the efficiency of the health care system as a whole. Namely, to make health care
servicesusable, they must beavailable/accessible, and their availability/accessi-
bility to every citizen as a potential user (patient) depends oninclusivenessof
citizens as active participants in the creation and functioning of the health care
system, European Science Foundation ( 2012 ).^37 Thus, health literacy represents a
conditio sine qua nonin the health care process.
Health literacy can be defined as “the personal, cognitive and social skills which
determine the ability of individuals togain access to, understand, and use infor-
mationto promote and maintain good health”, Nutbeam ( 2000 ).^38
The topic of health literacy has become the subject of scientific debate in the
1970s, when first serious research began in the US, Simonds ( 1974 ).^39 In the report
“Healthy People 2010”, U.S. Department of Health and Human Services ( 2000 ),^40
the connections between poor education, low health literacy, poor health and early
death were emphasised. In the period 2009–2012, the “European Health Literacy
Survey HLS-EU” was carried out in Europe comparing HL in eight selected EU
member states by measuring “how people access, understand, appraise and apply
information to make decisions in terms of HC, disease prevention and health
promotion”. The results implied that 47 % of the people are at the risk of inadequate
health literacy, HLS-EU Consortium ( 2012 ).^41
One of the key reasons for the inefficiency of the health care system is precisely
the inability to make informed and autonomous decisions by its users! Namely, we
are faced with aknowledge and information asymmetrybetween users and pro-
viders of health care, Zweifel et al. ( 1997 ).^42 Inadequate communication, insuffi-
cient information and instructions that patients hardly understand causebarriers
while using health care services, Dukic ́et al. ( 2013 ).^43 This is precisely why health
literacy is viewed as a key outcome of health promotion and disease prevention and
thus accentuated as a prerequisite to achieve the level of an inclusive and partici-
patory medicine, European Science Foundation ( 2012 ).^44 ,^45
(^37) Ibid., 21.
(^38) See Nutbeam ( 2000 ), pp. 259–267.
(^39) See Simonds ( 1974 ), pp. 1–10.
(^40) See U.S. Department of Health and Human Services ( 2000 ).
(^41) See HLS-EU Consortium ( 2012 ).
(^42) See Zweifel et al. ( 1997 ).
(^43) See Dukic ́et al. ( 2013 ).
(^44) Ibid., 21.
(^45) In attempt to approach the above-mentioned European initiative, Primorsko-goranska County
launched the Health Literacy Innitiative within the project “Healthy County” for the 2015–2018
period. One of the partners in this initiative is the Teaching Institute of Public Health of the
Primorsko-goranska County.
Personalised Medicine and Public Health 89