Digital health literacy: how new skills can help

improve health, equity and sustainability

POLICY
PRÉCIS

This Policy Précis takes stock of recent developments in the field of digital health literacy and
what it means for health equity. It also looks at promising practices from our members on the
ground and how further progress can be made across Europe.

The Situation
Digital health literacy is an essential element for
the successful transformation of health and care Digital health literacy “is the ability to seek,
systems, but it is vital to ensure that no-one is left find, understand, and appraise health information
behind. Digitally health literate people can more from electronic sources and apply the knowledge
actively manage personal health and care. This in gained to preventing, addressing or solving a health
turn can also have positive effects on the efficiency problem”. 1
and sustainability of health systems. Better digital
health literacy can lead to enhanced prevention
models, better observance of healthier behaviours cultural, and societal factors.5 Complex evaluation
and improved wellbeing.2 and regulation is slow to keep pace with innovation
and societal changes. With few fixed guidelines for
Digital health literacy and equity are closely linked. implementation and assessment, there are risks as
People lower along social gradients tend to have well as benefits. Enabling an effective and equitable
higher disease burdens and health needs, yet transition requires actions from health and other
they are more vulnerable regarding access to and systems; digital innovation by states and societies as
understanding of health information.3 They may be well as companies; development of public services
less aware of issues of privacy, health data use, and and professionals; and broader education, social
data protection4 and are also more likely to experience inclusion and social justice improvements.
digital exclusion. Increasingly health information is
collected, disseminated and transformed through The World Health Organization (WHO)7 is increasingly
online platforms, including websites and social paying attention to digital health literacy, with
media, forums, or blogs. This raises new challenges publications such as the important first WHO
regarding the quality and reliability of the platforms Guideline Recommendations on digital interventions
and information, including the issue of a misleading for health system strengthening (2019) and Digital
marketing. technologies: shaping the future of primary health
care (2018).
Effective and equitable digital transformation in
health is vital for modern systems and empowering Other important sources are UNICEF’s approach to
citizens and patients. But current digital health tools digital health8 and Health literacy for people-centred
often insufficiently account for varying abilities and care: where do OECD countries stand?9.
wrongly assume that all users are homogenous. Digital
health literacy is shaped by economic, environmental,

THE PUBLICATION OF EUROHEALTHNET POLICY PRECIS IS SUPPORTED BY THE EUROPEAN COMMISSION,

THROUGH THE PROGRAMME FOR EMPLOYMENT AND SOCIAL INNOVATION (EASI 2014-2020). THIS PUBLI-
CATION DOES NOT NECESSARILY REFL ECT THE POSITION OR OPINION OF THE EUROPEAN COMMISSION EuroHealthNet
EuroHealthNet
EUROPEANEUROPEAN
PARTNERSHIP FOR IMPROVING
PARTNERSHIP FOR IMPROVINGHEALTH, EQUITY
HEALTH, EQUITY & WELLBEING
& WELLBEING
 Digital Health Ecosystem
eHealth governance mHealth
National, regional and global eHealth Medicine and public health supported by mobile devices
coordination tools such as mobile phones, patient monitoring devices, and
other wireless devices

Electronic health records Digital health literacy

Set of skills, knowledge, and attitudes that a
Information on the health of every patient
person needs in order to develop functionally in
recorded in digital format
the Information Society

Standards and interoperability

Communication between different
technologies and software application, using Social networks
standards for the effective, accurate and Use of social networks in health promotion
reliable exchange and use of data

Telehealth and telemedicine Big data

Health services delivery using ICT, especially where Use of unconventional data for decision-making in
distance is a barrier to receiving health care public health

Source: WHO6

Following up
EuroHealthNet is working with Partners across Europe to develop a new Guide on Investments for Health
Promotion (forthcoming, 2019) to help build capacities and increase innovative implementation, including
for digital health literacy.

EU Policies and jj The European Commission to digital health literacy as the

Communication on Enabling the medium to ensure accessibility,
Programmes digital transformation of health decrease inequities and reduce
In the EU eHealth Action Plan and care in the Digital Single barriers.14
(2012–2020) increasing digital Market; empowering citizens and
health literacy is listed among one building a healthier society (2018). EU educational policies have
The more detailed “Working
of the measures aiming to support indicated links between digital
Document” accompanying this
the wider deployment of eHealth Communication endorses the literacy and health; but so far the
strategies.10 A more specific and recommendation of improving term ‘digital health literacy’ is not
up to date strategy is needed from digital health literacy to facilitate extensively or fully used:15
the new European Commission, access to healthcare in a fair and jj The Communication on A new
with clear resources dedicated inclusive way.12 skills agenda for Europe (2016)
via the next Multiannual Financial outlines the benefits of education
jj The European Commission
Framework 2021-27. Digital health and training, including through
Recommendation Paper on
literacy is also mentioned in Patient Access to Electronic digital advances in health and
more recent EU actions, but with Health Record Information (2018) care systems.16
insufficient emphasis: promotes more awareness-raising jj The Report on Improving Policy
jj EU Council Conclusions on Health activities on digital health literacy and Provision for Adult Learning
in the Digital Society (2017) to help citizens to acquire skills to in Europe (2015) recognises that
highlight the importance of digital understand and appraise data.13 digital skills are key to reducing
and health literacy in designing jj The advisory report of the EU social inequality, increase
and implementing digital tools Expert Panel on effective ways of inclusion, cohesion and active
to avoid creating further health investing in Health Assessing the citizenship and improving mental
inequalities and ensure quality Impact of Digital Transformation and physical health.17
and safety of the services.11 of Health Services (2018) refers
 POLICY
PRÉCIS

Pathways to Progress
Work in 2019 with our expert and responsible Partners has led to recommendations that should be urgently
and systematically developed and implemented at all levels. We recommend the following:

Policy
jj An EU Joint Action of Member States and experts 5G mobile technologies, to reduce risks of exacerbating
on improving digital health literacy for all, as part geographical, social and economic determinants of
of a comprehensive implementation strategy and digital health literacy inequities.
plan within the EU Digital Strategy with funds from
programmes including ESF+, Horizon Europe, and
InvestEU. Public
jj That citizens and specific user groups throughout the
jj That digital health literacy is a component towards life course are systematically and inclusively involved
universal delivery of the UN Agenda 2030 and in the transparent co-creation, design, planning,
Sustainable Development Goals, with metrics and implementation and evaluation of digital health and
targets in the EU and WHO Europe 2030 plans and care system and services.
the EU Semester for Economic and Social Policy
Co-ordination. jj That education and training for all throughout life
includes strengthening competences and systematic
Protections updates to improve health literacy, including the impacts
of changing commercial, technological and policy
jj That health equity impact assessments are determinants.
implemented in public and private practices, with
common frameworks and guidelines including digital
health literacy issues. Professionals
jj That training across health professions is improved
jj That EU regulations are brought forward on how on digital health and wellbeing developments and
digital literacy is upheld, for example through search the key components of digital health literacy. This
engines and in specific health systems components. includes people in the wider public health workforce
jj That digital tools and services are more inclusively
of associated professions including, carers, educators,
developed with precautionary protections concerning cultural and ancillary service workers. Training should
sensitive health data. include capacity building for objective trainers, not only
from digital providers and advocates.

Practices jj That providers of digital health services are required

jj A new information and guidance hub for promising
to demonstrate their knowledge and competences in
and evaluated practices via the EU Steering Group for relevant fields as a precautionary part of the innovation
Promotion and Prevention, with an equity focus. and assessment process, including their commitment to
an improvement in digital health literacy.
jj That digital health literacy is considered as a core
part of multi-sectoral actions at all levels, from
international to local.
jj That access for all is prioritised in provision and
upgrading of necessary infrastructures, for example

www.eurohealthnet.eu • [email protected]
Making it Happen
EuroHealthNet Members and Partners are taking action. Here are just three examples among many:

The Netherlands
Pharos, the Dutch Centre for both public and private sectors. As part of the
of Expertise for Health Norwegian Youth Health Strategy, the Health
Disparities is involved Directorate facilitates health literacy through
in the Acceleration digital information and help services among young
Programme for Patient people. This has resulted in the project DIGI-UNG21,
and Professional which coordinates and develops digital services for
Information Exchange adolescents aged 13 to 20 years, with a focus on
(VIPP).18 This programme facilitates development of healthcare and school health services. The platform
online portals to allow patients to access their own also includes services regarding access to education,
medical data. Pharos collaborates with hospitals, the job-market, and help from child welfare services.
rehabilitation centres and similar institutions19 Insights indicate that young people seek tailored,
to ensure that online portals are developed in an reliable and relevant digital services based on their
inclusive way. It uses a panel of less literate people life realities, plus simpler access to public services
to test and improve services for accessibility, user- online.
friendliness and comprehensibility. Knowledge and
best practices on development and implementation Portugal
strategies to support accessible online portals are
collected and shared. Pharos has also developed a The Directorate General
‘4 steps to eHealth4All’ working model which not of Health (DGS), launched
only develops comprehensible and easy to use digital the Serviço Nacional
tools but also enables local partners in prevention de Saúde 24 (SNS 24)
22

and care to implement digital tools within local in 2017, as part of the
infrastructures.20 government 2020 strategies
and healthcare system
Norway reforms, with a specific focus
on strengthening digital
The National Health health literacy across the
Directorate supports population. The main objective of SNS 24 is to serve as
policies that promote single access point for health information. It is a free
participation from online and telephone service that provides first-hand
all citizens across health information and responds to enquiries 24/7.
age, gender, ethnic SNS 24 provides advice and guidance on a range of
background, social health behaviours as well as enabling users to book
economic status vaccinations. It offers services that allow people to
and levels of health solve health-related issues without having to go
literacy. The universal design of information and to a primary care service or hospital. The platform
communication technology is a legal requirement is accessible across a range of devices and aims to
support users in plain and simple language.
EuroHealthNet is the European Partnership for Health, Equity and Wellbeing. We are active in policy, practice and research.
Our unique focus is on reducing health inequalities through action on the social determinants of health, integrating sustainable
development goals, and contributing to the transformation of health systems. The main members of the partnership are authorities
and statutory bodies responsible for public health, health promotion and disease prevention at national, regional and local level.
For further information and references visit www.EuroHealthNet.eu.

Published: September 2019

THE PUBLICATION OF EUROHEALTHNET POLICY PRECIS IS SUPPORTED BY THE EUROPEAN COMMISSION,

THROUGH THE PROGRAMME FOR EMPLOYMENT AND SOCIAL INNOVATION (EASI 2014-2020). THIS PUBLI-
CATION DOES NOT NECESSARILY REFLECT THE POSITION OR OPINION OF THE EUROPEAN COMMISSION.
EuroHealthNet
EUROPEAN PARTNERSHIP FOR IMPROVING HEALTH, EQUITY & WELLBEING

www.eurohealthnet.eu • [email protected]
FOOTNOTES
1. Definition adapted from https://www.who.int/global-coordination-mechanism/ 13. https://ec.europa.eu/digital-single-market/en/news/recommendation-
working-groups/digital_hl.pdf european-electronic-health-record-exchange-format
2. https://www.pifonline.org.uk/wp-content/uploads/2018/05/Gill-Rowlands- 14. https://ec.europa.eu/health/expert_panel/sites/expertpanel/files/docsdir/022_
presentation-2-May-2018.pdf digitaltransformation_en.pdf
3. Liobikienė, G., & Bernatonienė, J. (2018). The determinants of access to 15. For example, “Supporting people across Europe in gaining the skills and
information on the Internet and knowledge of health related topics in European competences needed for personal fulfilment, health, employability and social
countries. Health Policy, 122(12), 1348-1355. inclusion helps to strengthen Europe’s resilience in a time of rapid and profound
change” means supporting also digital skills
4. https://rjh.goingeast.ca/2016/12/07/critical-digital-health-literacy/
16. https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52016
5. http://ec.europa.eu/information_society/newsroom/cf/dae/document. DC0381&from=en
cfm?doc_id=5170
17. https://cdn4.fpfis.tech.ec.europa.eu/epale/cdn/farfuture/z4aiXacxARSd
6. https://www.who.int/global-coordination-mechanism/working-groups/digital_ KaZHuR7Cnty_YDPohi-JRWr2KjXPooc/mtime:1457602691/sites/epale/files/
hl.pdf wg_al_2015_final_report_final_.pdf
7. http://www.euro.who.int/en/health-topics/Health-systems/pages/news/ 18. https://www.vipp-programma.nl/over-vipp
news/2019/2/what-you-need-to-know-about-digital-health-systems
19. The Leiden University Medical Center (LUMC), the IJsselland Hospital (Capelle
8. https://www.unicef.org/innovation/reports/unicefs-approach-digital- aan den IJssel) and the St. Antonius Hospital (location Utrecht).
health%E2%80%8B%E2%80%8B
20. https://www.pharos.nl/e-healthweek-2019/
9. https://www.oecd-ilibrary.org/social-issues-migration-health/health-literacy-
for-people-centred-care_d8494d3a-en 21. https://www.helsedirektoratet.no/rapporter/ungdomshelse-i-en-digital-verden/
Ungdomshelse%20i%20en%20digital%20verden%20(DIGI-UNG%20del%201).
10. https://ec.europa.eu/digital-single-market/en/news/ehealth-action-plan-2012- pdf/_/attachment/inline/e3016f1c-fd0f-4990-80cf-f97ac8742968:0c16037004a
2020-innovative-healthcare-21st-century 34de79c595b1e2da16dc4ee85b632/Ungdomshelse%20i%20en%20digital%20
11. https://eur-lex.europa.eu/LexUriSer v/LexUriSer v.do?uri=OJ:C:2017: verden%20(DIGI-UNG%20del%201).pdf
440:0003:0009:EN:PDF 22. https://www.sns24.gov.pt/en/
12. https://ec.europa.eu/digital-single-market/en/european-policy-ehealth