Zarcadoolas et al., 2007: Health Literacy

The authors argue for an expanded definition of health literacy. They also argue that “teachable moments” (real-life crises) allow us to apply health literacy concepts and to improve how people understand, interpret and apply health information.

The authors define health literacy much in the same way science communication scholars define science literacy:

“The wide range of skills, and competences that people develop to seek out, comprehend, evaluate, and use health information and concepts to make informed choices, reduce health risks and increase quality of life” (pp. 196-197). Presumably, individuals who are ‘health literate’ would be able to “participate in the ongoing public and private dialogues about health, medicine, scientific knowledge and cultural beliefs” (p. 196).

The authors state that there are four components of health literacy:

(1) Fundamental literacy (the ability to read, write and interpret numbers);

(2) Science literacy (knowledge of fundamental scientific concepts, ability to understand scientific uncertainty, etc);

(3) Civic literacy (awareness that personal health decisions can impact public health);

(4) Cultural literacy (ability to tailor health information to meet the needs of audiences with diverse cultural beliefs).

The last part of the article describes how these different components interacted during the fall 2001 anthrax attacks. The mailing of anthrax-laced letters to media outlets and Senate office buildings represented a “teachable moment” – a situation in which people desired potentially life-saving information. What was anthrax? Who was at risk? What should concerned citizens do (or not do)? What was the government doing (or not doing)?

The authors argue that a key opportunity was missed to better understand and even improve the public’s health literacy.

· Fundamental literacy: The Centers for Disease Control and Prevention posted anthrax information on its website that was written, according to the authors, “at the college and post-college level,” making it difficult for most people to understand (p. 198).

· Science literacy: Did the public understand that the public health response was based on ever-evolving (and thus uncertain) information about the biology and behavior of anthrax spores?

· Civic literacy: This component stresses how individual health decisions can potentially impact public health. When NBC anchor Tom Brokaw (whose office had previously received an anthrax-laced letter) held a vial of the antibiotic Cipro while saying “in Cipro we trust,” public health officials became concerned that individuals would take antibiotics in the absence of anthrax exposure (surveys suggested that between 3-6% of respondents did so). Obviously, antibiotics can have negative side effects even if taken after a proven exposure to a bacterial agent.


· Cultural literacy: From a cultural literacy perspective, there was the issue of how race factored into the public health response. For example, postal employees who worked at facilities later found to be contaminated with anthrax considered themselves at risk almost immediately, even though health officials did not immediately agree. Since it was not believed that anthrax spores could escape sealed envelopes and contaminate their surroundings, no definitive exposure had take place and postal facilities were kept open.

This was in stark contrast to when anthrax was opened in Senate office buildings weeks earlier. In light of a proven exposure, Senate employees were given prophylactic antibiotics. By the time that this policy was applied to postal workers, the antibiotic of choice had shifted to Doxcycline (which was in greater supply and had less fewer side effects that Cipro). However, health officials faced criticism that racism played key factor – not only was treatment for mostly-black postal workers delayed for weeks, some argued, but the medication was somehow inferior to what the mostly-white Senate employees had received.


Personally, I think that the author’s focus on understanding and improving health literacy is a one-way street, much in the tradition of the deficit model. Health officials have the power, as they define what health literacy is and what it should not be. I would argue that officials need to improve their own literacy as part of their risk communications. For example, people might have difficulty grasping the concept of scientific uncertainty, but health officials often have trouble acknowledging it in the first place. The pressure to sound certain is immense in times of crisis, with certainty often being equated with competency.

If/when officials become more willing to examine their conceptualizations of audiences, risk communication as a whole will benefit. Fortunately, this is already happening.