Within the health literacy (HL) discourse, the development and spread of organizational health literacy (OHL) reflects a shift from viewing HL as an individual trait to a systems-level responsibility, as organizational structures can hinder or support individual HL. By improving these structures, the HL of targeted populations can be systematically strengthened, helping to mitigate socio-economic effects on health outcomes and promoting health equity. Austria began work on OHL in the 2010s, earlier than many European countries. Inspired by the US Institute of Medicine’s “10 attributes of health literate organizations” a concept and self-assessment tool for hospitals was published in 2013. Since then, OHL has become a key element of Austria’s national HL strategy and a focus of the Austrian Health Literacy Alliance. This work has led to the development of tools and supported the integration of OHL into the national healthcare system, for example through HL-related questions in routine patient surveys that promote organizational learning. For health equity, primary care is important not least through supporting the HL of people in the context of basic healthcare provision. In Austria, HL support is legally defined as an organizational responsibility of primary care settings. Against this background, the article provides background information on OHL developments in Austria, focuses on recent data and results from piloting an OHL assessment tool in primary care settings in the context of the European Joint Action PreventNCD, and discusses potential learnings for the Austrian Health Literacy Alliance and for supporting HL and equity through primary care.