Research documenting links between levels of education and health outcomes suggests people with higher educational attainment may have a health advantage. Health literacy issues that go beyond basic skills include health information communication; literacy and health as cultural and social practices; a relationship among health information, literacy, and behavior; and impact of the Internet on use of health information. First, the medical literature emphasizes simplification of health materials. Physicians should use language the general public readily understands. Second, health literacy depends on context, and individuals' cultural world views and social practices must be taken into account in determining their level of health literacy. Third, these factors in addition to health knowledge and health literacy affect adoption of health behavior: perception of risk, self-efficacy beliefs, physical environment, and perceived costs and benefits. Fourth, Internet users tend to have higher literacy levels and better access to the vast amounts of health information available online that can empower consumers to participate actively in their health care and challenge the decisions of health care and insurance providers. Components of an effective health literacy system are an information dissemination system with readable, culturally sensitive materials; coordinated health literacy learning system; measurement and assessment system; formal and informal health advice system; and professional health provider learning system. (Contains 20 references.) (YLB)