The integral role of health literacy in health promotion in times of polycrisis

In these times of polycrisis, the role of health promotion is as important as ever for empowering families, communities, organizations and societies. Polycrisis, understood as the convergence of a global health pandemic, economic challenges, environmental and climate issues, political and cultural/geopolitical conflicts, amplifies the complexities individuals face in accessing, understanding, processing, appraising and applying/utilizing information and resources, especially in the area of health. The social and economic impacts of polycrisis (1) across different populations result in, and enhance existing, inequalities in health. There is no better time than now to recognize the role of health literacy in health promotion at all levels as a vehicle for empowerment. The ability to make informed decisions regarding health behaviors, preventive measures and access to healthcare services becomes paramount. In this editorial, we explore the vital role of health literacy in health promotion during polycrisis, highlighting its significance in empowering individuals, fostering community resilience and addressing the unique challenges posed by overlapping crises.

Health literacy as a determinant of health

Whether as a social determinant of health or as a mediator of the effects of social determinants of health, health literacy association with health and well-being has been increasingly acknowledged based on a wealth of research (2). Important policy statements such as the World Health Organization Shanghai Declaration on Promoting Health in the 2030 Agenda for Sustainable Development recognize health literacy as one of the three pillars of health promotion, alongside good governance and the role of cities and communities for health (3). National and international surveys for well over a decade (4) have demonstrated the social gradient with regard to health literacy particularly concerning socio-economic issues (5). Health literacy initiatives in times of polycrisis should address these disparities, ensuring that information and relevant services reach vulnerable populations and are tailored to their specific needs. Additionally, numerous studies have shown that there is a need to address mental health literacy as well as promoting the use of preventative health services among people with lower levels of health literacy (6).

Health literacy and health crises

In the context of the COVID-19 pandemic, the role and contribution of health literacy in health promotion was evident early on (7) for empowering individuals, communities and organizations. Yet, in the early stages of the crisis there was a lack of attention given to, and a dearth of resources allocated for, health promotion action within national action plans for health crisis preparedness. Health promotion action in general, and more specifically a focus on health literacy, was often not evident (8). Amidst the complexities of overlapping crises, empowerment is crucial for individuals and communities to make informed decisions about their health and seek health services needed. In times of crisis, the most vulnerable populations often suffer more than others, leading to the understanding that health literacy may play an important role as a social vaccine (9). Polycrisis often bring about heightened uncertainty and anxiety. In such situations, health literacy acts as a tool for empowerment, providing individuals with the skills to understand, critically evaluate and apply health information to their unique circumstances. As such, health literacy is a resource for increasing resilience and strengthening coping mechanisms.

Advocating and action for promoting health literacy

In light of all above, the role of advocacy for health literacy in health promotion is paramount. Thus, in revising the 2018 IUHPE Position Statement on Health Literacy – Towards a Vision of a Health Literate World, IUHPE shows its commitment to promoting health literacy on a number of levels (10) to achieve health, well-being and equity.

This Statement, developed by the IUHPE Global Working Group on Health Literacy, ratified by the IUHPE Executive Board in October 2023, was revised to respond to global developments, including crises, since first released in 2018. These include: the COVID-19 pandemic, non-communicable diseases, growing populism in infomedia and misinformation, planetary health needs, the threat to some long-standing democracies, global health policy opportunities, broad expansion of coordinated measurement initiatives and research, digital health, and AI breakthroughs and challenges (11). The statement highlights increased attention given to evidence-based intervention, expanded organizational interest in health literacy, particularly in health and educational systems including relevant stakeholders, growing international collaboration and more.

The Statement also reflects a natural paradigm shift from the focus on personal health literacy to include collective and organizational structures with a systemic approach. Thus, in the revised Statement, the updated definition of Health Literacy is used: ‘Health literacy represents the personal competencies and organizational structure, resources and commitment which enable people to access, understand, appraise and use information and services in ways which promote and maintain good health’ (12).

As such, the 2023 Position Statement advocates for a systems approach to health literacy action in a number of key areas: 1. health literacy and health promotion policy, acknowledging systems approaches and organizational health literacy; 2. evidence-based interventions including tailoring health communication; 3. promoting health literacy measurement and research supported by necessary resources; 4. building capacity in the workforce including training and empowering stakeholders, particularly in health-promoting settings, as well as supporting civil society to be active participants in their well-being (13).

To note, the revised IUHPE Position Statement on Health Literacy is designed for practical use and is aligned with the IUHPE Strategic Plan of 2021–2026 and other recent advocacy initiatives by IUHPE, namely the Position Statement on Planetary Health Promotion and Indigenous World Views and Knowledge (14).

Communities, primary care and relevant organizational stakeholders are coming to the forefront even more than in the past for the role they play in co-producing health and well-being (15), as is seen in the original research article in this issue of Global Health Promotion by Kılınç and colleagues entitled ‘Public health literacy in primary users in western Turkey’. Their findings show that in Turkey ‘public health literacy’ needs to be given priority in order to tackle challenges that affect local and global health (16).

There are still many challenges to confront and many others are on the close horizon. While we are diligently working towards achieving digital health literacy, leaving no one behind, let us not forget the value of the rich and deeply-rooted ancestral wisdom that underpins health action and promotion in so many cultures (17). Furthermore, when we embrace the settings approach for health promotion, we can conceptualize a coordinated ‘supersetting approach’ where multiple settings work in synergy with each other to promote health and health literacy (18).

Conclusion and way forward

In times of polycrisis, health literacy emerges as a critical determinant of individual, community and societal well-being. The challenges posed by overlapping crises necessitate a comprehensive approach to health promotion that integrates health literacy strategies, embedded within organizations. By tailoring communication, promoting digital health literacy, engaging communities, addressing mental health concerns and tackling socio-economic disparities, societies can build a resilient and health-literate population capable of navigating the complexities of polycrisis. As health promotion continues to evolve, acknowledging and addressing health literacy in the context of polycrisis is essential for fostering a healthier and more informed, empowered global community.

As mentioned by Iago and colleagues in their original research article in this issue of Global Health Promotion entitled Health Literacy, Coping with Pandemic among Leisure Time Monitors’, health literacy is more important than ever in the face of these global health threats, which have impacted all levels of the social-ecological model, including individual health behaviors, family relationships, organizational behavior, state policy-making, mortality statistics and the international economy in the space of a few months and even weeks (19).

In terms of dealing with polycrisis, we may be headed for a state of chronic polycrisis, in which case health literacy research, action and policy will fill a need to accommodate this new norm. Health literacy is one of the fundamental building blocks for a resilient society, empowering individuals, stakeholders, organizations and societies by investing in well-being and health equity.