CONCLUSION
Current understanding of the relationship between literacy and health, and growing understanding of the concept of health literacy should temper uncritical enthusiasm for current policy to increase patient participation in health care. Unless health literacy is better understood and more overtly accounted for in the implementation strategy, the policy goal to achieve an actively participating patient population is unlikely to be met, reaching only a subset of patients with higher literacy skills and greater confidence with the healthcare system. Worse, increasing patient participation, without specific interventions to address low health literacy, may well result in increased health inequalities.