Abstract: Objective To understand the health literacy of residents and related factors in Lishui, Zhejiang province, and provide scientific evidence for the future health education. Methods After multi-stage stratified random sampling, a household survey was conducted with a national standard questionnaire in Lishui. Descriptive epidemiological analysis was conducted on the survey results. Results A total of 1 205 residents aged 15-69 years were surveyed. The overall level of adjusted health literacy (AHL) was 20.40% in residents in Lishui, with 20.06% in males and 20.33% in females, 26.30% in urban residents and 16.54% in rural residents. Age group 25-34 years, people with college degree or above, and white collar workers had higher AHL levels (31.03%, 53.80% and 52.51%). The AHL level of healthy lifestyle and behavior, basic healthy knowledge and concept, and basic healthy life skills were 23.53%, 27.68% and 28.61% respectively. The AHL levels about chronic disease prevention and basic medical care were low among the six types of health problems (10.69% and 21.72%). Education level, occupation and annual family income level were the main factors that could affect people's AHL level. Conclusion There was still a gap between the resident's AHL level in Lishui and the national requirements. It is necessary to strengthen the health education in rural area, in middle-aged and elderly population as well as people with lower education level with the emphasis on prevention and treatment of chronic diseases and basic medical care service.