I am elated that health literacy and cultural competence are becoming a solid part of the evidence-based mainstream of public health and clinical medicine. As a young U.S. Army Special Forces soldier and medic half a century ago, some of my best training and health literacy experience resulted from living with and being immersed in the culture and language of the tribal Montagnards of Southeast Asia. From them, I learned that people are the best experts in their own lives and trying to impose a one-size-fits-all solution simply does not work.

In the decades since then – in numerous roles from soldier to physician, professor to surgeon general, father to friend – I fully realized that health literacy (HL) is the ultimate global currency of health and well-being. Without health literacy, medicine fails, public health fails, and people pay the cost for those failures with their lives. This could not be truer than in the emergence of new diseases around the world, and, in particular, the COVID-19 pandemic. As our systems of medicine and public health become increasingly stressed by growing demand, challenged by the emergence of new threats to health, and unable to respond to the needs of the public they serve, improving health literacy becomes increasingly important.

In a world that is growing increasingly complex in political, cultural, and social realities, general literacy rates vary from a low 19% in Niger to South Korea where nearly 100% of the adult population is literate. Yet, disparities remain the most critical issue – two-thirds of the world’s non-literate citizens are female.

As we strive to improve HL in order to enhance the quality and length of life and reduce health care costs, ‘Health literacy in clinical practice and public health: new initiatives and lessons learned at the intersection with other disciplines’ is a much needed publication that clearly denotes the importance of health literacy as the most effective and cost efficient way to improve public health, prevent illness, and advance medical care.

As important as improving general literacy is, the average citizen often struggles with limited health literacy and is surrounded by public health and medical care systems that demand HL to understand and navigate needed health care. That is, both people and health systems continue to have difficulty in comprehending, synthesizing, communicating clearly, and acting on necessary scientific information to improve health and well-being. People and the health systems that surround them struggle to sustain healthy behavioral changes that are necessary to prevent or mitigate disease. Citizens and their leaders also often fail to connect the quality of their lived and natural environments with the quality of the broader public’s health and well-being. An unhealthy environment produces unhealthy people just as unhealthy people produce an unhealthy environment.

As this book goes to press, illustrations of the aforementioned problems abound in the global response to COVID-19. For example, significant differences in therapeutic responses to the pandemic have emerged within and between nations despite extant evidence about the pandemic’s health risks. Significant public health consequences, including an overwhelmed health care system and preventable deaths, sometimes have been the result of inconsistent and delayed local, regional, and national implementation of physical distancing as well as other evidence-based protocols to thwart global pandemics.

In addition, occasional occurrences linked to COVID-19 provide a sobering reminder about the use of social media to diffuse health disinformation and misinformation, which can appeal to populations with limited health literacy. For instance, British activists have used social media to allege the COVID-19 pandemic’s diffusion is accelerated by the expansion of 5G network phone services and cell phone towers. The latter allegations prolong pre-pandemic assertions that cell phone towers and services represent an omnipresent, deliberately concealed threat to public health.

The continuation of health conspiracy theories and delayed government responses each illustrate the consequences of limited health literacy and its potential to generate public and health policy indecision and confusion – in this case during a pandemic.

In the U.S., health care’s stakeholders increasingly perceive health literacy as a robust field of practice. Moreover, there are organizations, researchers, practitioners, and networks working to advance health literacy that stretch around the globe. While we have experienced great advances on every continent from an idea initiated by small groups, there is much more that needs to be done. The editors of this volume have aggregated global researchers and their knowledge through ‘scientific crowd sourcing’ and they have significantly advanced the science of health literacy. In three major sections, global thought leaders in health literacy explore and report on their efforts to foster progress in clinical practice and public health.

Meanwhile, as preventable disease and its resulting economic burden continues to mount in the U.S. and globally, the currency of health literacy and cultural competence becomes ever more valuable. Improving health literacy in health and medical organizations, health professionals, and the public is the pathway to better health for all at reduced costs.

Similarly, the biomedical science that needs to be translated via HL principles creates an enduring challenge. Providers know how to keep many people healthy and prevent disease through simple lifestyle practices – and medical science often knows how to help people regain their health after they become ill. However, whether you live or practice in Bangladesh or Beverly Hills – successful health outcomes are derived from a culturally competent and health literate translation of biomedical and related sciences into applied care.

While all health and medical practitioners must be aware of (and incorporate) health literacy and cultural competence practices in their disciplines and daily practices, it is noteworthy that many best practices emerge in the communities where pressing social and cultural issues are best understood. Just as I learned from the Montagnards of Southeast Asia as a young medic in the U.S. Army, we cannot impose our world view and science upon people without first understanding their reality.

Although the future is bright for health literacy and its supporters, significant work remains and funders must begin to fully prioritize health literacy in their missions. We must engage more practitioners across disciplines like pharmacists, EMT’s, and nurses. We must bring in commercial sectors – from grocery stores to the entertainment industry. We must expand our content distribution networks and continue to create more health literate content. Through the latter approaches, we increase the chance to diminish disease and health’s economic burden as well as create healthier populations.

Health literacy can become the basis for a new partnership among the public, medical systems and professionals, and public health practitioners and systems. As those systems of health become increasingly stressed by issues like the COVID-19 pandemic, the need for all individuals, families, and communities to have the ability to make evidence-based and informed decisions becomes ever more critical in order to improve health for all at a lower cost.

On a final note, as autocrats rise and fake news and political instability trumps the truth globally, I am concerned about the unintended public health consequences of the lack of needed global coordination to reduce morbidity and mortality and improve the quality of life for millions suffering from preventable diseases and resulting economic burdens.

This new publication clearly articulates our past challenges and future opportunities while advancing the science of health literacy. Overall the book, which is enthusiastically recommended for all health and medical practitioners and researchers, sets the practice and research of health literacy on an evidence-based, common, thoughtful, effective, efficient, and applied course.