Both conceptualizations challenge current health and
patient education methods and are helping to stimulate
a more sophisticated understanding of the process of
health communication in both clinical and community
settings, as well as highlighting factors impacting on its
effectiveness (Coulter & Ellins, 2007). Both clearly depend upon levels of literacy, numeracy and language competence
in individuals and populations. Individuals with undeveloped
skills in reading, oral communication and numeracy
will not only have less exposure to traditional health
education, but also less developed skills to act upon the
information received. For these reasons, strategies to
promote health literacy will remain inextricably tied to
more general strategies to promote literacy, numeracy and
language skills in populations. Innovative initiatives such as
the English Skilled for Health program illustrate the potential
of combining the two goals, by bringing health
‘‘content’’ into an adult literacy program (Department for
Education and Skills, 2006).