Health literacy policies: European perspectives

Abstract

Introduction Health literacy in Europe and the role of policy-makers Health literacy can be defined as the ability to read, filter and understand health information in order to form sound judgements (European Commission, 2007). Health literacy enables individuals to make informd decisions, which makes health literacy an important public health goal that can potentially reduce health inequalities within societies (Nutbeam, 2000). Where the topic of health literacy has mainly received attention within the realm of research and clinical practice, it is increasingly being recognised that efforts are needed on a health policy level to enhance health literacy on a population level (Kickbusch et al, 2013). Health literacy is not just the responsibility of the general population or of a single sector: it crosses boundaries, professionals and jurisdictions (Mitic and Rootman, 2012, p 17). Policy-makers are important stakeholders in this, and enhancing health literacy should therefore be a target of (national) policies. In recent years, the interest in health literacy has been growing in European Union (EU) member states. The number of scientific studies on the topic is increasing, various educational and care improvement initiatives are being undertaken, and some countries have developed a national policy or formulated specific goals regarding health literacy in their general public health targets. Many of these activities were inspired by the first European international comparative study on health literacy, the European Health Literacy Survey (HLS-EU) (Pelikan et al, 2012; see also Chapter 8, this volume). The HLS-EU study was conducted in 2011 and focused on the level of health literacy in the general population of eight European countries: Austria, Germany (Nord-Rhein-Westphalia), Ireland, the Netherlands, Spain, Greece, Poland and Bulgaria. Since then, other European countries have also used the HLS-EU instrument to measure the level of health literacy in their population (Espanha and Avila, 2016; Palumbo et al, 2016). In 2013 the World Health Organization (WHO) published a report describing the ‘solid facts’ on health literacy in Europe (Kickbusch et al, 2013), which was in part based on the outcomes of the HLS-EU study, indicating that nearly half of all adults in the eight European countries that participated in the survey had inadequate or problematic health literacy skills (Pelikan et al, 2012). The difference between countries in this respect was considerable. Of the eight countries, the Netherlands performed relatively best (28.7% poor/inadequate health literacy) whereas Bulgaria had the worst rates (62.1% poor/inadequate health literacy). Since the health status of a country’s population is generally correlated with the health literacy levels of the population, the WHO report called for action among policy-makers and health professionals to put policy and strategies into place that could enhance the population’s level of health literacy and thereby their overall health status (Kickbusch et al, 2013). In the years following the HLS-EU study, initiatives have been undertaken by various stakeholders across the EU to advance health literacy on the European agenda (Sorensen et al, 2013). Furthermore, in the European Commission’s health strategy, Together for health (2007), health literacy was included and linked to citizen’s empowerment (Sorensen et al, 2013). During the years following the HLS-EU study, several initiatives at the national and regional level have been undertaken in different European countries to improve health literacy (Heijmans et al, 2015). Until recently, no overview was present of the health literacy activities within European countries. To obtain this, the European Commission financed a study on sound evidence for a better understanding of health literacy in the EU: the HEALIT4EU study. (aut. ref.)