The WHO European Action Network on Health Literacy for Prevention and Control of Noncommunicable Diseases

197 ТОМ 5 | ВЫПУСК 2–3 | ИЮНЬ–СЕНТЯБРЬ 2019 Г. | 123–329ПАНОРАМА ОБЩЕСТВЕННОГО ЗДРАВООХРАНЕНИЯ SHORT COMMUNICATION The WHO European Action Network on Health Literacy for Prevention and Control of Noncommunicable Diseases Oxana Drapkina1, Maria da Graça Freitas2, Bente Mikkelsen3, João Breda4, Eduard Salakhov5, Maria Lopatina1, Andrea Silva da Costa2, Anastasia Koylyu3, Julianne Williams4, Kremlin Wickramasinghe4, Miguel Telo de Arriaga2 1 National Medical Research Center for Preventive Medicine, Moscow, Russian Federation 2 Directorate General of Health, Lisbon, Portugal 3 WHO Regional Office for Europe, Copenhagen, Denmark 4 WHO European Office for the Prevention and Control of NCDs, Moscow, Russian Federation 5 Ministry of Health of the Russian Federation, Moscow, Russian Federation Corresponding author: Maria Lopatina (email ms.lopatina@gmail.com) ABSTRACT The WHO European Action Network on Health Literacy for Prevention and Control of Noncommunicable Diseases (HL-NCD Network) was launched in January 2019 in Lisbon, Portugal, and is currently co-chaired by two countries: Portugal and the Russian Federation. The HL-NCD Network is intended to collate global and national health literacy experiences and scale up health literacy interventions in order to improve the implementation of noncommunicable disease (NCD) prevention and control, and promote health through the life-course. This short communication provides an overview of the goals, objectives, organization, time frame of work and plans for the future of the HL-NCD Network. Keywords: HEALTH LITERACY, NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL, ACTION NETWORK, EUROPEAN REGION BACKGROUND In the WHO European Region, the five major NCDs (diabetes, cardiovascular disease, cancer, chronic respiratory disease and mental disorders) account for an estimated 86% of deaths and 77% of the disease burden (1). Despite the progress achieved by some countries in implementing their commitments for the prevention and control of NCDs, many countries still face significant challenges and much still needs to be done (2). Health literacy provides a  strategic tool for tackling NCDs. Countries are therefore encouraged to implement and scale up actions to strengthen health literacy (2). Despite having a good understanding of what health literacy consists of and good evidence that low health literacy is associated with health inequalities, poor health outcomes and NCDs, there is limited data and guidance for Member States to develop systematic evidence-based interventions to increase health literacy in their populations. The HL-NCD Network aims to scale up health literacy interventions to improve overall population health in the Region. Many Member States of the WHO European Region have already started to implement health literacy policy and interventions. A  recent Health Evidence Network report on health literacy identified 46 existing and/or developing health literacy policies at international, national and local levels in 19 Member States of the Region (36%) (3). The report also found little evidence of health literacy activities and their effectiveness in the lived environment, the media and digital/ e-health literacy, although some of this information may be available when evaluations of current projects are published. A low rate of policy identification through searching the peer- reviewed literature may reflect a lack of engagement in policy evaluation by the academic community. Evidence suggests that low health literacy is associated with worse health outcomes, such as more hospitalizations, greater 198 VOLUME 5 | ISSUE 2–3 | JUNE–SEPTEMBER 2019 | 123–329PUBLIC HEALTH PANORAMA THE WHO EUROPEAN ACTION NETWORK ON HEALTH LITERACy FOR PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES use of emergency care, lower receipt of preventive services (e.g. mammography screening), poorer ability to take medication appropriately, poorer ability to interpret labels and health messages, and, among elderly people, poorer overall health status and higher mortality rates (4). A 2018 systematic review of the effectiveness of health literacy interventions in the European Union identified some promising health literacy initiatives, especially those tailored to the needs of patients, addressing functional, interactive and critical skills, and using easy-to-understand spoken animations (5). THE WHO EUROPEAN ACTION NETWORK ON HEALTH LITERACY FOR PREVENTION AND CONTROL OF NCDS The HL-NCD Network was established to promote health literacy and achieve progress in preventing and controlling NCDs and promoting health throughout the life-course. The HL-NCD Network will collate global and national health literacy experiences and support the scaling up of health literacy interventions, especially through demonstration projects from countries of the WHO European Region, with a view to improving the implementation of NCD prevention and control initiatives and strengthening mental health through the life-course in different settings. The Network was launched in January 2019 in Lisbon, Portugal, at a European workshop on developing, implementing and evaluating health literacy initiatives across the Region to support the prevention and control of NCDs. Representatives of 22 Member States took part in the workshop to learn from one another by sharing experiences related to health literacy projects in NCDs, and others have already expressed their interest in participating in the HL-NCD Network. The workshop included country delegates and global experts in the field of health literacy, who gathered to discuss a  range of issues from developing national health literacy projects to the role of governments and promoting digital health literacy. National and regional initiatives focused on health literacy for NCDs exist in a number of areas (e.g. nutrition, physical activity, sexual and reproductive health, school health) (6). However, much more progress needs to be made in terms of approaches and implementation. The HL-NCD Network aims to work in alignment with other networks and projects such as the Action Network on Measuring Population and Organizational Health Literacy (M-POHL Network), which emphasizes the importance and value of enhancing health literacy in Europe by ensuring that high-quality, internationally comparative data are available to facilitate evidence-informed policy-making. The M-POHL Network aims to institutionalize regular, high- quality, internationally comparative European health literacy surveys and support data collection on organizational health literacy as prerequisites for evidence-based policy and practice on health literacy (7). GOALS AND OBJECTIVES OF THE HL-NCD NETWORK The long-term goal of the HL-NCD Network is to support the achievement of Sustainable Development Goal (SDG) target 3.4 and the further implementation of actions to prevent and control NCDs and promote health through the life-course, as well as to share experiences to help the further scaling up of health literacy interventions in alignment with the WHO European Region initiatives in health literacy. The objectives of the Network, in line with the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 in the WHO European Region (8) and other WHO regional and global strategic and technical documents, are to: • establish a Member States community of practice in health literacy for NCD prevention and control by: △ sharing experience among Member States and stakeholders in promoting health literacy as a  tool for NCD prevention and control, as well as good practices in the areas of development, implementation, monitoring and evaluation of national or regional health literacy-related projects; and △ generating and disseminating evidence-based knowledge on the contribution of health literacy to the WHO European Region and global health agendas, especially achievement of the SDGs and NCD-related targets across the life-course, including reduction of inequity; • advocate for health literacy at national level by: △ promoting the development of national strategies and action plans on health literacy in NCDs and mental health through the life-course; or △ including health literacy in existing health promotion strategies/plans, and relevant actions to be undertaken, especially among vulnerable groups. 199 ТОМ 5 | ВЫПУСК 2–3 | ИЮНЬ–СЕНТЯБРЬ 2019 Г. | 123–329ПАНОРАМА ОБЩЕСТВЕННОГО ЗДРАВООХРАНЕНИЯ THE WHO EUROPEAN ACTION NETWORK ON HEALTH LITERACy FOR PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES HL-NCD NETWORK: ORGANIZATION, TIME FRAME OF WORK ANNUAL WORKPLAN The work of the HL-NCD Network will be guided by an annual workplan that is currently being shaped to meet its objectives and Regional priorities. Progress reports will be prepared and shared annually with WHO governing bodies. Advisors and observers will participate in the Network’s activities to provide advice and technical support and, to promote a cross-sectoral approach, relevant actors and interested parties may also be invited to take part in discussions. ORGANIZATION AND TASKS The Network Secretariat coordinates the work of the HL-NCD Network, in accordance with WHO strategic documents and guidance. The HL-NCD Network was launched through an initiative of Portugal and the Russian Federation, and these countries will co-chair the Network Secretariat for the first two years of operation. For both countries, the HL-NCD Network is a powerful engine to strengthen the progress already made on NCD prevention. Following this, co-leading countries will be elected in rotation, following agreement by Member States. In collaboration with the WHO Regional Office for Europe, the tasks of the Secretariat are to: • facilitate and coordinate Network activities; • be responsible for formal communication on behalf of the Network; • distribute information about the Network, including establishing a website for the Network; • plan and support the organization of Network meetings; • be responsible for the preparation of progress reports. PLANS FOR THE FUTURE In acknowledgement of the potential and importance of health literacy as a  tool to achieve the SDGs, the WHO Regional Office for Europe is currently developing a European initiative on health literacy through the life-course, including a relevant roadmap and other activities to support the implementation of health literacy. These will consider the experiences and opportunities for strengthening health literacy, share good practice and make recommendations for strengthening health literacy (including digital literacy) in order to accelerate progress towards better health outcomes for people of all ages. The HL-NCD Network’s contributions to the initiative, especially in relation to SDG target  3.4, will consist of providing experience-based information on each country’s policy development, implementation and evaluation in health literacy related to NCDs. The HL-NCD Network will also support the implementation of demonstration projects involving case studies, proof of concept and the scaling up of interventions that will be used to advance national and international health literacy practice so as to support countries in accelerating progress towards realizing their high-level commitments to prevent and control NCDs. The first European demonstration projects were launched globally under the WHO Global Coordination Mechanism on the Prevention and Control of NCDs Working Group 3.3 on health education and health literacy for NCDs (9), and are currently being developed; additional demonstration projects will also be designed and developed. The Network will share experiences of developing national demonstration projects, which could be considered for further scaling up in other programmatic areas (besides NCDs) and thus will support the broader Regional agenda on health literacy. Furthermore, training courses in capacity-building will also be organized within the HL-NCD Network, for participants from both the health and non-health sectors, to support countries in implementing concrete health literacy projects in NCDs. INVITATION TO PARTICIPATE IN THE HL-NCD NETWORK The HL-NCD Network is open to all Member States of the WHO European Region and will eventually also be open to other stakeholders as observers, depending on Member State’s agreement. It is desirable for two participants from each Member State to be nominated to the Network by the ministry of health, one to represent the political level and the other the technical implementation level. Participation in the Network is voluntary and without a financial commitment. More information about participation in the HL-NCD Network is available on request from Anastasia Koylyu at koylyua@who.int. 200 VOLUME 5 | ISSUE 2–3 | JUNE–SEPTEMBER 2019 | 123–329PUBLIC HEALTH PANORAMA Acknowledgements: The authors would like to express their gratitude to the representatives of Member States, temporary advisors and observers who supported the establishment of the HL-NCD Network and participated in the first HL-NCD Network meeting for taking an active part and contributing to the formation of the Network and its further development. Sources of funding: None. Conflicts of interest: None declared. Disclaimer: The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the World Health Organization. REFERENCES1 1. Noncommunicable diseases. Copenhagen: World Health Organization; 2017 (Fact sheets on sustainable development goals: health targets http://www.euro.who.int/en/health- topics/noncommunicable-diseases/noncommunicable- diseases). 2. Political declaration of the third high-level meeting of the General Assembly on the prevention and control of non- communicable diseases. New York: United Nations; 2018 (A/RES/73/2; https://www.who.int/ncds/governance/third- un-meeting/en/). 3. Rowlands G, Russell S, O’Donnell A, Kaner E, Trezona A, Rademakers J et al. What is the evidence on existing policies and linked activities and their effectiveness for improving health literacy at national, regional and organizational levels in the WHO European Region? Copenhagen: WHO Regional Office for Europe; 2018 (Health Evidence Network (HEN) synthesis report 57; http://www.euro.who.int/__data/assets/ pdf_file/0006/373614/Health-evidence-network-synthesis- WHO-HEN-Report-57.pdf?ua=1). 1 All references were accessed 20 August 2019. 4. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107. doi: 10.7326/0003-4819-155-2-201107190-00005. 5. Visscher BB, Steunenberg B, Heijmans M, Hofstede JM, Devillé W, van der Heide I et al. Evidence on the effectiveness of health literacy interventions in the EU: a  systematic review. BMC Public Health. 2018;18(1):1414. doi: 10.1186/ s12889-018-6331-7. 6. Schools for Health in Europe [website]. Haderslev: Schools for Health in Europe Network Foundation; 2019 (https:// www.schoolsforhealth.org/). 7. The Vienna statement on the measurement of population and organizational health literacy in Europe. Vienna: Action Network on Measuring Population and Organizational Health Literacy; 2018. (https://dory.goeg.at/s/ yo6HazJ2HBcnbZn#pdfviewer). 8. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: World Health Organization; 2013 (https://www.who.int/nmh/ events/ncd_action_plan/en/). 9. The WHO GCM/NCD Working Group on health education and health literacy for NCDs (Working Group 3.3, 2016– 2017). In: WHO Global Coordination Mechanism on the Prevention and Control of NCDs [website]. Geneva: World Health Organization; 2019 (https://www.who.int/global- coordination-mechanism/working-groups/working- group-3-3/en/). n THE WHO EUROPEAN ACTION NETWORK ON HEALTH LITERACy FOR PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES