National Health Literacy policies and what we can learn from them

Policy documents addressing health literacy issues

Many Member States of the European Union and other countries in the world are addressing health literacy issues, for example in policies tackling inequalities in health, in programmes for older vulnerable groups or in activities promoting self-management and adherence to medical plans.

Some countries have specific policies or strategies in the area of health literacy, vulnerable groups with low literacy. The IROHLA project analysed these documents to see how countries envisage development of health literacy interventions.

Some important commonalities and difference identified.

  • Definition of health literacy: Although countries use slightly different definitions all of them agree that “health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”. Some distinguish two components: individual health literacy and the health literacy environment.
  • Problem analyses: Countries see health literacy as a priority mostly because of equity, right to access to healthcare, and human rights in general. Countries also mention healthcare costs, adherence to medical plans, and costs of healthcare as considerations. Countries often link health literacy efforts to initiatives addressing chronic diseases, like diabetes and cardiovascular diseases and to mental health.
  • Proposed actions aimed at individuals with low health literacy: Here national strategies vary widely. Some are not mentioning evidence-based interventions at all, but just mention general principles. Many countries focus on functional health literacy, reading and writing skills, understanding information. Some countries provide detailed example of good practices, e.g. Canada.
  • Proposed actions/interventions aimed at communities: Most countries recognise the important roles families, neighbours and communities have in strengthening health literacy and link activities to social inclusion, participation in society and activation of the older people.
  • Proposed actions/interventions aimed at professionals: Country strategies mention communication skills as important area of improvement to assist patients with lower health literacy levels. Some countries refer to legal obligations of informed consent and the obligations of health professionals to provide complete and understandable information. In some strategies the importance of incorporating health literacy topics in medical training and education are mentioned.
  • Proposed actions/interventions aimed at health sector: Country strategies acknowledge that sustainable health literacy needs changes in the health institutions. At the organisational level (e.g. hospitals) health literacy needs to be integrated in policies for providing of care. Examples mentioned are understandable information, accessible buildings, motivated staff
  • Cost-benefit analyses: Policies often mention arguments of costs in general terms, e.g. expected higher efficiency when patients understand health information better and adhere more to treatments. None of the policies translates expected results into clear cost-effects. However, some indicate that they will start monitoring.
  • Expected results or outcome of the policy: Countries define expected outcomes in terms of more cost-effective, equitable, safer, and higher quality health services; and eventually improved health outcomes. Some mention a society that is more informed, empowered, and engaged in health protection and promotion.

The study HEALIT4EU has produced a state-of-the art insight into:

  1. intervention studies on health literacy that are performed in EU Member States;
  2. policies, programmes and actions that are being initiated and implemented in EU Member States; and
  3. the possibility to estimate health literacy levels using a prediction model.

The study found that EU member states have a national level policy (Austria, Ireland, Italy, Portugal, Spain, and the United Kingdom). However, policies and initiatives on health literacy were identified in sixteen (16) EU Member StatesFind website here

Here you can find the national health literacy policies and strategies of:

  1. Australia: Consumers, the health system and health literacy: Taking action to improve safety and quality, August 2014 Download PDF here
  2. USA: National Action Plan to Improve Health Literacy, Dept of Health, 2010 Download PDF here
  3. USA: Health Literacy: A Prescription to End Confusion, Institute of Medicine, 2004 Download PDF here
  4. USA: Improving Health Literacy for Older Adults, Expert Panel Report, Dept of Health and CDC, 2009 Download PDF here
  5. Canada: An Intersectoral Approach to Improve Health Literacy for Canadians, A Discussion Paper, Public Health Association Canada, 2012 Download PDF here
  6. Canada: A Vision for Health Literacy Canada, Report of an Expert Panel on Health Literacy, CPHA 2008 Download PDF here
  7. Ireland: National Health Literacy Policy and Strategy, Reearch Report NALA 2002 Download PDF here
  8. Scotland: Making It Easy, Health Literacy Action Plan for Scotland, NHS Scotland 2014 Download PDF here
  9. Netherlands: Laaggeletterdheid te lijf, signalering ethiek en gezondheid, Gezondheidsraad 2011 Download PDF here
  10. Netherlands: Kennissynthese Gezondheidsvaardigheden, niet voor iedereen vanzelfsprekend, Nivel 2014 Download PDF here
  11. Germany: Nationales Gesundheitsziel, Gesundheitliche Kompetenz erhöhen, Patient(inn)ensouveränität stärken. Bilanzierung, Aktualisierung, zukünftige prioritäre Maßnahmen,, 2011 Download PDF here
  12. Switzerland: Förderung der Gesundheitskompetenz – Erhebung der Aktivitäten der Kantone, Schweizerische Eidgenossenschaft (2013) Download PDF here
  13. Austria: Rahmen Gesunheitsziel 3 Gesundheitskompetenz der Bevölkerung stärken, Bundesministerium fur Gesundheit, Wien 2014 Download PDF here Download PDF here
  14. Wales: Health Literacy in Wales, a scoping document, Public Health Wales, 2010 Download PDF here
  15. Europe: Health Literacy; the Solid Facts, WHO-Europe 2013 Download PDF here
  16. Singapore: Singapore Action Plan to Improve Health Literacy (Presentation only) Download PDF here


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