Pillar 1 focuses on an individual’s theoretical knowledge of health, disease, risks, information access and other aspects that contribute to health literacy.

Pillar 2 covers mental wellbeing, self-awareness and agency.

Mental wellbeing: There are many different definitions of mental wellbeing but they generally include areas such as: life satisfaction, optimism, self-esteem, mastery and feeling in control, having a purpose in life, and a sense of belonging and support. The World Health Organisation defines mental health as a state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. The positive dimension of mental health is stressed in WHO’s definition of health as contained in its constitution: “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.”

Self-awareness is the personal, practical application of an individual’s health knowledge (Pillar 1) to their own health situation; in other words, health literacy combined with the internalization of knowledge. This may involve personal or professional assessments, reference to records and tests. The result is a baseline assessment of their mental and physical state – that is, an individual’s health capital or health status ‘scorecard’.

Agency is the capacity and the intention of an individual to take action based on their knowledge and awareness of their particular situation and condition – physical and mental.

Self-awareness and agency are important because…

• They provides the basic starting position for all future self-care activities. Everyone has some positive health capital and it is important to identify these areas of strength. Over time, improvements in health can then be registered against this baseline.
• Secondly, it allows an individual to identify and act on areas needing improvement. It is human nature to avoid confronting unpleasant realities – for example excessive body weight, insufficient exercise or risks attached to particular activities such as smoking or alcohol consumption. A baseline assessment and ongoing monitoring of self-care activities helps to overcome this tendency to avoid addressing our bad habits.

Lastly, having a sound understanding of their health situation and motivation to change allows an individual to have more useful and impactful interactions with health care providers. For example, a person who knows their body mass index (BMI) or has a general understanding of any previous test results will likely gain more from a consultation with a General Practitioner than someone who is not aware of such factors.

Lack of health literacy is the cause of…

• An insufficient understanding or motivation to improve one’s health situation will limit the potential gain that can be achieved through self-care. As with any long-term, challenging goal, if the benefits gained from self-care are not recognised, an individual’s motivation and drive may fade over time.
• A lack of self-awareness and agency also plays a part in the slow, incremental, loss of health that leads to many non-communicable diseases. No one becomes overweight or develops risk-factors for non-communicable diseases overnight; these problems develop slowly over years of poor self-care and inadequate self-awareness.

WHO recommendations for self-awareness…

• In the 1999 interagency document “Partners in life skills education”, the WHO identified self-awareness as one of the skills relevant to good health across all cultures.
• As a component of health literacy, the WHO states that “awareness of the determinants of health… encourages individual and collective actions which may lead to a modification of these determinants.”

Measuring health status