Can numeracy and literacy fill the health gaps of Europe?

health europeProfessor Helmut Brand, president of the European Health Forum Gastein (EHFG), Jean Monnet Professor of European Public Health and head of the Department of International Health at Maastricht University, The Netherlands. He serves on the European Advisory Committee on Health Research (EACHR) of WHO Europe and on the Expert Panel on “Investing in Health” (EXPH) for the European Commission.

Europe is undergoing a period of profound demographic change. Populations are ageing, fertility patterns are changing, modern living has impacted our habits, and consequently, there is an increasing prevalence of people living with one or more chronic disease. Cases of diabetes, for example, are expected to rise from 58.9 million cases in 2015 to 71.1 million by 2040. Today over 10 million people are living with dementia in Europe and it is set to double by 2050. All the while, governments struggle to manage health care spending as much of the continent recovers from the damaging global recession and faces a rising cost of treatments.

With so many potential stumbling blocks for European health systems, can we all truly access quality care?

I say we can. Demographics do not define Europe’s destiny. By proactively considering the challenges and seizing opportunities for new approaches to health care, we can influence our health outcomes for the better. A key lesson for individuals and governments alike: we stand to learn a lot from our neighbours. Working together, we can avoid reinventing the wheel, and promote a better understanding of health care at individual and community level to support health systems as a whole.

Mind the gap: measuring health system performance

Though each country starts from its own context and its health system serves a unique population, most have a similar end goal: well-equipped, efficient and sustainable health system to meet the needs of all citizens.  As such, there is value to be derived from measuring how well countries are doing against comparable health indicators.

This is already well underway. In the recent report “So What?”, prepared by the European Commission Expert Group on Health System Performance Assessment (HSPA), the OECD, the World Health Organisation Regional Office for Europe and the European Observatory on Health Systems and Policies, the authors state: “Countries often benchmark with other countries. Whilst the challenges involved in these comparisons are well known, it is also evident that information deriving from international comparisons can provide the basis of further scrutiny and a deeper comprehension of the policies required to improve the status quo.”

Platforms such as the European Union and the OECD offer an excellent means by which governments can share where they are succeeding and where there are gaps. Which prevention tactics are effective in reducing childhood obesity? How can we improve outpatient care for the elderly? Particularly pertinent as government resources are challenged in keeping up with demographic change, this exchange of best practices can facilitate sound strategies for quality health interventions.

Such cross-border collaboration is also the objective of the annual European Health Forum Gastein (EHFG), taking place on 28-30 September. This year’s conference theme, Demographics and Diversity in Europe, places the focus on what new solutions for health one country can learn from the other, to better respond to demographic trends.

Close the gap: accelerating health literacy in Europe

Health literacy, the competence to understand and apply information to make decisions for health care, disease prevention and health promotion, remains a public health challenge in Europe. In the most recent publication of Health Promotion International, I discuss together with colleagues research that demonstrates health literacy on this continent is still at its infancy.

The ability for an individual and their community to be fully informed and engaged in their own care is a necessary step in tackling the burden of chronic diseases in Europe. Take diabetes for example. The HSPA report examines the incidences of hospital admissions for diabetes patients across Europe. Such acute deterioration in the health– such as cardiovascular, renal and neurological complications – is traumatic for patients, expensive for health systems, and often, avoidable.


An effective primary health care system should be capable of implementing a baseline of access to quality health care that prevents the emergence and progression of many major chronic diseases. But to respond to rising populations and limited health system resources, we must also strengthen what is below primary care – community level care. The more each patient, carer, and member of a community is empowered and involved in their own health care delivery and the greater the health literacy amongst the population, the better.

As highlighted by the European Patient’s Forum, empowered patients are part of the healthcare team, crucial for the performance of health care systems. This concept was explored in depth at last year’s EHFG, and is a discussion that will continue to be of pertinence to the Forum for the foreseeable future. A key recommendations of HSPA’s reports states: “In future, greater attention should be given to the assessment of patient experiences, such as patient reported experiences and patient reported outcomes. Health care in most countries is still not sufficiently patient-centred, despite the patients’ participation being increasingly emphasised in recent decades.”

Learning from our neighbours, whether they be neighbouring countries or neighbouring members of the community, will help us keep up with the health care demands of demographic change.

Useful links

Health at a Glance: Europe 2014

Slow growth in health spending but Europe lags behind (OECD Health Statistics, 2015)

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