in co-operation with academic and practice partners LBIHPR: A-1020 Vienna, Untere Donaustraße 47, Austria | [email protected]| www.lbihpr.lbg.ac.at | +43 1 2121493 -10 | FAX - 50 The impact of health literacy on health Jürgen M. Pelikan Prof. em. (University of Vienna) Key Researcher LBIHPR, Vienna Director, WHO-CC Health Promotion in Hospitals and Health Care, Vienna Health promotion conference 2013 Tallinn / Estonia, 7 th June 2013
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in co-operation with academic and practice partners
Jürgen M. Pelikan Prof. em. (University of Vienna) Key Researcher LBIHPR, Vienna Director, WHO-CC Health Promotion in Hospitals and Health Care, Vienna Health promotion conference 2013 Tallinn / Estonia, 7th June 2013
2 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
Overview
1. Health Literacy is high on the European Health Policy Agenda
2. Why is Health Literacy important these days?
3. The Concept of Health Literacy
4. The European Health Literacy Survey (HLS-EU)
5. Results of the HLS-EU Survey
1. General Health Literacy
2. Self-Assessed Health
3. Health Literacy explaining inequalities in self-assessed Health
4. Health Literacy explaining inequalities in self-assessed health in different
Age-Cohorts
6. Summary of Results
7. Conclusions
8. References
3 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
1. HEALTH LITERACY IS HIGH
ON THE EUROPEAN HEALTH
POLICY AGENDA
4 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
1. Health Literacy is high on the European Health
Policy Agenda
Together for Health: A Strategic Approach for the EU 2008-2013 “Promotion of health literacy programmes for different age groups” (Commission of the European Communities, 2007)
EU Health Programme 2008-2013:
“ It seeks to […]generate and disseminate health information and knowledge..”
HEALTH 2020: “Health literacy is a key dimension of Health 2020,
the European health policy framework.” (Jakab Z. WHO Regional Director for Europe)
European Review of Social Determinants of Health. (WHO Regional Office for Europe, 2012)
HEALTH LITERACY. THE SOLID FACTS (2013)
(WHO Regional Office for Europe 2013)
5 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
2. WHY IS HEALTH LITERACY
IMPORTANT THESE DAYS?
6 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
2.1 Health Literacy is an important social determinant
of health, related to inequality of health
Health Literacy
Social Determinants
•Age
•Gender
•Education
•Social Status
•Financial Deprivation
•Status of Employment
• Migration Background
Health Consequences
• Health Behaviors and Health Risks
• Health Status Indicators
• Health Service Use
• Health Care Cost
7 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
2.2 Health Literacy is a core concept of and related to
other concepts of Health Promotion
Health Promotion (Ottawa Charter, 1986): Definition: „ Health promotion is the process of
enabling people to increase control over,
and to improve their health.“ (Ottawa Charter)
HP principles: Enable, mediate, advocate & Equality
„HL is critical to empowerment“, WHO 1998)
Action area 4: Develop Personal Skills („ to exercise more control over their
own health and over their environments, and to make choices conducive to
health.“)
Action area 1: Build healthy public policy (Health literacy in all policies)
Action area 2: Create supportive environments (Health Literate Settings)
Action area 5: Reorient health services (Health literate health care
organizations)
Capacity Building (as a personal resource & as a situative infrastructure)
8 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
2.3 Health literacy is a measurable concept linked to
literacy research & there are effective interventions
available
HL is a measurable concept by different available
instruments
HL research & practice has been mainly developed for
patients & health care, and less so far for general
populations
Evidence shows that HL makes a difference for health care
(patient compliance, outcomes, costs etc.)
A number of effective interventions are available to deal
with low HL or improve HL in HC
An interesting proposal for a Health Literate Health Care
Organization has been made
9 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
2.4 Health Literacy is important for everybody in
different roles and tasks of every day life 1. The demands on personal skills of individuals for a successful life management rise
and continuously change with the complexity and dynamic of (late) modern societies.
2. Tasks and roles of managing ones life (e.g. as worker, consumer, patient, citizen) are
increasingly to be taken within various organizations and functional systems.
3. These tasks and roles require more and more personal information and
communication management for informed, responsible & accountable decision
making and action taking in different co-productive role-relations (quality).
4. Inadequate/ insufficient participation has an effect on the opportunities in life, the
quality of life and the life expectancy of the affected individual (equality & equity).
5. This applies in particular to health-/illness related aspects of lifestyle and to the role of
the “responsible patient”!
6. In “Health Societies” (Kickbusch) (almost) every decision we take – in our different
roles - (almost) always has an impact on our health.
7. Therefore, personal competences of individuals – in general literacy (reading, writing,
calculating), in particular language competence or more specifically health literacy,
media-literacy, IT-literacy, has become a focal point in science, politics and practice.
10 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
3. THE CONCEPT OF HEALTH
LITERACY
11 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
3.1 Integrated Model and Definition of Health Literacy
for the HLS-EU Study (Sorensen et al. 2012)
“Health literacy is linked to literacy and encompasses people’s knowledge, motivation and
competences 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 life course.”
12 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
3.2 Health literacy is based on other literacies and
skills
Health
literacy
Science, media,
IT literacy (etc.)
General literacy
(read, write, calculate)
Social communication Skills
Proficiency in local language
13 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
Improve personal abilities to … Make situations / systems more …
•access
•understand
•appraise
•apply
•accessible
•understandable
•appraisable
•applicable
•(concerning) Information of relevance for health-related decisions
Source: Parker, 2009
3.3 Health literacy is a relational concept and therefore
can be improved by different types of interventions
14 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
4. THE EUROPEAN HEALTH
LITERACY SURVEY (HLS-EU)
15 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
4.1 Objectives of the HLS-EU Study
1. Adapt a model instrument for measuring health literacy
in Europe
2. Generate first-time data on health literacy in European
countries, providing indicators for national and EU
monitoring
3. Make comparative assessment of health literacy in
European countries
4. Create National Advisory Bodies in countries
participating in the survey and to document different
valorization strategies following national structures and
priorities
5. Establish a European Health Literacy Network
16 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
4.2 Data Collection of HLS-EU Study
In 8 member states AT, BG, DE (NRW), EL
(Athens +), ES, IE, NL, PL
For stratified random samples of 1000 per country
For EU-citizen populations aged 15+
By computer-assisted personal interviewing
technique (CAPI) (BG, IE = PAPI)
Within the period of summer 2011
By TNS Opinion on behalf of HLS-EU consortium
With Euro-barometer methodology (EU citizens, not
residents!)
17 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
4.3 Indicators and Index of Health Literacy Format of items
„On a scale from very easy to very difficult, how easy would you say it is to ….
1.0 [N=892] [N=918] [N=975] [N=964] [N=958] [N=878] [N=971] [N=896] [N=7452] a…not significant on the 0,05 level; Self-Assessed Health from 1=very good to 5=very bad; Age in years; Social Status from 1=lowest place in
society to 10=highest place in society; Financial Deprivation from low deprivation to high deprivation; Education (ISCED) from 0= lowest education level to 6=highest education level; Gender from 0=male to 1=female;
30 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
5.3 HL EXPLAINING VARIATIONS IN
SELF- ASSESSED HEALTH
31 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
5.3.1 Association of Self-Assessed Health with General-Health
Literacy (Percentage Distributions for Total Sample)
[N=864] [N=859] [N=965] [N=964] [N=936] [N=848] [N=946] [N=843] [N=7224] a…not significant on the 0,05 level, Self-Assessed Health from 1=very good to 5=very bad; General-HL from 0=minimal HL to 50=maximal HL;
NVS from 0=minimal to 6=maximum; Gender 0=male, 1=female ; Age in years ; Education (ISCED) from 0= lowest education level to
6=highest education level; Financial Deprivation from low deprivation to high deprivation; Social Status from 1=lowest place in society to
10=highest place in society;
35 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
5.3.5 Effects of Multiple Predictors (Beta Weights and Adjusted R-Square) on Self -Assessed
Health, for Countries and Unweighted Total Sample (in a Model with 11 Predictors Alcohol Use,
standard weights (ns),) – means by HL-Levels and age groups
Nagelkerke/pseudo R²=0,46
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
25 or younger between 26 and 35
between 36 and 45
between 46 and 55
between 56 and 65
between 66 and 75
76 or older
inadequate HL
problematic HL
sufficient HL
excellent HL
total
38 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
6. SUMMARY OF RESULTS
39 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
6. Summary of Results
1. Limited health literacy is a problem of relevant proportions of citizens in
Europe, but to a differing degree in different member states, from around
1/3 to 2/3 of the population.
2. There is a considerable social gradient not just for health, but also for
health literacy, again differing by member state
3. In all included member states, self-assessed health and health literacy
are directly linked to a certain degree. Even, when important social
determinants are controlled for, general health literacy has a direct,
significant and second strongest effect, while functional health literacy
(NVS) has no significant effect at all!
4. This relationship of health literacy with self-assessed health is steadily
increasing for older age-cohorts!
40 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
7. CONCLUSIONS
41 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
7.1 Principal Conclusions for Research
1.Further research is needed, but not just more, but different
research, especially
1. for studying comprehensive HL in general populations
2. & for studying user-friendliness (readability/ complexity/ demands)
of situations, systems, services, products.
2. Research has to be done in a systematic comparative way using
standardized instruments to take into account regional socio-
cultural differences
3.There is need for an institutionalized sustainable framework like
OECDs PISA or WHOs HBSC projects for re4gularly studying HL
(starting with some countries and open to others; with a common core
instrument & the possibility of national addenda!)
42 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
7.2 Principal Conclusions for Practice & Policy
1.HL has to be monitored regularly for purposes of diagnosis of problems /
deficits and evaluation of interventions
2.Limited health literacy has to be tackled by policy and practice in a
systematic and sustainable way, adapted to regional differences
3. Interventions have to be directed at improving personnel competences of
individuals and groups by measures of education and training (for users and
providers)
4.Equally, if not more important are interventions directed at improving user
friendliness. (transparency, readability, navigability) of systems, services
and products
5.To effectively tackle inequalities, specifically designed programs oriented at
improving equity are needed.
6.For supporting vulnerable groups specific compensatory, empowering
measures (especially in health care/by health professionals) are mandatory.
43 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
7.3. The Health Literate Organization „A health literate
organization makes
it easier for people
to navigate,
understand, and use
information and
services to take care
of their health.”
(Brach et al. 2012)
44 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
8. REFERENCES
45 Pelikan, Jürgen M., 2013, The Impact of Health Literacy on Health, Tallinn, Estonia, 7th June 2013
8. References Brach, C., Keller, D., Hernandes, LM., Baur, C., Parker, R., Dreyer, B., Schyve, P., Lemerise, AJ., Schillinger, D. (2012): Attributes of Health
Literate Organization, Discussion Paper, Institute of Medicine of the national academies.