Keywords

The climate crisis, wars, a weak global economy, and the effects of the COVID-19 pandemic have led to uncertainty and challenges globally. The United Nations (UN) has warned that there is a lack of progress in reaching the Sustainable Development Goals (SDGs) and that this affects the world’s poorest and most vulnerable people (United Nations 2023). The need for health literacy is more urgent than ever to contend with such global challenges. This book contributes to a framework that can be used to strengthen health literacy and increase the possibility of achieving the associated SDGs.

SDGs are systematically measured and monitored for progress (WHO 2013b, 2024; United Nations 2015a; Our World in Data team 2023). The European Health Literacy Survey provides valuable data in improving health literacy worldwide. Data from this survey enables comparisons both within, and between, countries and has identified major inequities among populations (WHO 2013b, 2021). Throughout this book, we have considered it especially important to identify vulnerable groups in promoting equity for all people of all ages, aligned with the important principle of leaving no one behind (United Nations 2016, 2018).

Statistics have shown a strong decline in mortality from non-communicable diseases such as cancer, cardiovascular disease, diabetes, and chronic lung disease in Western countries. The decline has slowed down considerably during the last years, probably due to a lower number of smokers: policies/regulations have been introduced in many countries to support stopping smoking. Now the concern for the population is linked to other lifestyle factors, such as physical inactivity, unhealthy diet, and harmful use of alcohol (Ariansen and Larsen 2024). The UN’s Sustainable Development Goal Good health and well-being (SDG 3) aims to reduce early death from non-communicable diseases by 33% in the period 2015–2030 (WHO 2013a; United Nations 2015b). This book has looked at challenges linked to health literacy for patients with non-communicable diseases. We found that there is a need for health professionals and health organisations alike to be aware of the importance of improving health literacy for patients, users, and their families. In-hospital health services are not accessible to all patients and end users: there is a need for systems to be adaptable to individual needs alongside digital healthcare services. This builds on previous findings that many patients and users will benefit from user-friendly electronic patient portals and training on how to use them (WHO 2013b).

Chapter 1 provided a historical backdrop to sustainability and the development of the sustainability goals. It demonstrated the interconnection between all 17 sustainability goals and highlighted the fact that reaching each of these 17 goals requires a multidisciplinary approach. The wedding cake model used in this opening chapter (Fig. 1.1) served to show that achieving good health and well-being (SDG 3) is linked to the biosphere, society, and economic level. The top of the ‘cake’ shows that partnership and collaboration is key to achieving all the SDGs. This thread underpinned the thinking throughout the chapters. We have sought to show that the interaction between the individual and environment is crucial for the successful development of health literacy.

Improving health literacy requires patient participation and reduced inequalities among patients and health personnel. In western countries, there is comprehensive research on patient participation. Chapter 2 presented a model that added frame factors as a new perspective in research and practice in order to understand the complexity of patient participation and equality globally. We believe that there is great potential for this comprehensive model in studying patient participation in different cultures and healthcare systems.

It is important to develop knowledge about patients’ experiences of illness, treatment, and health literacy so that health education can be adapted for various groups and patients’ preferences. A qualitative research approach may therefore provide a greater in-depth understanding of patients’ experiences of various diseases. Chapter 3 highlighted different qualitative designs and methods for exploring health literacy from various perspectives. Knowledge from the patient and end user perspective is certain to be transferable and particularly valuable when working towards the aim of achieving person-centred health education and health literate–friendly organisations.

Transforming our world for sustainable development requires a systematic and a pedagogical approach to health literacy. To this end, Chap. 4 presented a pedagogical model and framework for building health literacy for obtaining good health and well-being and sustainable health services at a personal and an organisational level. This pedagogical model employs an ecological approach which means that the engagement of individuals, social networks, organisations, communities, and the population continues to be essential in the quest to build health literacy.

We have also explored supervision, which is known to be important in improving health literacy among patients and health personnel. Chapter 5 therefore presented a supervision strategy which can be used to make individuals and organisations aware of the knowledge, experiences, and values underpinning their practice. The pedagogical model and the supervision strategy complement each other, and we sought to show how valuable they are when planning, implementing, and assessing health education individually and in groups. Both Chaps. 4 and 5 are important resources for use in medical, health, and social education. Health literacy is a new and important learning outcome across the curricula.

Enhancing health literacy through sustainable digital healthcare solutions requires a comprehensive strategy, in which patients, users, family caregivers, healthcare professionals, IT engineers, and technicians must participate and collaborate. The findings in Chap. 6 highlighted that it is essential that digital health services are user-friendly at both individual and system levels. Furthermore, it concludes that digital health services ought to also be intuitive and adapted to any age-related cognitive and physical challenges.

Throughout Part III in particular, we felt it important to highlight health literacy from the point of view of various stakeholders, like patients, family caregivers, and health professionals. Experiences from patients with non-communicable diseases, users with visual impairment, and health personnel can bestow us with invaluable knowledge on how to create a health literate–friendly environment. Chapters 7, 8, and 9 dealt with experiences of health literacy during both clinical pathways and life. We have endeavoured to show that health literacy and levels of health literacy are based on context and that educational needs vary in the clinical pathway and over a person’s lifetime.

In Chap. 9, the sole informant is also a co-author. The experiences from this study showed that a user can contribute to different roles in research. The possibilities as well as the limitations with one of the researchers being both informant and co-author are discussed. The user’s important role has strengthened the trustworthiness of the study and contributed to relevant suggestions for improving the learning environment for the visually impaired.

Chapter 10 dealt with how to improve health literacy among immigrant women, while Chap. 11 discussed health literacy in palliative care. The chapters discussed the importance of health literacy for quality in palliative care and how innovative strategies, used in other walks of life, could be applied to groups of immigrant women to increase their health literacy. Once again, these approaches are potentially highly transferable and adaptable for different health services and groups.

During our work on this book, we have gained a great deal of insight into the value of health literacy as a prerequisite for patient participation and as a way of empowering persons and communities to manage challenges. Health-literate people and organisations will render people better equipped to make better-informed decisions related to their health and well-being.

Finally, looking forward, we would question whether health literacy should actually be more explicitly and clearly stated in the 17 current sustainability goals. Extrapolating from the findings in these chapters, we believe that increasing levels of health literacy will affect the entire population’s understanding and knowledge of a range of different areas. This could lend itself to, for example, an improved understanding about clean water and sanitation, nutrition, as well as the promotion of healthy environments. This may, in turn, lead to the achievement of SDG targets such as reducing infant and child mortality, preventing the spread of infectious diseases and the development of epidemics, and reducing mortality from non-communicable diseases as well as promoting mental health. We would therefore argue that health literacy and strategies to increase health literacy globally should be more clearly emphasised in the SDGs and in future policies which will be developed to achieve these SDGs.