🔍💡 Health literacy and human rights: Nearly half of Europeans struggle to understand health information, which constitutes a violation of fundamental rights. The Council of Europe is publishing a roadmap to transform health systems and ensure equitable access to information for vulnerable populations.
🔍➕ RELEVANCE ON THE GROUND
This strategic report from the Council of Europe is essential for public health, social care, and prevention professionals as it demonstrates how low health literacy constitutes a violation of human rights that perpetuates inequalities. It provides a concrete operational framework to transform health institutions into "literacy-competent" organisations, with targeted recommendations for eight vulnerable populations (Roma, homeless people, disabled individuals, migrants, LGBTI people, prisoners, elderly people, youth). The document offers a political roadmap applicable to the 46 European member states, integrating intersectoral governance, accountability mechanisms, and scientifically validated anti-stigma interventions.
Source: Promoting health literacy and human rights to reduce stigma and discrimination
📜🔗LINK
1. ANALYTICAL SUMMARY
Health literacy as a human rights imperative in the face of structural inequalities
In Europe, between a third and half of the adult population struggles to access, understand, evaluate, and use health information, which compromises self-care, access to care, prevention, and health promotion (p. 6). This gap is not evenly distributed: it is concentrated among people facing financial insecurity, low levels of education, the elderly, and individuals from immigrant or minority backgrounds, reflecting a social gradient that reinforces existing health inequalities (p. 6). The document establishes that health literacy is not merely a public health concern, but a fundamental human rights imperative, as its deficit disproportionately impacts vulnerable individuals and violates their right to health protection enshrined in the revised European Social Charter (Article 11), the European Convention on Human Rights (Articles 2, 3, 8), and the Oviedo Convention on Human Rights and Biomedicine (p. 6, 8).
A European roadmap to transform health systems
In light of the scale of the problem - particularly revealed during the COVID-19 pandemic where countries with better health literacy achieved better compliance and vaccination rates (p. 6) - the report proposes a political roadmap structured around seven strategic levers: establishing a binding European commitment on health literacy; operationalising rights through national action plans; developing targeted anti-stigmatisation initiatives for eight vulnerable population groups (Roma/Sinti/Travellers, homeless people, disabled people, migrants, LGBTI people, detainees, elderly people, young people); transforming health institutions into "health literacy competent organisations"; strengthening intersectoral governance; building rigorous accountability and monitoring mechanisms; bridging the digital divide (p. 27-30). The document emphasises that health literacy is not just an individual capacity but the product of an interaction between personal capabilities and systemic factors such as the quality of education, the complexity of the health system, the accessibility of information, the cultural competence of providers, and socio-economic conditions (p. 13-14).
2. KEY POINTS OF THE DOCUMENT
1. Health literacy as a potential violation of human rights and an issue of social justice
The report establishes an innovative conceptual framework by repositioning health literacy not as an individual deficit, but as a systemic responsibility requiring coordinated action from governments, health systems, educational institutions, and civil society (p. 10). When equitable conditions that allow everyone to access, understand, evaluate, and use health information are absent, the burden is shifted onto individuals, and those already in vulnerable situations are disproportionately affected (p. 8-9). The document demonstrates that when a Romani woman cannot understand prenatal care instructions due to language barriers and discrimination, when a detained person is denied access to mental health information, or when an elderly person cannot navigate digital health platforms, their right to health protection guaranteed by Article 11 of the European Social Charter is threatened (p. 12).
2. The conceptual framework "Health Stigma and Discrimination Framework" applied to health literacy
The document draws on the framework of Stangl et al. (2019) to analyse how low health literacy, based on triggering and facilitating factors, can be perceived as a marking leading to the experience and practice of stigma with harmful consequences (pp. 18-20). The model identifies several intervention points where health literacy can directly reduce stigma and discrimination: by addressing triggers (replacing fear-based beliefs with an accurate understanding of risks); by interrupting manifestations of stigma (for affected individuals, better personal literacy can reduce self-stigma); by improving access, engagement, and outcomes (making systems, information, and procedures more navigable); by addressing intersectional stigmas through multi-level action (pp. 18-20).
3. Differentiated analysis of eight vulnerable populations with identification of specific vulnerabilities
The report presents a detailed analysis of how stigma and low health literacy mutually reinforce each other for eight population groups (p. 21-26). For Roma/Sinti/Traveller communities: systematic discrimination, transience disrupting continuity of care, distrust of health systems, language barriers, demands for informal payments, segregated health facilities (p. 21). For homeless individuals: residential status as a barrier to accessing services, lack of a fixed address preventing registration, extreme poverty limiting access to information, physical and mental complexity, social stigma and discrimination by providers, competing survival priorities (p. 22). For disabled individuals: physical barriers to facilities, sensory barriers to information (visual, auditory), cognitive processing challenges, social isolation, behavioural discrimination by providers (p. 22-23). Data reveals that 41% of Roma have experienced discrimination in healthcare over a five-year period, their life expectancy is 5 to 15 years lower than the general population, and vaccination coverage remains 30 to 50% lower (p. 11).
4. The three progressive levels of health literacy according to Nutbeam's model
The document presents the model by Professor Don Nutbeam which describes three progressive levels of health literacy reflecting increasing autonomy and empowerment (p. 13-14). Thefunctional health literacyrefers to basic reading and writing skills that enable individuals to understand health information and navigate healthcare environments. Theinteractive health literacyinvolves more advanced cognitive and social skills, enabling individuals to actively engage with healthcare professionals, apply information in changing circumstances, and participate in shared decision-making. Thecritical health literacyrepresents the highest level, encompassing the ability to critically analyse information, understand the social determinants of health, and undertake individual or collective action to improve health conditions.
5. The significant economic and social costs of low health literacy
The report documents the scale of the problem with numerical data: low health literacy is associated with a 3 to 5% increase in healthcare spending due to avoidable hospitalisations, medication errors, and excessive use of emergency services (p. 11, 14). In Germany, 58.8% of adults have limited health literacy; in Denmark, between 8.8% and 20.2% of individuals perceive specific tasks related to understanding written health information as difficult or very difficult, with the lowest scores concentrated among low-income individuals, those with low education, living alone, or of non-Danish ethnicity (p. 8). In Italy, approximately 40% of respondents have inadequate or problematic health literacy, with these lower levels being strongly associated with precarious financial situations, foreign nationality, older age, and unhealthy lifestyles such as physical inactivity and smoking (p. 8). Gaps in digital health literacy affect about 40% of the population, with older adults and rural communities being the most affected (p. 11).
3. ACTION POINTS FOR LOCAL STAKEHOLDERS
1. Implement a self-assessment approach for organisations competent in health literacy
All health and public health establishments should adopt certification as "Organisations Competent in Literacy" aligned with internationally recognised standards (p. 29). This transformation includes leadership commitment, integration of health literacy into strategic planning, training for all staff, simplified navigation systems, patient engagement in governance, systematic use of plain language and teach-back methods, accessible multilingual communication formats, community partnerships, and continuous quality improvement. Local stakeholders can rely on the Council of Europe's Health Literacy Guide (reference 29) and the standards developed by Brach et al. (2012) defining the attributes of a health literacy competent organisation (reference 28, p. 29). Use the self-assessment checklist aligned with the 10 attributes of a health literacy competent organisation to audit current practices and develop a quality improvement plan.
2. Develop targeted anti-stigma interventions for specific populations in your area
The report details specific interventions by population (p. 28-29). For homeless individuals: eliminate fixed address requirements for health service registration, develop mobile and shelter-based care models, integrate health navigators with lived experience, create integrated care pathways, train providers to combat stigma, establish flexible appointment systems, develop materials in plain language aligned with survival priorities, and implement continuity of care protocols between regions with explicit legal protections against discrimination based on residential status. For older adults: targeted training in digital literacy, large print and audio information standards, medication reviews using teach-back methods, and intergenerational support programmes. For young people: comprehensive health literacy programmes in schools, training in resilience against digital misinformation, mental health literacy programmes reducing stigma, and meaningful participation in health policy design (p. 29).
3. Create or strengthen community health mediator networks for marginalised populations
For Rom/Sinti/Traveller communities, the document specifically recommends the expansion of community health mediator networks, the implementation of anti-discrimination training addressing entrenched stereotypes, the elimination of segregated facilities and informal payment practices, and the launch of public awareness campaigns to counter harmful narratives (p. 28). For migrants and refugees: ensure professional interpretation services in all care contexts, develop multilingual resources covering the vast majority of migrant languages, train staff in trauma-informed care, and establish legal protections guaranteeing access regardless of documentation status (p. 28). Local actors can use the approach of trained health mediators who act as cultural and linguistic bridges between communities and health services.
4. Establish local intersectoral governance with dedicated budget lines
Health literacy cannot be confined to health ministries. National inter-ministerial councils should coordinate actions between health, education, social affairs, justice, and digital sectors, supported by dedicated budget lines and impact assessments on health literacy for major policies (p. 29). At the local level, create intersectoral steering committees including public health, social services, national education, local authorities, user associations, and representatives of the affected populations. The document emphasises the formal integration of civil society into governance structures through consultation mechanisms, co-production requirements, and dedicated funding for community-led initiatives (p. 29). Stakeholders can rely on the German model presented by Schaeffer et al. (2020) on the implementation of the National Health Literacy Action Plan with a collaborative approach based on workshops with stakeholders (reference accessible via supplementary research).
5. Systematically integrate the reduction of the digital divide into all local strategies
Digital health literacy must be addressed as an urgent infrastructure priority (p. 30). The document recommends: universal digital literacy programmes in primary care, technology support centres for seniors in municipalities, simplified voice-activated health applications, mandatory digital accessibility standards, a hybrid service delivery model preserving non-digital options, community technology centres, and digital mediator training programmes. Digital gaps affect approximately 40% of the European population, with older adults and rural communities being the most affected (p. 11). Local actors must absolutely maintain non-digital care pathways alongside technological innovations to ensure equitable access.
4. ADDITIONAL REFERENCES
🔍➕ For more information, see the articles referenced by "Health Practices" on the topic of health literacy ➡️🔗https://pratiquesensante.odoo.com/1-4-litteratie-en-sante-falc
1. M-POHL (2021). International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19)
https://m-pohl.net/sites/m-pohl.net/files/inline-files/HLS19%20International%20Report.pdf
This report presents the results of the European health literacy survey conducted in several countries, providing baseline data and standardized assessment methodologies essential for measuring progress at national and local levels.
2. Council of Europe (2023). Guide to Health Literacy
https://www.coe.int/en/web/human-rights-and-biomedicine/guide-to-health-literacy
Operational guide from the Council of Europe providing principles and practical tools for integrating health literacy into health systems, with a focus on human rights-based approaches and the inclusion of vulnerable populations.
5. CROSS-ANALYSIS — VALUES OF HEALTH PRACTICES
Literacy:The document proposes a comprehensive conceptual framework distinguishing functional, interactive, and critical health literacy (p. 13-14), as well as the concept of organisations competent in literacy using plain language, multiple formats, active support such as interpreters and mediators, and co-design with communities to reduce complexity (p. 14).
Empowerment:Beneficiaries are conceptualised not as mere consultees but as active participants in health decision-making, policy design, and service delivery (p. 10), with an emphasis on developing individual and collective capacity to recognise discrimination, use complaint mechanisms, and engage in rights-based advocacy (p. 19-20).
Participation:The report formally requires the integration of civil society into governance structures through consultation mechanisms, co-production requirements, and dedicated funding for community-led initiatives (p. 29), with co-design requirements ensuring that vulnerable populations participate in the development of health literacy materials (p. 28).
Community health:The collective dimension is explicitly integrated through the recommendation to establish community health mediator programmes in regions with vulnerable populations (p. 27-28), formalised community partnerships (p. 29), and an approach recognising that population health literacy reduces the triggers of stigma (fear, blame, misinformation) while organisational health literacy reshapes environments so that stigma is neither reproduced nor rewarded (p. 21).
Ethics:Cultural and social biases are identified and systematically addressed, with the document explicitly denouncing the stigmatising labels that frame Roma as "unhygienic" or "non-compliant", homeless individuals as "irresponsible" or "drug addicts", disabled people as "incapable" or "dependent", migrants as "burdens" or "carriers of disease", LGBTI individuals in sexual and gender diversity as "deviant", detainees as "criminals" or "undeserving", elderly people as "fragile" or "technologically incompetent", and young people as "irresponsible" or "immature" (p. 21-26).
Human rights:The approach rigorously respects the principles of equity and inclusion by anchoring the analysis in three binding legal instruments: the revised European Social Charter (Article 11 establishing a direct right to health protection), the European Convention on Human Rights (Articles 2, 3, 8 protecting health indirectly through fundamental rights such as life, dignity, and privacy), and the Oviedo Convention on Human Rights and Biomedicine (ensuring ethical governance based on human rights in medicine and biomedicine) (p. 6, 8).
Intersectorality:The document explicitly recommends national inter-ministerial councils coordinating health, education, social affairs, justice, and digital sectors, supported by dedicated budget lines and health literacy impact assessments for major policies (p. 29), as well as at the level of the Council of Europe, a sustainable health literacy project accompanied by an annual forum, technical assistance mechanisms, and targeted research funding.
Partnership:Models of collaboration are formalised through the requirement for community partnerships as an attribute of organisations competent in literacy (p. 29), the expansion of community health mediator networks (p. 28), and the obligation for member states to periodically report on gaps, interventions, and measurable outcomes in health literacy (p. 27).
Combating discrimination:The document systematically identifies the discrimination experienced by the eight population groups: for the Roma, discrimination in 41% of cases over five years with requests for informal payments, segregated housing, and denial of treatment (p. 11); for homeless individuals, structural barriers such as the requirement for a fixed address and social stigma from service providers (p. 22, 28); for disabled individuals, inaccessible formats, unclear information about patient rights, and inadequate communication practices (p. 11, 22-23). Non-judgment and diversity are explicitly taken into account through the requirements for annual mandatory training in cultural competence for care providers, inclusive LGBTI standards in all public facilities, and gender-sensitive programming addressing reproductive health, violence, and autonomy (p. 28).
VIGILANCE POINTS IN ANIMATION
Risks of emotional triggering
The document addresses several sensitive themes that may provoke strong emotional reactions among participants:
Experienced discrimination and stigma:Detailed descriptions of experiences of discrimination in healthcare (41% of Roma having experienced discrimination over five years, p. 11; denial of treatment, segregated services, informal payment demands, p. 21) may resonate painfully with professionals or volunteers who have themselves experienced or observed discrimination, or with individuals from affected communities. Implicit testimonies of homeless individuals described as "irresponsible" or "drug addicts", of disabled individuals treated as "incapable", of LGBTI individuals facing "denials of gender-affirming care" or "heteronormative assumptions" (p. 21-26) can trigger personal or professional trauma.
Vulnerability and systemic powerlessness:The analysis of situations of extreme vulnerability (detained individuals with "restricted access to health information", p. 24; elderly individuals with "exclusion from decision-making", p. 25; young people "highly neglected as rights holders in their own health", p. 25) can generate a sense of powerlessness among professionals faced with rigid systems that they cannot always change. The mention that "when these [equitable] conditions are absent, the burden is shifted onto individuals, and those already in vulnerable situations are disproportionately affected" (p. 9) can create guilt among professionals who recognise that they have inadvertently contributed to these mechanisms.
Institutional failures and professional responsibilities:The document explicitly identifies stigmatising practices within health institutions: "disdainful attitudes, failure to provide interpreters or accessible formats, segregated services, or policies that implicitly exclude those without stable housing or legal status" (p. 9). For professionals working in these institutions, this analysis can generate a difficult confrontation with their own practices or those of their colleagues, creating discomfort, defensiveness, or moral distress.
Recommendations for respectful facilitation
Before the facilitation:
Clearly announce the sensitive themes that will be addressed (discrimination, stigma, vulnerabilities)
Remind of the framework of non-judgment and confidentiality
Identify available support resources (resource persons, withdrawal spaces if necessary)
During the facilitation:
Prioritise a systemic approach rather than a blame-oriented one: emphasise that the document aims to transform systems and not to blame individuals
Use the "Health Stigma and Discrimination Framework" (p. 18-20) to objectify the mechanisms and move away from moral judgement
Plan moments for breathing and decompressing, particularly after presenting the eight vulnerable populations
Value existing practices and levers for action rather than focusing solely on failures
Allow the expression of emotions (frustration, anger, sadness, helplessness) in a contained and respectful framework
Regularly remind of concrete recommendations and operational entry points to empower action
After the facilitation:
Allow time for a debriefing that enables participants to express their feelings
Propose concrete action pathways tailored to the context of each participant to transform emotion into commitment
Direct towards complementary resources and professional support networks
The document, although containing difficult findings, offers a constructive and emancipatory roadmap that can transform the initial emotion into energy for collective action and systemic change. The challenge of the facilitation is to maintain this balance between critical lucidity and empowering the actors.
6. EVALUATION OF THE RELIABILITY OF THE RESOURCE
Scientific relevance:The document presents excellent scientific reliability with 51 bibliographic references covering recent academic literature (2012-2026), including robust methodological sources (Stangl et al. 2019 for the stigma-discrimination framework, Sørensen et al. 2012 for the conceptual model of health literacy, Nutbeam 2000 and 2008 for levels of literacy), validated data from European population surveys (European Health Literacy Survey, national surveys in Germany, the Netherlands, Denmark, Italy), reports from leading international organisations (WHO, European Union Agency for Fundamental Rights), and publications in peer-reviewed journals (BMC Public Health, European Journal of Public Health, Health Promotion International). The author, Kristine Sørensen, is internationally recognised in the field of health literacy. The document explicitly mentions the use of AI Perplexity for linguistic editing and analytical support, demonstrating methodological transparency (p. 2).
Operational relevance:The report presents exceptional direct usability in the field with recommendations structured around seven operational axes, detailed specific interventions for eight vulnerable populations with concrete examples (removal of fixed address requirements for homeless individuals, Easy Read standards for disabled people, guaranteed interpretation services for migrants), mentioned self-assessment tools (checklists of the 10 attributes of competent literacy organisations), certification standards for competent literacy organisations aligned with international standards, and a multi-level governance framework specifying the responsibilities of member states, the Council of Europe, local health institutions, and civil society. The document incorporates a systemic approach recognising that health literacy results from the interaction between personal capacities and systemic factors, shifting the responsibility from "fixing individuals" to "transforming systems" (p. 9, 13-14).
7. Multiple Choice Questions — 5 QUESTIONS
Question 1: What proportion of the adult European population has inadequate health literacy according to the data mentioned in the document?
a) Approximately 15 to 20%
b) Approximately 20 to 30%
c) Approximately one third to half
d) Approximately 60 to 70%
Question 2: What are the three progressive levels of health literacy according to Professor Don Nutbeam's model presented in the report?
a) Basic literacy, intermediate literacy, advanced literacy
b) Functional literacy, interactive literacy, critical literacy
c) Individual literacy, collective literacy, systemic literacy
d) Passive literacy, active literacy, transformative literacy
Question 3: What percentage of the interviewed Roma have experienced discrimination in healthcare over a five-year period according to the European Union Agency for Fundamental Rights?
a) 21%
b) 31%
c) 41%
d) 51%
Question 4: Among the following recommendations for homeless people, which is explicitly mentioned in the document?
a) Create health centres dedicated exclusively to homeless people
b) Eliminate fixed address requirements for registration with health services
c) Develop specific health mobile applications
d) Increase the number of psychiatric hospital beds
Question 5: According to the document, what proportion of the European population is affected by gaps in health digital literacy?
a) Approximately 20%
b) Approximately 30%
c) Approximately 40%
d) Approximately 50%
COMMENTED CORRECTION OF THE MCQ
Question 1: What proportion of the adult European population has inadequate health literacy according to the data mentioned in the document?
✅ Correct answer: c) Approximately one third to half
📝 Explanation:The document clearly states in the executive summary and the introduction that "health literacy in Europe is constrained by the fact that a substantial proportion of the population, often estimated to be around one third to nearly half of adults, has limited abilities to access, understand, evaluate, and apply health-related information" (p. 6). This estimate is corroborated by the data from the European Health Literacy Survey mentioned on page 11, which reveals that "almost half of Europeans have inadequate health literacy, with significantly higher rates among low-education populations, older people, and migrants." —Source: p. 6, 11
Question 2: What are the three progressive levels of health literacy according to Professor Don Nutbeam's model presented in the report?
✅ Correct answer: b) Functional literacy, interactive literacy, critical literacy
📝 Explanation:The document explicitly presents Professor Don Nutbeam's model which "describes three progressive levels of health literacy reflecting increasing autonomy and empowerment" (p. 13-14). Functional health literacy refers to basic reading and writing skills that enable individuals to understand health information and navigate healthcare contexts. Interactive health literacy involves more advanced cognitive and social skills that allow individuals to actively engage with healthcare professionals and participate in shared decision-making. Critical health literacy represents the most advanced level, encompassing the ability to critically analyse information, understand the social determinants of health, and undertake individual or collective action to improve health conditions. —Source: p. 13-14
Question 3: What percentage of the interviewed Roma have experienced discrimination in healthcare over a five-year period according to the European Union Agency for Fundamental Rights?
✅ Correct answer: c) 41%
📝 Explanation:The document specifically cites research from the European Union Agency for Fundamental Rights documenting that "41% [of Roma] experienced discrimination in healthcare over a five-year period, including requests for informal payments, segregated facilities, and refusals of treatment" (p. 11). This statistic is also mentioned in the context of analysing Roma, Sinti, and Traveller communities facing systematic structural marginalisation, with a life expectancy 5 to 15 years lower than the general population and vaccination coverage 30 to 50% lower. —Source: p. 11, 21
Question 4: Among the following recommendations for homeless people, which is explicitly mentioned in the document?
✅ Correct answer: b) Eliminate fixed address requirements for registration with health services
📝 Explanation:The document specifically recommends for homeless individuals "the elimination of fixed address requirements for registration [with health services], mobile and shelter-based care models, health navigators with lived experience, integrated care pathways, anti-stigma training for providers, flexible appointment systems, plain language materials aligned with survival priorities, continuity of care protocols across regions, and explicit legal protections against discrimination based on residential status" (p. 28). The fixed address requirement is identified as a major structural barrier because "unstable housing, poverty, and survival priorities make it difficult to register for primary care, keep appointments, or securely store medications and documents" (p. 15, 22). —Source: p. 15, 22, 28
Question 5: According to the document, what proportion of the European population is affected by gaps in health digital literacy?
✅ Correct answer: c) Approximately 40%
📝 Explanation:The report clearly states that "gaps in health digital literacy further exacerbate exclusion, affecting approximately 40% of the population, with older adults and rural communities being the most affected" (p. 11). This statistic highlights the importance of the document's recommendations to bridge the digital divide, including universal digital literacy programmes in primary care, technology support centres for seniors in municipalities, simplified voice-activated health applications, mandatory digital accessibility standards, and crucially, a hybrid service delivery that preserves non-digital options to ensure equitable access (p. 30). —Source: p. 11, 30
8. FREQUENTLY ASKED QUESTIONS (FAQ)
1. What is health literacy and why is it considered a human rights issue?
Health literacy refers to the ability of individuals to access, understand, evaluate, and apply health information to make decisions regarding healthcare, disease prevention, and health promotion (p. 13). It is considered a fundamental human rights issue because its deficit disproportionately impacts vulnerable individuals and violates their right to health protection as enshrined in the revised European Social Charter (Article 11), the European Convention on Human Rights (Articles 2, 3, 8), and the Oviedo Convention (p. 6, 8). When health systems do not create equitable conditions for everyone to access and use health information, they shift the burden onto already vulnerable individuals, thus constituting a violation of states' obligations as duty bearers under international human rights law (p. 8-9, 11-12).
2. What is the difference between individual health literacy and organisational health literacy?
Individual health literacy concerns the knowledge, motivations, and skills of individuals to process health information, while organisational health literacy refers to how institutions design their structures, processes, and communication so that individuals can easily find, understand, and use health information and services (p. 14). Instead of placing the responsibility solely on individuals to be "health literate", organisational literacy asks whether hospitals, clinics, public health agencies, and social services create navigable environments for everyone, including those with limited literacy, language barriers, disabilities, or social vulnerabilities. Organisations competent in literacy engage their leadership, staff training, communication materials, digital tools, and physical spaces towards clarity, accessibility, and inclusion, using plain language, multiple formats, active support, and co-design with communities (p. 14, 29).
3. How do stigma and discrimination concretely affect the health literacy of vulnerable populations?
Stigmatisation operates at several interconnected levels: stereotypes involve negative generalisations (assuming that Roma are non-compliant or that elderly people are technologically incompetent), prejudice refers to the negative attitudes and emotional reactions built on these stereotypes, and discrimination is the behavioural expression of stigma, such as refusing services, providing lower quality care, excluding people from essential health information, or using coercive practices (p. 17-18). These forms of discrimination directly hinder the development of health literacy and the effective exercise of health rights. For example, for Roma communities, stigma manifests through segregated services, disdainful communication, and a lack of culturally appropriate information, leading to delays in seeking care, reduced use of preventive services, and persistent distrust of institutions (p. 21). For disabled individuals, it manifests through inaccessible consent forms, lack of sign language interpretation, absence of easy-read materials, and exclusion from shared decision-making (p. 22-23).
4. What are the concrete recommendations for transforming my health facility into a "health literacy competent organisation"?
The document recommends that all health and public health institutions adopt certification as "Health Literacy Competent Organisations" aligned with internationally recognised standards (p. 29). This transformation includes eight key components: management commitment with integration of health literacy into strategic planning; training all staff in health communication skills; simplified navigation systems with clear signage and streamlined patient pathways; patient engagement in institutional governance; systematic use of plain language and teach-back methods (having individuals rephrase to check understanding); accessible multilingual communication formats including visual, audio, and easy-to-read materials; formalised community partnerships with user organisations and vulnerable communities; continuous quality improvement with regular evaluation of health literacy practices and outcomes (p. 29). Use the self-assessment checklist aligned with the 10 attributes of a health literacy competent organisation to audit current practices and develop a quality improvement plan (information from supplementary research).
5. How can I adapt my health communications for people with low literacy?
The document recommends several validated approaches: systematically use plain language with short sentences, common words, a clear structure, and avoid medical jargon (National Action Plans should require that essential health information be provided in plain language with an appropriate reading level, p. 27-28); offer multiple formats including visual aids (pictograms, infographics), audio (recordings, voice messages), video, and interactive digital formats; translate essential materials into minority languages spoken by more than 5% of the regional population (p. 28); systematically use the teach-back method, which involves asking individuals to rephrase in their own words what they have understood to verify actual comprehension (p. 29); develop materials in "Easy Read" for individuals with intellectual disabilities or comprehension difficulties, with specific standards mentioned for disabled individuals (p. 28); co-design materials with target populations to ensure their cultural and linguistic relevance (p. 28).
6. What anti-stigma interventions have demonstrated their effectiveness according to the document?
The document is based on the Health Stigma and Discrimination Framework by Stangl et al. (2019), which identifies that the best interventions operate at multiple levels (pp. 18-20). At the trigger level: strengthen the health literacy of the population and professionals to replace fear-based beliefs with an accurate understanding of risks, challenge causal attributions that blame individuals by making social determinants and treatment effectiveness visible, equip health professionals with evidence, communication skills, and rights-based standards so that quality and safety concerns are managed by protocols rather than discriminatory practices. At the manifestation level: for affected individuals, develop personal health literacy to reduce self-stigmatisation by helping them understand their condition, available treatments, and rights; for communities and frontline staff, structured health literacy interventions such as dialogues, peer education, and co-designed materials to challenge stereotypes and prejudices. At the outcome level: make systems, information, and procedures more navigable so that individuals anticipating or experiencing stigma have clear and safe pathways to care; support shared decision-making and teach-back approaches that affirm dignity and agency (pp. 18-20).
7. How can I contribute to advocacy for health literacy policies at the local or national level?
The document provides several advocacy levers based on the legal obligations of states: relying on existing legal instruments by recalling that the revised European Social Charter (Article 11), the European Convention on Human Rights (Articles 2, 3, 8), and the Oviedo Convention establish binding obligations to guarantee the right to health protection, which includes effective access to health information (p. 6, 8, 27); advocating for the adoption of National Health Literacy Action Plans with a rights-based approach covering availability, accessibility, acceptability, and quality, with dedicated budget lines and annual reports to the Council of Europe (p. 27-28); demanding accountability mechanisms including biennial European Health Literacy Survey with oversampling of vulnerable populations, national indicators integrated into health information systems with equity-stratified reports, and public dashboards ranking the performance of member states (p. 29-30); mobilising civil society by demanding formal integration into governance structures through consultation mechanisms, co-production requirements, and funding dedicated to community-led initiatives (p. 29); using economic data showing that low health literacy is associated with a 3-5% increase in health spending due to avoidable hospitalisations (p. 11, 14) to convince decision-makers of the value of investment.
9. REWRITING IN EASY TO READ AND UNDERSTAND (FALC)
What is this document?
This document talks about health literacy.
Health literacy is understanding information about health.
The document is written for the countries of Europe.
What is the problem?
In Europe, nearly half of adults do not understand health information well.
These people struggle to:
Read a medical document
Understand what the doctor says
Know which medications to take
Choose the right health service
Why is it serious?
Not understanding health information is a serious problem.
It is against human rights.
Everyone has the right to protect their health.
But if you do not understand the information, you cannot take care of yourself properly.
Who is most affected?
Some people have more difficulties:
Roma, Sinti and Travellers
Homeless people
Disabled people
People from another country
LGBTI people
Prisoners
Elderly people
Young people
These people face discrimination.
Discrimination is when someone is treated poorly.
For example, a doctor who refuses to treat someone.
What does the document propose?
The document provides solutions to improve the situation.
Solution 1: Change hospitals and health centres
Hospitals must become "literacy competent organisations."
This means:
Using simple words
Provide information in multiple languages
Train staff to communicate better
Listen to patients
Solution 2: Train healthcare professionals
Doctors, nurses and other professionals need to learn:
To speak simply
To respect everyone
Not to discriminate
Solution 3: Help people who are struggling
For homeless people, we need to:
Remove the requirement to have an address to register
Create mobile care that comes to them
For elderly people, we need to:
Help them use digital tools
Also keep services without computers
For people who do not speak the language well, we need to:
Have interpreters
Translate important documents
Solution 4: Make laws
Governments must:
Create laws to guarantee the right to information
Ensure that health services comply with these laws
Publish reports every year
What can frontline professionals do?
If you work in health or social care, you can:
Use simple words when explaining something
Ask the person to repeat in their own words to check they have understood
Create easy-to-read documents with images
Working with organisations that know vulnerable people
Training your entire team to communicate effectively
Why is it important?
Understanding health information is a right.
It is important for:
Proper self-care
Preventing illness
Living healthily
When everyone can understand, everyone can better protect themselves.
It is good for each individual.
It is good for society as a whole.