A Tale of Two Perspectives on Health Literacy: Epidemiological and Health Promotion Approaches

Health literacy (HL) is a foundational concept in public health, yet the field remains divided between two primary perspectives. The epidemiological perspective treats HL as a measurable, individual-level characteristic for population surveillance, while the health promotion perspective frames it as a dynamic, context-dependent measure for community empowerment. This current issue argues that this divide is not merely academic but has significant pragmatic consequences, often leading to a research and policy prioritization of what is easily measurable, namely, functional health literacy over what is fundamentally meaningful for advancing health equity, such as critical health literacy. This viewpoint proposes that these two perspectives are not mutually exclusive but are, in fact, complementary and mutually reinforcing. The epidemiological approach provides the essential surveillance data to identify at-risk populations and benchmark progress, while the health promotion approach offers the methodological framework for developing contextually appropriate, empowering interventions. Synthesizing these views into an integrated framework is therefore essential, enabling the creation of more responsive, person-centered, and equitable health systems that are capable of achieving broader public health objectives, including Universal Health Coverage.