Health literacy and the Sustainable Development Goals—calling for systemic progress beyond individual responsibility

Ten years ago, the World Health Organization’s Shanghai Declaration placed health literacy at the heart of the Sustainable Development Goals (SDGs) agenda (World Health Organization 2016). The Declaration linked health literacy explicitly to equity, empowerment, education, and action on the determinants of health. A decade later, this vision is increasingly urgent. Progress towards the SDGs has been slow and uneven, prompting renewed attention to the conditions that enable people and communities to achieve better health and wellbeing (World Health Organization 2026, pg.2). Just 36% of the 139 assessable SDG targets are on track or making moderate progress, while 15% have regressed (United Nations Department of Economic and Social Affairs 2026, pg.2). Ongoing geopolitical conflicts, colonial legacies, the impacts of the climate crisis, and economic pressures continue to widen inequalities between and within countries, with the greatest burdens falling on populations already experiencing disadvantage (Persaud et al. 2021, Freeman et al. 2025, Rad 2025). Amid these developments, health literacy is again being recognized as an important public health goal for sustainable development, with growing emphasis on empowerment and critical engagement rather than individual comprehension alone (Nutbeam 2025). This is increasingly important as individuals, families, and communities are expected to navigate complex health systems, climate-related emergencies, and digital and commercial environments shaped by broader social, political, and economic systems (Jochem et al. 2022). While health promotion should focus on strengthening individuals’ personal health literacy, it must also address organizational and system-level health literacy capacities across the settings and environments of everyday life (Sørensen et al. 2021). Progress towards the SDGs will remain constrained if public health programmes and health systems are unnecessarily complex, difficult to navigate, or themselves create barriers to health and wellbeing. Identifying and reducing these systemic barriers is therefore critical to improving health and health equity (Volandes and Paasche-Orlow 2007, Sørensen et al. 2021). This requires a shift away from an emphasis on individual capability alone. To date, much health literacy activity has focused on whether people have the knowledge and skills to understand information, navigate health services, interpret risk, identify misinformation, and make informed choices about their health (Sørensen et al. 2012, Nutbeam 2025). While individual skills are important, this may have drawn focus away from the systems, structures, organizations, and environments that shape both the choices available to people and their capacity to act on them (Paasche-Orlow et al. 2006, The Lancet 2022). If health literacy remains myopically focused on individuals, it risks shifting responsibility away from institutions and systems, recasting problems created by complex services, unhealthy environments, and poor-quality information as deficits in people’s knowledge or capability (Santana et al. 2021) Health promotion has long recognized that health is shaped not just by individual knowledge and behaviour, but also by social, economic, commercial, environmental, and political conditions, and by the distribution of resources and power (Thomas et al. 2025). A person may access health information but still be unable to act on it because services are inaccessible, healthy options are unaffordable, living or working conditions constrain choice, commercial marketing promotes harmful products, or digital environments amplify misleading information. These barriers are central to both health literacy and health equity. Approaches centred primarily on individual and community behaviours may therefore have limited capacity to address health inequities without greater attention to the upstream conditions that produce them (Underwood et al. 2025). This is particularly important in health promotion because responsibility, equity, and power are closely connected (Abimbola 2026). People do not enter health systems, educational settings, or information environments on equal terms. Resources and opportunities—including education, income, material circumstances, language, geography, and social support—are unevenly distributed, shaping people’s ability to navigate these environments and act on health information (World Health Organization 2025). These differences shape people’s opportunities and capacities to navigate health information, services, and environments (Paasche-Orlow and Wolf 2007, Nutbeam and Lloyd 2021, Hidalgo et al. 2026). Importantly such inequalities can emerge early in life, as people enter education and other social systems with unequal access to resources and opportunities (Orkan 2019). Health literacy is therefore socially patterned by unequal access to resources and opportunities across the life course. Recognizing this is critical to understanding the contribution health literacy can make to achieving the SDGs. Doing so requires moving beyond individual capability to address the systems and conditions that shape health literacy and people’s possibilities for action. Organizational health literacy makes this responsibility explicit by focusing attention on what organizations must do to reduce complexity and create more accessible, responsive, and equitable environments (Brach 2017, Farmanova et al. 2018). This includes removing barriers and creating technology and services that are accessible, understandable, and enabling of participation (Ferreira-Alfaya 2025). This is why health literacy must centre equity-oriented approaches that explicitly consider structures and power (Abel and Benkert 2022). Strengthening health literacy requires institutions and governments to reduce systemic barriers and create the conditions that enable people and communities to act on health information (Rudd 2015, Kirchhoff et al. 2025, Maximiano-Barreto et al. 2025, Okan and Winkler 2026). Such approaches should be locally grounded, culturally responsive and attentive to community knowledge, while also addressing the structural conditions that constrain access and participation (Lie et al. 2012, Bawornthip et al. 2025). Contemporary global challenges illustrate why attention to systems and structures is increasingly important. Conflict, displacement, and the climate crisis can disrupt services, information systems, and community supports, limiting people’s capacity to act even when they understand health risks (Leppold et al. 2022, Abo-Rass et al. 2025). Women and girls may face additional barriers shaped by gender inequality and injustice, including reduced access to resources and services, and heightened exposure to violence and displacement (Mccarthy et al. 2023). Road safety provides a further example, where individual knowledge is important but where outcomes are also shaped by infrastructure, regulation, enforcement, and environmental conditions (World Health Organization 2023). Across these examples, a common principle emerges. People’s capacity to act is shaped by the systems and contexts in which they live, work, play, and learn (Thomas et al. 2025). This is particularly important within contemporary commercial and digital environments, including emerging AI technologies, which are now the everyday environments in which people live, work, and play. Most people routinely encounter health information through search engines, social media, influencers, targeted advertising, and curated platforms (Seidl et al. 2025). These environments are not neutral. Platform design, algorithms, and commercial business models shape what becomes visible, amplified, and credible (Zenone et al. 2023, Denniss and Lindberg 2025). The information environment is itself a determinant of health, requiring responses that extend beyond individual education to include platform governance, regulation, and community empowerment (Purnat et al. 2025). Health literacy should not place primary responsibility on individuals to navigate mis/disinformation and commercial health interests when powerful organizations help construct the environments in which these operate (Kickbusch et al. 2026). The commercial determinants of health provide a further example of how unequal power can undermine progress towards the SDGs and create challenges for health literacy (The Lancet 2022). Commercial actors influence health not only through products and services, but through marketing, knowledge production, public relations, political activity, and influence over policymaking—all within wider economic and policy systems (Thomas et al. 2024). This challenges approaches to health literacy that focus principally on creating more informed consumers. People should be supported to recognize marketing and critically appraise commercial claims, but critical health literacy cannot substitute for effective public policy and regulation of industries that harm health and create inequity. If health literacy is to contribute meaningfully towards attaining the SDGs, it must strengthen people’s capacity to understand and navigate these systems while also supporting institutional responsibility for making them healthier, fairer, and more accountable (Sørensen et al. 2021). This also draws attention to a relatively underdeveloped issue—the health literacy of decision-makers (Freedman et al. 2009). The Shanghai Declaration referred not only to the health literacy of citizens but also to that of policymakers and investors (World Health Organization 2016). Health literate policymaking requires the capacity to understand how decisions across sectors affect health and equity, critically assess evidence within contested political and commercial environments, and recognize inequalities in people’s opportunities to act (Abel and Benkert 2022). In this sense, health literacy is also a capability required of those who shape the systems in which health decisions are made (Kickbusch 2009). Improving decision-makers’ understanding of health literacy, and of how policy shapes people’s opportunities to access, understand, and act on health information, should be a key priority (Freedman et al. 2009). Such an approach brings health literacy more closely into alignment with longstanding health promotion concepts of empowerment and participation. Empowerment is not only about giving people information or increasing their confidence to make particular choices. It concerns their capacity to exercise greater influence over the conditions that shape their lives. People and communities need opportunities to understand not only the factors that shape their health, but also the structures, interests, and power relations that produce those conditions and influence whether they can be changed (Laverack and Wallerstein 2001, Reich 2002). As the 2030 SDG milestone approaches and the health literacy community gathers in Thailand for the 12th Asian Health Literacy Association Conference, this is an important moment to broaden the ambition of the field. The next phase of health literacy must move beyond a primary focus on individual knowledge and skills to address the systems, structures, and power relations that shape whether people are able to act on what they know. This requires health systems that are easier to navigate, institutions that are transparent and accountable, digital environments that support access to trustworthy information, commercial environments that are more effectively regulated to protect health, and policies that advance health, reduce inequities, and enable meaningful participation. The contribution of health literacy to the SDGs will ultimately depend on whether systems and environments are designed and governed in ways that support health, equity and participation. K.S. is Adjunct Professor at Aalborg University and the founder and director of the Global Health Literacy Academy, an independent organization providing research, consultancy, training, keynote speaking, and advisory services in health literacy. In this capacity, she works with a broad range of partners, including universities and research institutions, governments and public authorities, international organizations, foundations, private companies, and non-governmental organizations. These engagements may be paid or unpaid and include activities such as strategy development, capacity building, evaluation, and the implementation of Health Literacy by Design. Some of the Academy’s services draw on her published research, models, and tools. She declares no other financial or personal relationships that could inappropriately influence the present work. All other authors: No conflicts to declare. None declared. No data was used for this editorial.