[For a communication addressing populations' health literacy]

The concept of "health literacy" has been widely used in English-speaking countries for about 20 years. However, its meaning has evolved since its first definition as "cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health", to be most often centered on the narrower meaning of "functional health literacy", which is the ability to read and understand written medical documents. This narrow definition excludes illiterate populations and don't take into consideration the social skills. Moreover, it doesn't take into consideration the barriers erected by the culture. Working in the field of health communication, we propose the broadest concept of "health culture", which encompasses health literacy as well as all the representations that influence people decisions about their health. The health culture approach makes it possible to base strategies, messages and communication tools on the representations of the target populations, in order to sensitize them to the behavioral changes promoted by this communication. We show some examples of its application in public health programs in sub-Saharan Africa: breastfeeding, pregnancy support, Ebola virus disease, HIV testing, tuberculosis, and COVID-19.