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The purpose of this paper is to explore Finnish adolescents’ subjective health literacy (HL) in association to school achievement, learning difficulties, educational aspirations, and family affluence.

Nationally representative data were collected in Finland as a part of the international Health Behaviour in School-aged Children study. The respondents consisted in total of 3,833 adolescents (7th and 9th graders) from 359 schools. The Health Literacy for School-aged Children instrument was applied to measure adolescents’ subjective HL, while the Family Affluence Scale was used to measure adolescents’ socioeconomic status. Information was gathered on school achievement, learning difficulties, and educational aspirations.

Approximately one-third of the adolescents manifested a high level of HL, around 60 per cent had a moderate level of HL, and about one-tenth had low HL. The HL level was lower for boys than for girls, and lower for 7th graders than for 9th graders. In the total sample, the strongest explanatory variables for HL were school achievement in the first language, and educational aspirations.

This study provides the first nationally representative examination of adolescents’ subjective HL levels, and how these vary across age and gender groups. In drawing conclusions and presenting suggestions for HL interventions, it is important to verify the nature of the HL examined in any given study, and how it was researched.

The aim of this paper is to define health literacy as a learning outcome in schools, and to describe the learning conditions that are relevant for targeting health literacy.

The paper draws on theoretical and empirical educational literature, and also the experiences of the authors.

Health literacy is defined as consisting of five core components: theoretical knowledge, practical knowledge, critical thinking, self‐awareness, and citizenship. The first three components are rather similar to the commonly‐accepted health literacy concept, but the definition given in this paper expands the concept via two additional – but essential – components. It is emphasized that when one is aiming to develop students' internal capacity to construct their own meanings regarding health topics, these two additional components are called for. The paper argues that one of the main aims of health teaching in schools should be to foster students' ability to define their own beliefs, identity and social relations. Moreover, if it is desired that students should become responsible citizens, acting in an ethically responsible way, competencies such as ethical reflection skills should be developed in schools. The paper also highlights the fact that the development of certain health literacy components calls for particular kinds of learning conditions.

The paper identifies the core components of health literacy as a learning outcome and gives practical examples of means to achieve a particular target.