🔍💡 Health Literacy: 9 countries show how to transform systems to no longer leave the public distanced from information and care. This equips decision-makers, regional health agencies, and field actors to demand clear, funded, and evaluated policies. #HealthLiteracy #PublicPolicies🧭📊 From slogans to action: this WHO review details how China, Germany, Norway, and Scotland have structured their national health literacy plans, with measurable objectives, governance, and monitoring. A strategic reference for communities, hospitals, and associations. #HealthEquity🔍➕ This report is useful for programme managers, health city workshop coordinators, regional health agency directors, hospitals, and social care structures that want to integrate health literacy into their local plans and contracts. It provides concrete examples of national strategies (measurable objectives, governance, funding, monitoring) that can be transposed into regional or territorial plans. It also highlights the priorities to advocate for in dialogue with decision-makers (leadership, dedicated funding, life-course approach, tackling inequalities)
Source: ✍️ World Health Organization (2025). Integrative Review of National Health Literacy Policy Blueprints as a Tool for Change toward Health Literate Systems 6 Kristine Sørensen; World Health Organization (WHO), Department of Health Promotion, Enhanced Wellbeing Unit
📜🔗LINK
Number of pages: 22 pages (IV + 18)
1. ANALYTICAL SUMMARY
1.1. Context: health literacy as a determinant and political issue
The report reminds us that health literacy is a modifiable social determinant of health, central to individuals' ability to access, understand, judge, and use health information and services for themselves and their loved ones. Population data (particularly the HLS19 survey in 17 European countries) show that at least one third of the population experiences difficulties, with a concentration among individuals with low education levels, financial insecurity, or perceived poor health. The document emphasises the costs associated with low literacy (overuse of emergency services, complications of chronic diseases, lower use of prevention) and the issue of resilience in times of crisis (COVID-19, disasters). It places literacy within a strong international framework (ECOSOC 2009, European strategy “Together for Health”, Political Declaration on UHC 2019, WHO European roadmap on literacy) and notes that, despite these commitments, literacy often remains absent from concrete political dialogue.
1.2. Operational contributions: what national plans reveal
The study identifies and compares nine national blueprints: action plans, strategies, frameworks or declarations from Australia, China, Germany, New Zealand, Norway, Portugal, Scotland (United Kingdom) and the United States. It describes for each country the political origin, the actors involved, the structuring of objectives, the monitoring mechanisms, and the emphasis placed on equity and the organisation of services. A cross-sectional analysis highlights six structural requirements: political leadership, a bilateral population/organisations approach, a resource-based rather than deficit-based approach, a life course perspective, horizontal integration across multiple sectors, and dedicated funding. The report finally proposes implications for member states: to strengthen the measurement of literacy, develop explicit national plans, support organisational literacy, and secure funding for training, interventions, and their evaluation.
2. KEY POINTS OF THE DOCUMENT
The report demonstrates that health literacy is recognised as a modifiable social determinant of health and a condition for equity, resilience, and sustainability of systems, but is still poorly translated into concrete policies in most countries [file:1, p.1–4].
Nine national plans or frameworks meeting strict criteria (national level, government mandate, explicit focus on health literacy) are identified: China, the United States, Australia, Scotland, New Zealand, Germany, Norway, Portugal, and a new Australian framework currently under consultation [file:1, p.6–12].
Blueprints generally combine the measurement of literacy, prioritisation of vulnerable audiences, actions on organisations (communication, information, services) and multi-actor governance mechanisms including ministries, agencies, civil society and sometimes users [file:1, p.6–12].
The cross-cutting analysis highlights strong convergences: the importance of clear leadership, a positive vision of literacy as a resource, a lifelong approach, intersectoral cross-cutting and dedicated funding for training, tools and evaluations [file:1, p.13–17].
The report concludes that the rise of health literacy on political agendas remains fragile, that it depends on alliances between researchers, practitioners and decision-makers, and that lessons learned from pioneering countries should be used to structure new national and local plans [file:1, p.15–18].
3. ACTION POINTS FOR LOCAL ACTORS
Integrate health literacy as an explicit objective in local contracts (CLS, CPTS, establishment projects, medico-social CPOM) by drawing inspiration from the clear formulations of national plans, particularly regarding equity, user participation and access to comprehensible information [file:1, p.2–4, 6–8, 10–11].
Develop organisational literacy actions in hospitals, health centres, social centres and medico-social structures by using the described principles (making services easier to understand and use, reviewing materials, signage, reception procedures) and mobilising the cited resources (toolkits, attributes of 'health literate' organisations) [file:1, p.1–2, 4, 8–11].
Strengthen the local measurement of literacy needs (simple questionnaires, qualitative indicators) by drawing on the population-based approaches presented (HLS19, national surveys) to better target disadvantaged groups: individuals with low educational levels, in financial hardship, in perceived poor health, or distanced from digital technology [file:1, p.2–3].
Build territorial health literacy coalitions involving health services, local authorities, associations, schools, and social structures, similar to the multi-stakeholder processes described in American, Australian, or Norwegian plans (workshops, consultations, working groups) [file:1, p.7–8, 10–11, 16–17].
Advocate to decision-makers (elected officials, ARS, supervisory bodies) for the inclusion of budget lines dedicated to health literacy (training for professionals, adaptation of materials, mediation, evaluation), relying on data regarding additional costs associated with low literacy and on scenarios of gains for health systems [file:1, p.2–3, 16–18].
4. ADDITIONAL REFERENCES
🔍➕ For more information, see the articles referenced by "Health Practices" on the topic of literacy ➡️🔗https://pratiquesensante.odoo.com/1-4-litteratie-en-sante-falc
WHO. Health literacy. Geneva, World Health Organization, information sheet regularly updated (consulted 2025–2026). This document synthesises concepts, types of literacy, and global policy directions, and usefully complements the national examples in the report.https://www.who.int/news-room/fact-sheets/detail/health-literacy
Batterham RW et al. Building health literacy system capacity: a framework for health literate systems. Health Promotion International, 2021. This article proposes an operational framework to strengthen the capacity of systems to integrate health literacy, which is very useful for translating the lessons from the WHO review into organisations.https://pmc.ncbi.nlm.nih.gov/articles/PMC8672927/
WHO. Health literacy development for the prevention and control of noncommunicable diseases. 4-volume set, 2022. This series details approaches and tools for integrating health literacy into NCD policies and programmes and offers methodological and thematic supplements to the analysed report.https://www.who.int/activities/improving-health-literacy
5. CROSS-SECTIONAL ANALYSIS — VALUES OF HEALTH PRACTICES
Literacy: the document highlights clear definitions, emphasises the need for understandable information, and showcases existing tools (surveys, resources, 'health literate' organisational approaches), but does not provide practical communication guides in simplified language [file:1, p.1–4].
Empowerment: literacy is conceived as a resource for autonomy and agency, but the direct involvement of beneficiaries in the design or evaluation of policies varies by country and is poorly detailed in the analysis [file:1, p.7–11, 15–17].
Participation: several plans rely on consultations, workshops, town hall meetings, or expert groups, but the co-construction mechanisms with users are mainly described from the perspective of institutions and remain poorly documented in their concrete modalities [file:1, p.7–8, 10–11].
Community health: the collective dimension appears through population-based approaches, action on social determinants, and the mobilisation of civil society, but community-based initiatives (mediation, peers, local networks) are only briefly touched upon [file:1, p.2–3, 6–12, 16–17].
Ethics: the report links literacy, dignity, equitable access, and the fight against stigma, particularly through a resource-based rather than deficit-based approach, but the explicit discussion of cultural or social biases in tools and policies remains limited [file:1, p.1–4, 13–17].
Human rights: health literacy is articulated with the right to the highest possible standard of health, universal health coverage, and international commitments, and the report emphasises the importance of equity and non-discriminatory access to services [file:1, p.1–4].
Intersectorality: the plans analysed mobilise health, education, the social sector, and sometimes environment and work, showing that health literacy is supported by intersectoral partnerships and integrated into other agendas (NCD, digital, environment) [file:1, p.3–4, 6–12, 16–17].
Partnership: the collaboration models involve ministries, agencies, researchers, practitioners, NGOs, and sometimes international networks (M-POHL, IHLA, IUHPE), but the modalities of shared governance and associative steering are not well detailed [file:1, p.2, 5–7, 10–11].
Combating discrimination: the report documents literacy inequalities and recommends approaches targeting marginalised groups, but the explicit dimension of combating discrimination (racism, sexism, etc.) is underdeveloped, being mentioned more in terms of equity and inclusion [file:1, p.2–3, 15–17].
6. EVALUATION OF THE RELIABILITY OF THE RESOURCE
From a scientific perspective, the resource is based on a systematic review of policy documents (search in PubMed, Google, Google Scholar, specific inclusion criteria) complemented by informal consultation with experts and international networks (M-POHL, IHLA, IUHPE) [file:1, p.5]. The references mobilised cover the main international works on health literacy (Nutbeam, Sørensen, Duong, HLS19 studies, cost data, COVID-19 studies), with an updated bibliography including WHO documents from 2021–2022 and policy analyses up to 2023 [file:1, p.1–4, 19].
From an operational perspective, the report provides a solid overview of the choices made in nine pioneering countries, with sufficient details on processes, orientations, and mechanisms to inspire national, regional, or local strategies, even if the concrete tools (grids, checklists, materials) must be sought in the cited national documents or other WHO resources [file:1, p.6–18]. For professionals and field volunteers, it serves as a basis for advocacy and strategic framing rather than an intervention manual, but the identified principles can be directly transposed into territorial diagnostics, action plans, and organisational literacy approaches [file:1, p.13–18].
7. MCQ — 5 QUESTIONS
PART 1 — Questions (without answers)
Question 1 (p.1–2):
In the report, health literacy is primarily defined as:
a) The ability of systems to produce clear messages
b) The knowledge and skills of individuals to access, understand, judge, and use health information and services
c) The general level of educational attainment of the population
d) The ability of professionals to explain treatments
Question 2 (p.2–3):
According to the report, a major effect of low health literacy at the system level is:
a) A systematic increase in user satisfaction
b) A reduction in hospital costs
c) An increase in the use of emergency services and complications from chronic diseases
d) A decrease in social health inequalities
Question 3 (p.6–8):
Among the following countries, which has a national action plan on health literacy according to the analysis?
a) Portugal
b) Switzerland
c) Canada
d) Japan
Question 4 (p.13–14):
Among the identified cross-cutting characteristics of national blueprints, we find:
a) The absence of explicit political leadership
b) A vision of health literacy as a burden to be reduced
c) A bilateral approach acting on both individuals and organisations
d) The systematic exclusion of non-governmental actors
Question 5 (p.16–18):
Among the recommendations of the report to advance health literacy policies, which is highlighted?
a) Limit the collection of data on literacy to reduce costs
b) Focus actions solely on individual skills
c) Develop and implement explicit national strategies with funding and monitoring
d) Replace national plans with one-off communication campaigns
PART 2 — Commented correction
Question 1 (p.1–2):
✅ Correct answer: b) The knowledge and skills of individuals to access, understand, evaluate and use health information and services
📝 Explanation: The report, drawing on the WHO glossary, defines health literacy as a set of personal knowledge and skills, mediated by organisations, that enable individuals to access, understand, evaluate and use information and services to promote their own health and that of others [file:1, p.1–2]. The other options either isolate only the systems (a, d) or confuse literacy with general education level (c).
Question 2 (p.2–3):
✅ Correct answer: c) An increase in the use of emergency services and complications from chronic diseases
📝 Explanation: The report synthesises work showing that low literacy is associated with more frequent hospitalisations, increased use of emergency services, less effective management of chronic diseases, and higher health costs, far from the cost reduction or inequality suggested by other options [file:1, p.2–3].
Question 3 (p.6–11):
✅ Correct answer: a) Portugal
📝 Explanation: Portugal is among the nine identified countries, with a National Health Literacy Plan across the life course, while Switzerland, Canada, and Japan do not meet the criteria set for blueprints in this review [file:1, p.6–11].
Question 4 (p.13–14):
✅ Correct answer: c) A bilateral approach acting on both individuals and organisations
📝 Explanation: The report emphasises the need for a ‘two-sided’ approach: strengthening individuals' skills and transforming organisations to make access, understanding, and use of services easier, breaking away from a vision focused solely on individuals [file:1, p.13–14]. The other proposals explicitly contradict the findings (importance of leadership, resource-based approach, involvement of non-governmental actors).
Question 5 (p.16–18):
✅ Correct answer: c) Develop and implement explicit national strategies with funding and monitoring
📝 Explanation: Among the implications, the report calls for the establishment of clear national strategies, with objectives, governance, funding, measurement and evaluation mechanisms, rather than ad hoc actions or those focused solely on the individual [file:1, p.16–18]. The limitation of data collection or only occasional communication is presented as insufficient.
8. FREQUENTLY ASKED QUESTIONS (FAQ)
What does ‘blueprint’ for health literacy mean in this report?
Answer: It refers to structuring national documents (action plans, strategies, frameworks or declarations) commissioned by a government, explicitly focused on health literacy and covering a range of actions and implementation mechanisms at the national level [file:1, p.5–6].
Which countries currently have national health literacy plans analysed in this report?
Answer: The review identifies China, the United States, Australia, Scotland (United Kingdom), New Zealand, Germany, Norway, Portugal, as well as a developing Australian strategic framework [file:1, p.6–12].
How is health literacy related to social health inequalities?
Answer: The data shows that low levels of literacy are concentrated among people in financial hardship, with low education levels, poor perceived health, or low social status, which reinforces the impact of social determinants and exacerbates inequalities [file:1, p.2–3].
Does the report address organisational literacy and how?
Answer: Yes, it emphasises that health literacy is not solely the responsibility of individuals and acknowledges the concept of organisational literacy, which is the ability of organisations to make their information and services understandable and usable in an equitable manner, citing several existing resources and tools [file:1, p.1–2].
What methods were used to identify national plans?
Answer: The authors conducted a systematic search in three databases (PubMed, Google, Google Scholar) using keywords combining "national", "health literacy" and policy terms, supplemented by targeted web exploration and consultation with experts and international networks [file:1, p.5].
How can this report be used by local or community actors?
Answer: It can serve as a basis for advocacy with decision-makers to include health literacy in regional and local plans, guide the structuring of territorial strategies (objectives, governance, funding, evaluation), and inspire organisational literacy initiatives within health and social structures [file:1, p.13–18].
What are the main limitations identified by the authors?
Answer: The authors highlight the limited number of blueprints meeting the criteria, the absence of formalised plans in many countries, the difficulty in accessing certain documents, and the fact that the results mainly reflect countries that already have strong engagement in health literacy [file:1, p.5, 15–17].
9. REWRITING IN EASY TO READ LANGUAGE
9.1. Easy to read summary
Title of the report
The report is called: "Integrative Review of National Health Literacy Plans".
It discusses how countries help people better understand health.
Why health literacy is important
Health literacy means understanding information about health.
It also means knowing what to do for your health and that of your loved ones.
Many people struggle to understand health information.
This can make care more difficult and more expensive.
Countries therefore need to help individuals and health services.
What the report does
The report looks at nine plans in different countries.
These plans explain how each country wants to improve health literacy.
They talk about objectives, audiences, actions, and organisation.
The report compares these plans to see what works well.
It provides ideas for other countries to also make plans.
9.2. Key points in Easy Read
Idea 1: Health literacy is a health determinant
When people misunderstand health information, they take less care of themselves.
They go to the hospital more often in emergencies.
They use prevention less, such as vaccines or screenings.
Idea 2: Some groups are more disadvantaged
People with little money often have more difficulties.
People with few years of schooling do too.
People who feel unwell are at greater risk.
Idea 3: Organisations also have a role
It is not only up to individuals to make an effort.
Hospitals and services must communicate clearly.
They must write simple documents.
They must help people to ask questions.
Idea 4: Countries can make plans
Nine countries have written plans for health literacy.
These plans outline what to do, who is responsible, and how to track progress.
They aim to reduce inequalities and support vulnerable groups.
Idea 5: What local actors can do
Professionals can simplify their documents.
They can check that people have understood.
Associations can support individuals within the healthcare system.
Decision-makers can allocate money for these actions.