Global health literacy plans and actions by the governments

Peter Chang1, Kristine Sorensen2
1Taiwan Association for Health Literacy and Communication; International Health Literacy Association; Chung-Shan Medical University (Taiwan;
2 Global Health Literacy Academy; International Health Literacy Association (Denmark;

Health literacy has been of great attention to many professionals and academics, and shown to play more significant roles in healthcare organizations. However, there have been great variations in the degrees of attentions and supports as well as the approaches by the governments around the world. The study aims to identify and compare the governmental actions and achievements in a global scale and to provide the comparisons in between.

A survey to understand the extent of illiteracy among American youths as assessed by a test specially constructed as part of the Health Examination Survey during 1966-70 was one of the earliest health literacy study by the Department of Health and Human Services in the USA (1). Later in 2003, the 2003 National Assessment of Adult Literacy (NAAL) was the first large-scale national assessment in the United States to contain a component designed specifically to measure health literacy – the ability to use literacy skills to read and understand written health-related information encountered in everyday life. The NAAL health literacy component also established a baseline against which to measure progress in health literacy in future assessments (2). In Europe, the England National Health Service (NHS) concluded in its survey that between 43% and 61% of English working age adults routinely do not understand health information and a financial cost of 3% to 5% of the annual UK health budget. It addressed the importance of improving population health literacy, together with increasing system and practitioner awareness of the challenges faced by people with lower levels of health literacy, was an absolutely vital pre-cursor to achieving in its chapter two of the “Five Year Forward View”, and the emerging Supported Self Care program in particular (3). In one of the champions for health literacy in Europe, The Netherlands by its Legislation Patient rights laid down in legislation on informed consent, which obliged health care providers to provide proper understandable information and to get the patient’s approval before treatment. In 2011, Netherlands’ National Health Council produced an advice for the Minister of Health with regard to tackling low literacy in the health sector, which the minister promised to implement. This was to further strengthen the position of vulnerable patients and their legal right with regard to informed consent. The Ministry of Health supported the health literacy activities as part of equity in health approach, but leaves actual implementation to the stakeholders in the field (4). Many other countries in Europe also addressed the issues in the governmental levels actively, including Denmark (5) and Germany (6), the later, recently, was under the patronage of the Federal Ministry of Health with funding from the Robert Bosch Foundation and the Federal Association of the AOK and launched in 2018 as the National Action Plan Health Literacy (7).

In Europe in general, a report “Study on sound evidence for a better understanding of health literacy in the European Union” provided an update on the general overview of the efforts by the Europe Union member States (8), that “in most countries health literacy is just starting being addressed through policies or activities”. On the other hands, challenges were addressed “though health literacy is on the agenda in most of the EU Member States, in many countries the efforts are not coordinated through a policy at the most appropriate level”. “A more programmatic and evidence-based policy to health literacy in individual EU Member States and further exchanges of knowledge and best-practices at EU level could be beneficial with regard to the outcomes of these efforts” are recommended. However, Europe has taken the lead in addressing the issue, evidenced by the serious works of the World Health Organization Europe, in the works of “Health literacy, the Solid Facts” (9) and recently “Investing in health literacy POLICY BRIEF 19 What do we know about the co-benefits to the education sector of actions targeted at children and young people?” (10).

On the other hands, Australia has taken more serious and solid steps in addressing health literacy in its national program (Chapter 4.3) “Health literacy can influence how much and how effectively people do this. It has two major components (ACSQHC 2014a): Individual health literacy is about a person’s ability to access, understand and apply health information; for example, to complete health care forms or navigate the health care system, and the health literacy environment describes the infrastructure, people, policies and relationships of the health care system. Aspects of the health literacy environment include patient referral pathways, coordination of care, and hospital design”. There are also Initiatives to improve health literacy addressed by the “Commission and Healthdirect Australia”, which developed ‘Question builder’, an online tool for patients to prepare for a medical appointment, and allowed patients to select questions they want to ask at the appointment and prepare for questions the doctor may ask them. The Commission also released ‘Top tips for safe health care’, a booklet that provides information about what people should consider when interacting with the health system, such as finding good information, asking about care after leaving hospital and giving feedback (11, 12). Another active player in Asia Taiwan has demonstrated significant interest in health literacy researches and practices in the past few years. The governmental body Health Promotion Administration in the Ministry of Health and Welfare also positively supported as a powerhouse of various health literacy programs: “approximately 51.6% of adults have insufficient and limited health literacy; 30% to 50% of adults have difficulty in mastering health information”, and has “put the promotion of health literacy in people as an important national policy, established a health literacy integration resource center, planned to accomplish the national action plan in the end of 2019, and built a supportive environment to strengthen the skills of health service providers as well as develop guidelines of friendliness health literacy materials”(13). Thailand government was also demonstrated as one of the champions in South East Asia (SEARO) for health literacy in national program since early 2000. The ThaiHealth also made efforts in the “establishment of the QLF by ThaiHealth as a stand-alone statutory agency” as “a strong and practical systematic engagement with education as one of the major social determinants of health”. As addressed “The QLF is addressing health literacy, but even more directly relating to a key social determinant of health,..”(14). The Philippines is another new head up to its national program initiated by the Philippine Statistics Authority (PSA) which approved National Health Literacy Survey (NHLS), as a project of the Health Promotion and Communication Service of the Department of Health (DOH) in cooperation with the Philippine Council for Health Research and Development in late 2018 (PCHRD; 15). Another active player in health literacy would set Israel one of the best examples. Israel with its high literacy rates, with its 2020 developmental goals including health literacy (16), as well as aims in its hospitals.

The survey study in health literacy will continue to collect, analyze, and compare the governmental plans and actions across the globe and to illustrate better practices and policies in perspectives by the governments around the world. The details will be provided in the 7th AHLA Conference and updated in future manuscripts.

*no conflict of interest declared.


(1) Vital Health Stat 11. 1973, 131:1-35.

(2) Orthop Nurs. 2009; 28(1): 27–34.










(12) Top tips for safe health care. Sydney: ACSQHC. Viewed 18 December 2017.