Health literacy across the life course: Understanding equity and the influence of culture and gender

The use of the term ‘health literacy’ has grown significantly over the past two decades. While definitions of health literacy have remained contested, and continue to evolve in Australia and globally, there is generally a shared understanding that the concept is important. The origin of health literacy emerged out of an education paradigm that recognised how literacy levels impacted health. The concept was simple-improve literacy, and improved health will follow. Yet, more recent conceptualisations suggest that health literacy is far more complex and impacted by a range of individual and environmental components across the life course. In this chapter we will explore and discuss equity, gender and culture as important impacts on the health literacy environment. Using a gender-based and culturally focused lens, we apply a health literacy environment framework to two case studies, involving Aboriginal people living in the Northern Territory (NT), Australia. We critique and apply these constructs in relation to improving the health literacy environment and addressing the inequity of Aboriginal health outcomes. We argue that a health literacy environment framework shifts the responsibility of good health away from an individual to a shared population-based responsibility between citizens, health systems and health service providers. It offers a tool to better understand the systemic factors that perpetuate inequity. We suggest this framework may have promising applicability in other global Indigenous contexts.