Low Health Literacy in Europe

Health literacy levels in the European Union

The European Health Literacy Survey (HLS-EU) carried out in 2011 in eight European countries showed that 12% of the population have inadequate health literacy and a further 35% have health literacy that is limited and thus likely to have problematic impacts upon health .

Health literacy score




The prevalence of inadequate and limited health literacy varies between European countries. Health literacy is associated with income levels, socio-economic status, belonging to minority ethnicity, as well as educational level and other social factors. Of the countries surveyed, the Netherlands had the lowest percentage of people with inadequate or limited health literacy (29%). In contrast, 61% of people in Bulgaria were found to have inadequate or limited health literacy. The survey found that increased age is a risk factor for low health literacy in all European countries. The HLS-EU found that a large majority of people over age 75 have inadequate or limited health literacy, precisely at the point in life when their healthcare needs are likely to be greatest. Given the ageing demographic profile of European residents, low health literacy in the older population is a significant problem. Addressing it will lead to healthier senior citizens who are better able to manage their own health. It will also lead to reductions in healthcare costs.

Health literacy strongly related to health

The same study showed that people with higher health literacy reported higher self-assessed health and less limitations due to health problems. Also, in the group with higher health literacy there where less long-term illnesses or health problems. See figure below.

Health literacy score (2)

What might European policy makers want to consider?

  • Interventions to improve health literacy are in line with European Union aims to achieve equity and social inclusion, for example by improving access to social and health services. European countries would benefit from a sustainable framework to encourage specific policies on health literacy.
  • Policies and action programmes that relate to healthy living and healthy ageing should be promoted. These policies can incorporate attention for health literacy.
  • Health literacy policies must take the ethnic diversity of Europe into account by encouraging adaptation of interventions to local circumstances.
  • Research and development in the area of health literacy during the life course will contribute to healthy ageing of the European population. Evidence-based interventions, tested locally, should be given priority in the array of possible activities. 2
  • Further research into cost effective interventions is necessary for improved sustainability of health systems.


Related links on HLCE: 

Understanding health literacyRecognizing low health literacy 



Sørensen K, Pelikan JM, Röthlin F, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). The European Journal of Public Health 2015: ckv043.

Heijmans M, Uiters E, Rose T, et al. Study on sound evidence for better understanding of health literacy in the European Union. Brussels: Directorate General for Health and Food Safety, 2015.