What is health literacy?
Health literacy empowers people to manage their health and well-being in everyday life. The definition most commonly used in Europe was developed in 2012 by the European Health Literacy Survey consortium (HLS-EU) as a basis for measuring the health literacy of populations:
“Health literacy is linked to literacy and entails people’s knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course.” [Sørensen et al., 2012]
Importantly, health literacy is relational, meaning it develops through interactions with others, such as healthcare professionals, family members, caregivers, and colleagues and is also interlinked with (healthcare-)organisations. Therefore, fostering health literacy is a shared responsibility, not just an individual one.
Adapted figure based on Parker, R. (2009)
The WHO currently defines health literacy as follows:
“Health literacy represents the personal knowledge and competencies that accumulate through daily activities, social interactions and across generations. Personal knowledge and competencies are mediated by the organizational structures and availability of resources that enable people to access, understand, appraise and use information and services in ways that promote and maintain good health and well-being for themselves and those around them.” [WHO, 2021]
Why strengthen health literacy?
Health literacy is one of the important determinants of health behaviour, health and equity. However, limited health literacy has proven to be a widespread public health challenge in most European countries.
Individuals with lower health literacy tend to make fewer healthy choices, engage in riskier behaviours, have worse overall health, and struggle with self-management. This also leads to higher healthcare costs and inefficient use of health services. Therefore, limited health literacy remains a significant public health challenge across most European countries, with strong evidence linking it to poor health outcomes.
Figure based on Eichler et al. (2009) & Palumbo (2017)
International mandates and guiding documents as a call for action
- The EU Strategy Together for Health included health literacy as one of the key starting points for the development of citizens’ empowerment.
- The United Nations ECOSOC (Economic and Social Council) Ministerial Declaration on Health Literacy of 2009 included the following call to action: “We stress that health liter-acy is an important factor in ensuring significant health outcomes and in this regard, call for the development of appropriate action plans to promote health literacy.”
- Nairobi Call to Action for Closing the Implementation Gap in Health Promotion: To advance the health literacy and health behaviour agenda, policy is needed to generate actions that support empowerment, information and communication technologies as well as to build and apply the evidence base, e. g. by developing systems to monitor, evaluate, document and disseminate health literacy
- Health Literacy – The Solid Facts – WHO Regional Office for Europe makes the case for policy action to strengthen health literacy especially on an organizational and systemic level.
- WHO Shanghai Declaration calls for the development, implementation and moni-toring of intersectoral strategies at national and local levels to strengthen health litera-cy in all populations.
- Montevideo Roadmap 2018–2030 on NCDs as a Sustainable Development Priority: Health literacy has the potential to reduce the prevalence and impact of Non-Communicable Diseases (NCDs).
- The HLS19 Survey by the M-POHL network measured the population health literacy in several countries of the WHO European.
- WHO Declaration of Astana on Primary Health Care encourages the improvement of health literacy through reliable information: “We will promote health literacy and work to satisfy the expectations of individuals and communities for reliable information about health. We will support people in acquiring the knowledge, skills and resources needed to maintain their health or the health of those for whom they care, guided by health professionals.”
- Health Literacy for People-Centred Care: Where Do OECD Countries Stand?: Health literacy is currently being addressed by OECD (Organization for Economic Co-operation and Development) Member States and has been highlighted by the OECD in its recent “skills outlook”.
- International Union of Health Promotion and Education (IUHPE 2018, revised 2023): The Position Statement on Health Literacy: a practical vision for a health literate world points to the need to support health literacy policy, practice and research at a global level.
- Adelaide Statement II on Health in All Policies: Education improves health literacy, which, in turn, influences health through behaviour changes that impact children, their families and wider communities.
- WHO European Roadmap for Implementation of Health Literacy Initiatives throughout the Life Course.
- WHO Regional Office for Europe Flagship Initiative Behavioural and Cultural Insights: Health literacy is seen as one of the pillars of this initiative.
- Geneva Charter for Well-Being: Developing health literacy is seen as a priority throughout the life course and should start in early child development and education. This includes the necessity for international collaboration to sustainably improve health literacy.
- As a call to European-wide action, the Council of Europe in Strasbourg launched a Guide to Health Literacy contributing to building trust and equitable access to healthcare.
