Acquiring health literacy as a moral task

“Health literacy” refers to the knowledge and skills required to make optimal use of the health system. In the West, the question “how to live?” is increasingly answered by reference to medical and psychological norms and concepts: the concept of “health” has expanded enormously. Teaching migrants to become “health literate” is therefore a process of resocialisation or acculturation. If it is done without regard for their own ideas and values, it will be an attempt at assimilation – and like most such attempts, it will usually fail. If migrants are not consulted and involved in the design of their own health services, the services will not be optimally accessible and inclusive, which will lower the performance of the health system. This paper seeks to argue that becoming a “literate” user of Western health care involves learning a new morality.

Evidence is presented to illustrate the increasing medicalisation and psychologisation of life in the West and the argument that concepts of health are value‐based.

Migrants are not empty vessels simply waiting to be filled up by Western expertise; they have their own ideas and values, which may clash with those that underlie health care. Integration of migrants into health systems can only take place through dialogue, in which both sides show respect for each other's views. The confrontation with other ideas and values can enrich mainstream health care in the West.

The paper encourages readers to go beyond a purely technical interpretation of “health literacy” and consider its moral and political dimensions.