Health literacy : The solid facts

Health literacy

The solid facts

Editors: Ilona Kickbusch, J?rgen M. Pelikan, Franklin Apfel & Agis D. Tsouros

ABSTRACT

This publication makes the case for policy action to strengthen health literacy. Evidence, including the results of the European Health Literacy Survey, is presented that supports a wider and relational whole-of-society approach to health literacy that considers both an individual's level of health literacy and the complexities of the contexts within which people act. The data from the European Health Literacy Survey show that nearly half the Europeans surveyed have inadequate or problematic health literacy. Weak health literacy skills are associated with riskier behaviour, poorer health, less self-management and more hospitalization and costs. Strengthening health literacy has been shown to build individual and community resilience, help address health inequities and improve health and well-being. Practical and effective ways public health and other sectoral authorities and advocates can take action to strengthen health literacy in a variety of settings are identified. Specific evidence is presented for educational settings, workplaces, marketplaces, health systems, new and traditional media and political arenas.

Keywords

Consumer health information Decision making Health literacy Health management and planning Health policy Social determinants of health

ISBN: 978 92 890 00154

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? World Health Organization 2013

All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full.

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Text editing: David Breuer Cover and inside design: Christophe Lanoux, Paris, France Layout: Phoenix Design Aid

Cover photos from left to right: World Health Organization/Leo Weakland; World Health Organization/Connie Petersen; World Health Organization; World Health Communications Associates

Contents

Foreword............................................................................................................................................................................................... iv Contributors....................................................................................................................................................................................... vi Introduction....................................................................................................................................................................................... 1 A. Making the case for investing in strengthening health literacy.................................... 3 1 European Health Literacy Survey................................................................................................................................. 4 2 Health literacy ? a key determinant of health...................................................................................................... 7 Example: noncommunicable diseases..................................................................................................................... 12 3 Limited health literacy ? an underestimated problem and equity challenge.................................. 15 Example: migrants and minorities............................................................................................................................... 19 4 Health literacy builds resilience among individuals and communities................................................. 22 Example: Netherlands Alliance for Health Literacy............................................................................................ 24 B. Taking action to create and strengthen health literacy?friendly settings................... 26 5 Attributes of health-literate settings.......................................................................................................................... 28 6 Health literacy is a key attribute of a healthy city............................................................................................... 29 7 Attributes of health literacy?friendly organizations......................................................................................... 31 8 Educational settings............................................................................................................................................................. 35 9 Marketplace and community settings...................................................................................................................... 40 10 Workplace settings............................................................................................................................................................... 44 11 Health care settings............................................................................................................................................................. 49 Example: adherence to medication........................................................................................................................... 54 Example: programmes for self-managing chronic disease.......................................................................... 56 12 Media and communication............................................................................................................................................. 59 13 Social media and mobile health................................................................................................................................... 63 C. Developing policies for health literacy at the local, national and European Region levels..................................................................................................... 68

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Foreword

The WHO Solid Facts series was launched 15 years ago as an accessible source of intelligence on important and promising public health topics deemed worthy of more policy attention and action. It has two purposes. First, it aims to distil the best available evidence on these topics based on often-complex scientific studies and reviews. Second, it identifies policy implications and action points that could convert these ideas into realities. Importantly, in addressing these goals, the Solid Facts series has also appraised the strength of available evidence and identified where research and more solid facts are needed. Distilling evidence is especially challenging for cutting-edge public health concepts and the need to attract the attention of decision-makers. The strength and the extent of the available evidence may vary depending on the subject area, setting, health system or methods applied.

Several factors make health literacy a compelling and timely topic in the Solid Facts series. Literacy and health literacy are fundamental components of pursuing health and well-being in modern society. As societies grow more complex and people are increasingly bombarded with health information and misinformation and confront complex health care systems, becoming a health-literate person has become a growing challenge. Importantly, we now understand that poor health literacy adversely affects people's health. Literacy has been shown to be one of the strongest predictors

of health status along with age, income, employment status, education level and race or ethnic group. Nevertheless, although understanding of literacy and health literacy as critically important determinants of health continues to grow, they remain neglected areas of public health action and research. This publication aims to help to change this situation.

To this end, this publication provides a concise overview of evidence on health literacy. Most evidence, until recently, has come from the United States of America and mainly focuses on people's functional health literacy (people's ability to read and understand basic health-related information) and the management of chronic diseases. The European Health Literacy Survey, summarized here, has generated a rich new source of high-quality data on the comprehensive health literacy of general populations that enables comparisons both within and between countries and has made major inequities visible. Importantly, the European Health Literacy Survey tools can serve as a basis for strengthening capacity to measure how the many promising interventions described here may affect population health.

This publication emphasizes information about practical and effective ways public health and other sectoral authorities and advocates are taking action to strengthen people's health literacy. It especially focuses on the health literacy?friendliness of the various

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