The health literacy movement has been socially constructed over time. Unlike the consumer health information movement, which developed with broad public support, the health literacy movement has been fashioned primarily from the top down, initiated by policy makers and imposed on targeted populations. Interest in the health literacy movement has waxed and waned, often dependent on political agendas. In an era of increasing health care costs, it is not surprising that health literacy is once again at the forefront, given that economists and policy makers currently estimate the cost of limited health literacy in the United States to be between $1.6 to $3.6 trillion annually. Health literacy has been recognized as an issue key to the success of health care reform and to the continued advancement of the nation's status as an international leader where health and well-being are concerned. Yet, the health literacy movement has met with limited success. (Contains 1 table.)