Direktion für Entwicklung und Zusammenarbeit DEZA Health ...Direktion für Entwicklung und...

Eidgenössisches Departement für auswärtige Angelegenheiten EDA Direktion für Entwicklung und Zusammenarbeit DEZA

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Health Literacy in Switzerland Erika Placella, SDC Health Advisor

WHO GCM/NCDs WG 3 - 2016-2017, Geneva, 27th-28th February 2017

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Towards a Health Literacy concept

In 2005, Swiss Federal Office of Public Health started a conceptual and strategy process on Health Literacy (HL).

In 2007, Federal government adopted the "e-Health-Strategy Switzerland» in which HL is central as regards the electronic medical record.

2 studies (2006, 2016) carried out by MSD and Picker Europe on HL: economic study on HL and HL survey.

HL is central in the Health 2020 Strategy (2013): increasing self-competence in health issues, empowering insurees and patients and increasing their involvement in health policy, improving self-management skills, reinforcing individual responsibility and equality of opportunity, etc.


HL is one of the key health promotion pillars to achieve

agenda 2030 adopted by Switzerland.

In line with the Shanghai Declaration, Switzerland recognizes that HL is a critical determinant of health and promotes focused investments in its development; supporting potential “best buys” on HL interventions.

Switzerland recognizes that HL is founded on inclusive and equitable access to quality education and life-long learning.

Switzerland recognized the role of HL measurement, including HL surveys, to enhance HL responsiveness.


HL is a cornerstone of the National Strategy for Prevention of NCDs (2017–2024).

Dimensionen der Gesundheitskompetenz


Health Literacy 2015 Population Survey in Switzerland

Aiming at measuring what is the extent of the problem of limited HL in Switzerland.

Findings: problem of insufficient HL in Switzerland is broad but not deep: a relatively large number of residents have problematic HL (45%). 9% have inadequate HL. 10% have excellent HL, and 35% adequate HL.

Problematic HL is a more frequent occurrence in Switzerland than in most HLS-EU countries.


Source: Health Literacy 2015 Population Survey in Switzerland


Assessing and understanding information about disease prevention, especially with regard to vaccinations.

Assessing the advantages and disadvantages of treatment options (44% very or fairly difficult) and whether a second opinion should be obtained (35%).

Understanding the information on food packaging (37%).

Assessing the trustworthiness of information about diseases or health risks in the media (39% each).

Finding information about the health implications of policy changes (47%).

Where do the greatest problems regarding HL lie in CH?


Finding information about the health promoting effects of people living environment (35%).

Following the instructions of doctors and pharmacists (10%), understanding instructions on how to take medicines (10%) and following them (11%).

Calling an ambulance in an emergency (10%).

Finding information about support options with regard to unhealthy behaviour or information about health-promoting behaviour (12% each).

Costs associated with low HL have been estimated at 3%-5% of the annual costs for health.


The strongest driver of low HL is financial deprivation.

People who rarely or never exercise have lower HL.

Individuals with supplementary outpatient insurance on average have higher HL than those without.

With increasing age, people tend to have lower HL. Many middle-aged individuals, meanwhile, have problematic HL.

As the level of education increases, HL increases as well.

Women have higher HL than men.

Migrant background has only a weak influence on HL.

Which groups are particularly affected by inadequate HL?


Individuals with lower HL get significantly less exercise than individuals with higher HL.

Individuals with lower HL tend to have a higher likelihood of suffering from one or more long-term illnesses.

The lower an individual's HL, the more likely he/she is to have been hospitalized or to have used emergency services.

Number of visits to the doctor tends to increase with increasing HL.

Individuals with low HL are more likely to be smokers. The same does not apply to alcohol consumption, which tends to be lower with lower HL.

What are the consequences of inadequate HL in CH?


Strategies to address problems identified by HL 2015 survey under development, with 2 strategic orientations :

1) Reduce the % of people with low HL • Assuring greater accountability, enhancing education system • Enhancing access to more clear and understandable

information; revitalizing the social campaigning approach. • Empowering consumers and patients organizations,

mobilizing health leagues, Cantons (lead) and Media. • Making a health portal available (Austria, Germany)?

2) Optimize health system • Education and training of health literacy professionals. • Foster HL at health institutions level (patient electronic-file). • Central role of FOPH in connecting institutions.

Preliminary Action Lines to address HL in CH


At individual level

Providing information and monitoring: addictions monitoring (NCDs), Système de monitorage alimentation et activité physique (MOSEB).

Supporting information platforms, especially for persons speaking a foreign language (i.e. www.migesplus.ch/)

Campaigning: Alcohol and tobacco prevention (www.smokefree.ch), Organ donation (www.Leben-ist-teilen.ch) HIV/STI-Prevention (www.lovelife.ch).

Connecting stakeholders, fostering public debate, collaboration and exchange of best practices (Dialogue «Politique nationale de Santé», Cantons involvement).

Current FOPH Initiatives

http://www.migesplus.ch/





http://www.smokefree.ch/





http://www.leben-ist-teilen.ch/









http://www.lovelife.ch/






At institutions and health professionals level

Medical education (incl. CME): maintaining the register of medical professions, working closely with universities, regulation bodies, professional organizations, cantonal authorities, providing information on law on medical professions.

Support to health institutions and hospitals, i.e. in the field of transcultural competencies: “Swiss Hospitals for Equity», www.hospitals4equity.ch/index.php/en/home-en, or E-Learning Tool, www.elearning-iq.ch (migrants)

Support to people living with chronic diseases, www.evivo.ch/web/evivo-fr/home

Health coaching, http://www.gesundheitscoaching-khm.ch/en/patients/what_is_health_coaching

http://www.hospitals4equity.ch/index.php/en/home-en











http://www.elearning-iq.ch/







http://www.evivo.ch/web/evivo-fr/home








http://www.gesundheitscoaching-khm.ch/en/patients/what_is_health_coaching











Health Promotion Switzerland (Foundation) plays also an important role in HL, as regards national prevention and health promotion campaigns.

Other Current HL-related initiatives in Switzerland


Swiss Alliance for Health Literacy and Competence

Swiss Society for Public Health, Swiss Medical Association, Health Promotion Switzerland, MSD and Careum Foundation created the Swiss Alliance for Health Literacy and Competence in 2010.

Coordination platform aiming at improving framework conditions (incl. at regulatory level) to increase HL of population in order to positively influence its determinants of health, evaluate the risks and navigate through health system more autonomously.

Fostering intersectoral collaboration and synergies between health stakeholders and other actors (academic institutions, research, education system, economy, politics and media).


Switzerland collaborates with Germany, Austria,

Luxembourg and Lichtenstein, on HL (WG).

Projects and activities

Illiteracy program in collaboration with the Swiss Federation Lire et Ecrire.

Promotion of HL/competencies in Health. An inventory of activities carried out by Cantons (2011), to better assess to which extent the concept of HL and competencies in Health is understood, defined and implemented (including as regards the regulatory and policy framework) by the concerned stakeholders at canton level, to gather best practices.

Action guide on promoting HL (2016)


HL in 3 domains: treatment, prevention and health promotion.

HL is a transversal issue involving various sectors (health, education, sport) and stakeholders, including the private sector (food and beverage industry, insurance companies, etc.) and civil society.

HL is important for individuals as well as for the entire society.

Life-course dimension of HL.

3 levels of HL: functional, interactive and critical competencies.

Strong focus on equity.

Focus on disadvantaged groups (migrants, people with comorbidities, socially and economically disadvantaged).

Key principles defined by the Swiss Alliance for HL and Competence

Semaine de la Prévention du Tabac Ecole des Charmilles, Genève, Décembre 2016

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