This article is part of our special report Resilient and innovative EU health systems.
SPECIAL REPORT / People who are well-versed in health issues make better lifestyle choices, avoid developing chronic diseases and lead longer lives. But with health literacy varying greatly across the EU, campaigners are calling for action from politicians.
A new consensus paper on how to advance health literacy in Europe was launched on Friday (4 October) at the European Health Forum in Gastein, Austria.
It shows that 47% of the population in eight European countries are estimated to have insufficient levels of health literacy.
According to the paper, health literacy can be understood as "people's knowledge, motivation, competencies to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the course".
The joint document was developed by a broad policy coalition comprising the pharmaceutical giant MSD, the European Patients' Forum (EPF), the Standing Committee of European Doctors (CPME) and Maastricht University.
In the eight countries surveyed – Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain –, 41% of respondents showed limited levels of literacy related to healthcare.
Some 43% had difficulties grasping the notion of disease prevention and 51% struggled with health promotion – or the ability to advance one's own health.
People with higher health literacy levels are less likely to develop chronic diseases and make healthier lifestyle choices. They are usually more adherent to treatment and tend to lead longer lives.
At the same time, high or low health literacy levels also have an impact on the efficiency of healthcare systems, said participants at the Gastein health forum.
Kristine Sørensen from the Maastricht University’s European Health Literacy practice, said that the consensus paper was a wake-up call for policymakers, but also for people in the medical professions. She said the policy coalition had already met with the European health commissioner, Tonio Borg, to discuss an EU strategy on health literacy as a cross-cutting issue.
While there are marked differences in levels of health literacy between countries, there are also great differences within states, according to the consensus paper.
Certain groups within the population are at greater risk – for example the elderly, people with low levels of education or socio-economic status, as well as those who report suffering bad health.
Limited health literacy has wide-ranging consequences, experts say. People with poor health literacy are hospitalised more often, are more likely to take inappropriate treatment or prescriptions and are less inclined to take preventative measures.
Alexander Rödiger, director of EU affairs at MSD, said a high level of health literacy was good for patients, but also beneficial for society at large as it contributes to making healthcare systems more efficient.
Sylvain Giraud, head of unit for the European Commission’s health and consumers directorate (DG Sanco), said that the health literacy dimension was "very important" as surveys had shown that a 30-year old man who had completed university studies could expect to live 17 years longer than a 30-year old man who had not continued with education.
"This probably means that the best way to improve health literacy would be to invest a lot in education and invest a lot in social care,” Giraud stated.
Karin Kadenbach, an Austrian MEP (Socialists and Democrats), said that although she was the former health minister of Austria, she had sometimes found it difficult to find the right doctor, treatment and information.
“When I was the health minister, I tried to better communicate. I sometimes saw that we spent a lot of money on topics, on communication that didn’t reach the people that really should be reached.
“It makes no sense to produce a lot of brochures or to have a lot of material in a hospital and though we say literacy, this is not just about letters, but also pictures and pictograms," she said.
Kaisa Immonen-Charalambous, senior policy advisor at the European Patients' Forum (EPF), said: "Tackling chronic diseases is one key challenge for the sustainability of European health systems. This needs to involve greater investment in prevention and health promotion, but also changes to the way healthcare is delivered. Patient empowerment is a key dimension of the EU reflection process on chronic diseases. Patients and citizens are increasingly expected to take a more proactive role in managing their health, ultimately becoming 'co-producers of health'. However, they are currently not supported to do that."
Bulgarian MEP Antonia Parvanova from the Alliance of Liberals and Democrats for Europe (ALDE), said: “I think that no one will be able to benefit from the most –sophisticated healthcare system and public health initiatives if there is a very low level of health literacy in a society and if people rely on unreliable sources or if there are practices spread around which are referring more to their grandmothers’ knowledge and understanding than to contemporary understanding of diseases and treatments. So the role that health literacy has especially when it comes to health promotion and prevention is absolutely crucial.”
Katrín Fjeldsted, president of the Standing Committee of European Doctors (CPME), continued: “Health literacy has existed for ages, but it’s just now with the web that it’s more accessible and there’s more of it. What’s the quality of this information and who’s responsible for it? You can get all sorts of information, but you don’t know what’s right or wrong. That brings you back to Big Brother. Should Big Brother edit what’s on the internet? Or can it be free for all to put information there including wrong information? It’s a very complicated issue."
Josef Probst, director general at the Main Association of Austrian Social Security Institutions in Austria: “If you want people to make a healthy choice, you have to make the system transparent and if you only address the healthcare system, you have to have a transparent nutrition policy. If you can’t read what’s in the packages without glasses and if you are able to read and you don’t understand it, it’s not transparent enough buying the right packages in the supermarket.”
“Once we try to understand the rationality of our citizens in ordinary behaviour; the way we are thinking when we are buying food and goods… About 50% of the considerations are related to health. This is a much bigger investment than the money for our public health," said Gediminas ?erniauskas, Lithuanian vice minister for health.
The Gastein Health Forum meeting in Austria is Europe's largest gathering of health policymakers.
This year’s conference discusses how to secure the EU's healthcare systems for the future after years of budget cuts due to the financial crisis.
The eurozone debt crisis has forced some governments to drastically cut their public health budgets in an effort to contain deficits.
For example, in Greece, the public healthcare system has come under enormous pressure during the crisis, with hospitals and pharmacies cutting back on medical supplies. Spanish authorities have legally restricted access to care for undocumented migrants.
>> Read our LinksDossier: Austerity: Healthcare in hardship