The efficiency of health systems relies to a large extent on the way they are perceived, understood, and trusted, as well as on the accessibility of the services they offer, whilst ensuring respect for human rights. Those elements are greatly affected by people’s health literacy. Limited health literacy is closely related to adverse health outcomes whereby health literacy becomes a critical social determinant of health. This has an impact on the use of health services, health costs and the ways in which people engage with the health system. Despite investments in health services, many people are often not supported in accessing, understanding, appraising, and applying information to navigate complex health systems and environments.

European health systems face a range of challenges, including reductions in funding, ageing populations, increased immigration, cultural diversity, personnel shortages, waiting lists for patients, managed care, home care, long-term care, the growing use of technology and digital health services and tools, and health threats. The COVID-19 pandemic has clearly shown that health literacy is a matter of public concern. Health literacy is highly content- and context-related and it relates to low-income, medium-income and high-income countries alike.


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