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Health literacy: working together to improve health
Bente Mikkelsen
Director of the Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe
Kristina Mauer-Stender
Acting Director of the Division of Information, Evidence, Research and Innovation,
WHO Regional Office for Europe
The WHO European Region has recently launched several initiatives in order to support the growing national interest in health literacy, with many Member States having already developed or integrated health literacy policies into existing public health strategies or plans, as, for example, evident from the newly launched WHO Health Evidence Network Synthesis Report (1). This special issue of Public Health Panorama seeks to highlight a wide range of health literacy approaches, initiatives and investigations at many societal levels and sectors. It follows the recent edition that, inter alia, presented the work of the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL), which aims to institutionalize a regular, internationally comparative, high-quality European health literacy survey and support the collection of data on organizational health literacy, as prerequisites for evidence-based policy and practice on health literacy (2). This editorial briefly reviews some of the specific topics that are addressed in this current issue, and contextualizes them within the broader landscape of health literacy promotion within the WHO European Region.
The WHO Regional Office for Europe is proud to lead a health literacy initiative that builds on the Region’s strong engagement in health literacy as part of a health promotion agenda that has spanned over decades. To make progress in the implementation of documents such as Health 2020: a European policy framework and strategy for the 21st century (3), and the more recent Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development (4), it has been, and remains important to improve health literacy to ensure that individuals, communities, organizations and governments make healthy choices. This is also vital in achieving the Sustainable Development Goals.
In order to create a world where everyone can live healthy, productive lives, it is important to enable individuals, communities and Member States to learn from each other.
Working together, investing in health literacy policy, implementing effective action and monitoring progress is key for transforming societies and ensuring progress towards these Sustainable Development Goals and WHO’s Thirteenth General Programme of Work to promote health,
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keep the world safe and serve the vulnerable. The process of this transformation, and the role of governments and policy stakeholders, is discussed within this issue of Panorama.
Additionally, this special issue describes the work of the WHO European Action Network on Health Literacy for Prevention and Control of NCDs. This Network builds an expert community of practice to accelerate implementation of health literacy initiatives combating noncommunicable diseases. The inspiration behind the Network was derived from a progress report on the National Health Literacy Demonstration Projects (5), which are also described here. This special issue of Panorama also seeks to highlight the successes, challenges and lessons learned from several specific Member States, with the hope that these experiences will inform future endeavors to promote health literacy across the WHO European Region.
When considering health literacy in a life-course perspective, a whole range of settings and arenas for public health action must be taken into account, including multisectoral engagement. Communities can play a critical role by supporting individuals in accessing trustworthy information and making healthy choices, while institutions and organizations can work to make health information easy to access, understand, evaluate and use, and to ensure that navigation of information systems is through the introduction of carefully designed health information technologies. In their position statement on health literacy, which is described in this issue of Panorama, the International Union for Health Promotion and Education (a global professional nongovernmental organization dedicated to health promotion) promotes a systems approach across organizations, communities and societies (6).
Settings-based approaches to health promotion, including a focus on healthy and age-friendly cities and health promoting schools, may benefit from further integrating health literacy initiatives into their work. In this issue, there is a discussion about the role of schools as an important setting for the development of health literacy among children and adolescents, and the importance of early childhood as a time to promote equity and health literacy. Such work connects to the larger mission of Schools for Health in Europe; a network of countries who have established national health promoting schools initiatives, which, along with the Health Behaviour in School-aged Children survey, promote and monitor health literacy through a whole-school approach, in which the school environment contributes to the promotion of health literacy.
The physical environment—cities and schools—may benefit from health literacy promotion, but it is also important to consider its potential relevance to the digital environment. In
the coming years, as people spend more time online and using mobile devices, it will be important to identify how to ensure that these ‘digital environments’ may also be used to improve health literacy, as well as to address digital health literacy itself (7).
This special edition also draws attention to several cross- cutting issues that constitute highly pressing or crucial action areas within the framework of health literacy. For example, it is important to build capacity among decision-makers so that they can understand and promote health literacy. The understanding of health literacy and health literacy responsiveness is crucial in addressing equity gaps both at a political and societal level (6). Another priority is the promotion of health literacy throughout the life course, and in doing so activating many sectors, partners and organizations (5, 6, 8). This issue includes several pieces that highlight challenges and opportunities for strengthening health literacy among specific populations, including adults living with chronic diseases and those that might be vulnerable or marginalized.
The importance of collecting population-level measures of health literacy in order to inform public health implementation strategies, evaluate the effectiveness of interventions and track progress over time is also addressed in this issue. Toward this end future interventions may benefit from employing existing instruments to measure health literacy (9, 10).
There are also instances when health literacy initiatives must focus on specific challenges. For example, the WHO Regional Office for Europe has coordinated a number of awareness campaigns for the public, health-care professionals, policy- makers, decision-makers and the media. These campaigns, such as European Immunization Week, World Antibiotic Awareness Week, World TB Day, World Hepatitis Day and World AIDS Day, have a special focus on particular issues. Similarly, sometimes it is important to focus on health literacy during a particular situation, such as emergencies, as seen in the recently released WHO Emergency risk communication five-step capacity- building package for European countries. This need for health literacy initiatives to focus on specific issues is illustrated in an article about introducing vaccinations for human papillomavirus, and the need for a clear communication strategy.
Overall, by showcasing a wide range of health literacy initiatives from across the region, we hope that this special issue will initiate reflections on a number of considerations behind the implementation of health literacy initiatives. It highlights the need to be context-specific, and to take measures to ensure that
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the initiatives do not increase health inequalities (5). Successful intervention strategies could stem from local contexts and develop into areas of patient-centred care, organizational or community health literacy responsiveness (6, 11–13).
Furthermore, health literacy should be seen as a tool to enable existing or new public health strategies in all settings.
Health literacy is a crucial determinant of health. This special issue of Panorama therefore highlights a number of initiatives in the Region related to the promotion of health literacy, and ultimately, the empowerment of individuals and communities to engage in collective health promotion action.
REFERENCES
11. Rowlands G, Russell S, Donnell AO, Kaner E, Trezona A, Rademakers J, et al. What is the evidence on existing policies and linked activities and their effectiveness for improving health literacy at national, regional and organizational levels in the WHO European Region? Health Evidence Network Synthesis Report, No 57. Copenhagen:
WHO Regional Office for Europe; 2018 (https://apps.who.int/
iris/handle/10665/326251)
2. Dietscher C, Pelikan J, Bobek J, Nowak P. The Action Network on Measuring Population and Organizational Health Literacy (M-POHL) A network under the umbrella of the WHO European Health Information Initiative (EHII).
Public Heal Panor. 2019;5(1):65–71 (https://apps.who.int/
iris/handle/10665/325113).
3. Health 2020: A European policy framework and strategy for the 21st century. Copenhagen: WHO Regional Office for Europe; 2013 (EUR/RC62/9; http://www.euro.who.int/
en/health-topics/health-policy/health-2020-the-european- policy-for-health-and-well-being/publications/2013/health- 2020.-a-european-policy-framework-and-strategy-for-the- 21st-century-2013).
4. Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development. Geneva: WHO; 2016 (http://
www.who.int/entity/healthpromotion/ conferences/9gchp/
shanghai-declaration.pdf).
1 All references were accessed on 7 August 2019.
5. WHO GCM/NCD Working Group on Health Education and Health Literacy for NCD’s. Interim Report (WG 3.3, 2016–
2017) [website]. Geneva: World Health Organization; 2017 (https://www.who.int/global-coordination-mechanism/
working-groups/working-group-3-3/en/).
6. IUHPE Position Statement on Health Literacy:
A Practical Vision for a Health Literate World. Global Health Promotion 25, no. 4 (December 2018): 79–88.
doi:10.1177/1757975918814421.
7. Griebel L, Enwald H, Gilstad H, Pohl AL, Moreland J, Sedlmayr M. eHealth literacy research—Quo vadis?
Inform Health Soc Care. 2018 Dec;43(4):427-442.
doi: 10.1080/17538157.2017.1364247
8. Moreira L, “Health literacy for people-centred care: Where do OECD countries stand?”, OECD Health Working Papers, No. 107, Paris: OECD Publishing, https://doi.org/10.1787/
d8494d3a-en.
9. Haun JN, Valerio MA, Mccormack LA, Sørensen K, Paasche-Orlow MK. Health Literacy Measurement: An Inventory and Descriptive Summary of 51 Instruments.
J Health Commun. 2014;19 Suppl 2:302-33. doi:
10.1080/10810730.2014.936571.
10. Farmanova E, Bonneville L, Bouchard L. Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues. Inquiry. 2018 Jan- Dec;55:46958018757848. doi: 10.1177/0046958018757848.
11. Batterham RW, Hawkins M, Collins PA, Buchbinder R, Osborne RH. Health literacy: applying current concepts to improve health services and reduce health inequalities. Public Health.
2016;132:3–12. doi: 10.1016/j.puhe.2016.01.001
12. Geboers B, Reijneveld SA, Koot JAR, de Winter AF. Moving towards a comprehensive approach for health literacy interventions: The development of a health literacy intervention model. Int J Environ Res Public Health.
2018;15(6). doi: 10.3390/ijerph15061268.
13. Visscher BB, Steunenberg B, Heijmans M, Hofstede JM, Devillé W, van der Heide I, et al. Evidence on the effectiveness of health literacy interventions in the EU: A systematic review. BMC Public Health. 2018;18(1):1–12. doi: 10.1186/
s12889-018-6331-7.n
