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?

The issue Health literacy is the capacity of individuals, families and communities to make sound health decisions in the context of everyday life: at home and the workplace; and in the community, marketplace, health care system and political arena. Increasing health literacy is a critical empowerment strategy to increase people's control over their health through improving their ability to seek out health information, express themselves on health issues and take responsibility for their health. Low health literacy is associated with poorer health, more illness and health inequalities, and it is likely to be associated with less cost-effective health systems. Addressing the issue of low health literacy, therefore, has the potential to increase health, health equity and health system effectiveness through building citizens' capacities for health. The synthesis question The objective of this report is to address the question "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?" Types of evidence The report identified policies and other relevant documents through an evidence review of peer-reviewed and grey literature, supplemented by an enquiry of experts in health, health literacy and policy in the Region and by health literacy policies included in the most recent peer-reviewed document on health literacy activities published in the Region (European Union (EU) countries only: HEALIT4EU). Further efforts to identify policies from countries of the Commonwealth of Independent States were unfruitful. Results This synthesis identified 46 existing and/or developing health literacy policies at international (for three Member States), national1 and local levels in 19 of the 53 Member States of the Region (36%). Five policies were under development, 30 were currently active and 11 were time limited, with no evidence of a follow-on policy. Policies were examined to (i) describe the policy stages; and (ii) analyse the components (antecedents, actors, activities and beneficiaries) and activities using a new framework, the Health Literacy Policy Model. A wide range of activities was identified at international, national and local levels. Baseline health literacy data are not available in all Member States. Evidence is emerging of successful activities to build health literacy at the individual and community levels, particularly in the areas of health and education, with some activities in the workplace. More activities are focused on building skills in individuals than in communities. Many policies have complementary areas of focus, where sharing of knowledge and resources could be beneficial. There is currently little evidence of activities and effectiveness in the areas of the lived environment, the media and digital/e-health literacy, although some of this information may be provided when evaluations of current projects are published. A low rate of policy identification through searching the peer-reviewed literature may reflect lack of engagement in policy evaluation by the academic community. Finally, policy-makers should be made aware of the facilitators of successful health literacy policy implementation, such as intersectoral working, political leadership and overcoming cultural barriers, and ensure that potential barriers to success, such as lack of evidence of the health, social and economic benefits of the policies, are addressed through rigorous evaluation. The economic effect of health literacy policy is an important area for development, as this evidence synthesis did not identify any evaluation of economic effects arising from the policies. Policy considerations Based on this evidence synthesis, the following policy considerations are proposed: • consider the existing policies and related activities gathered in this review to develop or enhance health literacy policies and related activities to benefit citizens, patients and communities; • broaden the range of areas of activity required for holistic health literacy policies to include the lived environment, the workplace, the media and digital/e-health, at all societal levels – individual, community, organization and system (legislative); • strengthen the evidence base for health literacy at all societal levels to ensure that policies address needs specific to the national or local context; • incorporate robust qualitative and quantitative evaluations into health literacy policies and interventions – quantitative methods could include pre- and post-activity health literacy evaluations of evidence of health, social and economic effects at all levels; and • incorporate facilitators of successful implementation, such as intersectoral working, political leadership and strategies to overcome cultural barriers, into health literacy policy. Member States would benefit from adopting such comprehensive frameworks and using metrics to design effective policies that support the development of a health-literate Europe. (aut. ref.