With the growing interest in health literacy for public health has come a reconsideration of the concept and of the goals of public health. In 2000 Nutbeam sought to distinguish ‘levels’ of health literacy as follows:

Functional

Sufficient basic skills to function in everyday life. The most recent research evidence of functional literacy indicates that around 16% of adults have literacy levels lower than those attained by the average 11 year old, and 46% have similarly low levels of numeracy.

Interactive

More advanced skills in interpreting information from different sources and balancing these in decision making.

Critical

Application of skills and analysis of information to exert control and participate in managing own health and contributing to wider decision making.

Other commentators have sought to identify the key dimensions of health literacy. These have been described as:

• Basic health knowledge
• Competencies to navigate the health systems and act as an adequate partner to professionals
• Consumer competencies to make health decisions in the selection and use of goods and services and to act upon consumer rights if necessary
• Informed voting behaviour in the political arena, knowledge of health rights, advocacy for health issues and membership of patients and health organisations.