Health Literacy - Taking Health into our own hands

A laptop and a stephescope.

While there is an increasing number of Health Gadgets (e.g. sports watches) available and the Internet is flooded with health information it seems increasingly challenging for people to make decisions in favour of their health. Sources often are lacking scientific and medical quality and are influenced by economic interests. Western societies actively commercialize unhealthy lifestyles. In addition to that people are not supported sufficiently in the decision-making process and navigation in the health system. This does not only have negative effects on the individual but the whole community as decisions on health touch all sectors of social life – education, work, living situation, consumer behaviour, nutrition etc.

I am currently starting to write my thesis in the field of “Health Care and Prevention” on the topic of Health Literacy. In this short blog-post I want to share the first insights into the topic. I would be very grateful if you would post any ideas, questions or perceptions below.

The extent and ability to cope with health-related information is referred to as Health Literacy. The WHO has defined health literacy as “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.” [1] (for themselves, their families and the community they live in). The term therefore goes beyond the passive capability of reading health information (package information leaflets, Information, contracts etc.). Health literacy is the key to a high life quality. It includes 3 main aspects: living a healthy lifestyle, maintaining health and seeking the appropriate medical help in case of illness.

A study launched in 2017 has shown that 54% of the adult German population has a deficit in their health Literacy (38% have sufficient Literacy and only 7% have good Literacy) [2]; this includes difficulties to find right health-related information and evaluate them as well as in taking the right decision when it comes to a healthy lifestyle or disease management. A low or lacking health literacy leads to less healthy decisions, risky behaviour and less self-help. It also influences the compliance of patients and therapeutic successes – limited Health Literacy can lead to misuse, non-use, overuse or harmful interactions (e.g. with other medication or nutrition). Especially at risk are elderly, chronically sick, people with migration status or low education level. This leads to high personal and financial expenditure and therefore has restraining effects on development. The WHO estimates that 3-5% of the global health expenses can be linked to insufficient Health Literacy. In Germany alone, these are 9-15 billion Euro per annum. [3]

The importance of Health Literacy is not a new perception. Already in 1986 the Ottawa Charter of Heath Promotion recognized the need of greater self-determination and active contribution of patients in the health system. It stressed the importance of enabling people to increase their active contribution and control over their own health and general wellbeing, as well as ensuring healthier and sustainable living environments (in all aspects of life). The charter highlighted that health promotion and creation is not only the responsibility of the health sector, but rather demands the commitment and action of actors from different sectors of society. The European Health Literacy survey is a try to quantify the level of Health Literacy of a society. The Shanghai declaration (2016) obliged all member states to establish and launch national and communal strategies to strengthen the Health Literacy of the population. It particularly stresses the need for the development and implementation of explicit action plans.

The level of Health Literacy is dependent on many factors. Individual factors include age, gender, as well as constitution factors like individual character and personality traits. Furthermore Systematic factors include access to health information, the organisation of the health system and communication skills of professionals working in the health sector. These relationships are portrayed in the graph below. Intervention approaches should therefore always consider both factors and work on combined solutions in all sectors of life – education and nurture, consumer attitude, nutrition, living, working world and handling of media.

If we want to ensure a sustainably healthy society in all sectors of life – physical, mental, economic, social and ecological – we have to rethink our approaches to health and medicine. We have to approach health in a preventive not a therapeutic way. Rather than setting importance on only curing diseases we have to start to prevent their emergence in the first place. Health Literacy plays a fundamental role in this – it provides a foundation with which people have the ability and are empowered to play an active role in the determination of their, their families and their environments health. It also has great potential to reduce social inequalities and will yield other social benefits e.g. it could mobilize communities and individuals to address the social, economic and environmental determinants of health.
If we want to establish good Health Literacy it is necessary to start and coordinate a systematic and macrosocial ethical discourse. An interdisciplinary approach in primordial – specialists from different sectors of society have to work together to combine their ideas and knowledge in order to find solutions and establish effective action plans. But also, the population has to be actively integrated into the process – their current difficulties, feelings and ideas should be considered, and their capacities and knowledge actively fostered. 
The process of establishing good or even sufficient Health Literacy will take time. Actions and materials have to be systematically planned, tested and finally introduced. Rushed action will be counterproductive.



[2] Schaeffer, D., Hurrelmann, K., Bauer, U. und Kolpatzik, K. (Hrsg.): Nationaler Aktionsplan Gesundheitskompetenz. Die Gesundheitskompetenz in Deutschland stärken. Berlin: KomPart 2018.