Addressing health inequalities
Low rates of health literacy are strongly associated with socio economic deprivation and other factors that place individuals at risk of experiencing poorer health outcomes and inequalities. Individuals with higher socio-economic deprivation are more likely to have lower rates of literacy and comprehension and are also less likely to be able to have the resources needed to make use of health information – such as money, time, and social support (NHSE, 2023a). These inequalities can become compounded when groups with lower levels of health literacy are less likely to be actively involved in shaping decisions
about their care (Public Health England, 2015).
The following groups or individuals are more likely to experience low levels of health literacy and subsequent health inequalities, so may benefit from targeted interventions or support:
- Those experiencing higher levels of socio-economic deprivation.
- Those with language or cultural barriers (English not as first language).
- Migrant or refugee communities.
- Those with developmental language disorders.
- Those with neurodiversity resulting in communication barriers.
- Those with learning disabilities.
- Those with neurological conditions (e.g. because of a stroke or Parkinson’s Disease).
- Those with sensory impairments.
- Those living with dementia.
- Those with limited access to the internet (due to broadband or Wi-Fi access, or limited digital skills).
- Gypsy, Roma and Traveller communities – average literacy rate is approximately 30% (Dunn et al, 2024).
- Older generations.
- Other inclusion health groups or those in Core20PLUS5 ‘plus’ groups (NHSE, 2023c; NHSE, 2021b).
There are specific correlations between health literacy and individuals with language barriers, specifically related to the availability and quality of language and translation services. NHSE is currently developing an improvement framework for translation and interpreting services for community-based languages.
The Health and Care Act 2022 placed a legal duty on trusts to address inequalities, by having regard to the health and wellbeing of people and the quality of services provided to individuals, including in relation to inequalities (NHS Providers, 2022). The latest NHSE planning guidance operationalised this ask for trust boards to consider “wherever possible take actions that are consistent with narrowing existing health inequalities, including inequalities in access” (NHSE, 2025b). Improving health literacy is a tangible way to provide equitable access to healthcare services, to improve patient experience and reduce inequalities.
Although the links between health literacy and addressing health inequalities are clear, it is important to note that improving health literacy rates is shown to have broader organisational benefits, as it is likely to benefit all patients and communities regardless of their literacy rates. Most individuals are not likely to share that they might struggle to
understand or interpret health information, possibly in relation to shame or concerns about impacting on the relationship with healthcare professionals – meaning the true rates of poor health literacy are unknown or ‘hidden’ (Easton et al, 2010). Therefore, the World Health Organization advocates for a “universal right of access to health literacy” (World Health Organization, 2013).