Abstract
Background: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations. Methods: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews. Results: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29–62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model. Discussion: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.
Highlights
Health literacy has gained importance on the European health agenda
Whereas the results indicate that more than 10% of the total surveyed population had an inadequate level of health literacy, this proportion varied between 1.8 and 26.9% by country
The considerable proportions of people with limited or inadequate health literacy imply that the health literacy deficit is a challenge for public health in European countries
Summary
Health literacy has gained importance on the European health agenda. Closely linked to empowerment, it can be defined as ‘the ability of citizens to make sound decisions concerning health in daily life—at home, at work, in health care, at the market place and in the political arena’.1 The concept of ‘health literacy’ was originally used in the United States and Canada, it is being used internationally, in health care, and within the public health context.[2]. While several studies have demonstrated the prevalence of limited health literacy across the world,[7] population data on health literacy levels for the European Union (EU) have far remained unavailable. Three sets of beliefs appeared to underpin these attitudes: (i) pricing makes no difference to behaviour; (ii) government raises prices to generate income, not to achieve healthier behaviour and (iii) government is not trustworthy These beliefs were evident in discussions of all types of health-related behaviour. Acceptability might be increased if evidence regarding effectiveness came from trusted sources seen as independent of government and was supported by public involvement and hypothecated taxation
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