changing circumstances.2 Critical health literacy – a person’s ability to take control of the wider determinants of health.46 The highest level cognitive skills are required for critical health literacy, which, with social skills, enables people to take control of the wider determinants of their health. This includes identifying barriers to health in their environment – such as a lack of accessible green space – and then taking appropriate action.43 Health inequalities and health equity – health inequalities are differences in health between different populations. Such differences in health status are described as ‘inequitable’ where they are unfair or avoidable. Patient activation – The knowledge, skills and confidence a person has in managing their own health and care. Empowerment – Empowering people to make decisions about their health and healthcare that are right for them. Health literacy without empowerment may result in dependence on health professionals while a high degree of empowerment without health literacy might mean that a person is less able to make suitable health choices.49 Self-efficacy – The belief in one’s capabilities to achieve a goal or outcome. Although the concepts of health literacy, patient activation, empowerment and self-efficacy are distinct, the impacts are often intertwined.50-52