cultural literacy—recognizing and using collective beliefs, customs, world-views,
and social identity relationships to interpret and act on (as well as produce) health
information.
The ultimate goal of public health communication and education is to advance the
public’s health literacy. Investigating how health communication and education, indivi-
dual capabilities, and social processes interact to create health literate citizens is exciting
and important. Broadening the lens through which we investigate these complex abilities
is the next step in learning how health literacy develops and can be fostered.

NOTES
1. http://www.bt.cdc.gov/agent/faq/definition.asp