2.K. Round table: Navigational health literacy. Perspectives from Austria, Germany and Switzerland

Abstract Background Theoretical and empirical studies indicate that a lack of transparency and highly complexity makes it difficult for patients to navigate healthcare systems. This requires the competence to access, understand, appraise, and apply information about the healthcare system, its organizations and proceedings, i.e., navigational health literacy. Since little is known about navigational health literacy, partly due to a lack of measurement tools, a new instrument measuring navigational health literacy was developed as part of the Health Literacy Population Survey Project 2019-2021 (HLS19). It was applied in national health literacy surveys of the three German-speaking countries Austria, Germany and Switzerland among others. The empirical findings obtained in the three German-speaking countries and further perspectives on the topic will be presented and discussed in the workshop. Objectives of the workshop The workshop on navigational health literacy has three key objectives: 1) It gives an overview on the newly developed instrument for measuring navigational health literacy in HLS19, its development and validation; 2) it aims to discuss the distribution of navigational health literacy among the Austrian, German, and Swiss population and to highlight barriers and challenges for patients regarding navigation health literacy; and finally 3) it proposes steps to promote and strengthen navigational health literacy. Added value of the workshop The workshop is designed to enhance the understanding of navigational health literacy and to propose future scenarios and steps for action to develop and implement better health literacy outcomes. By the end of the workshop, participants – will have discussed the methodological approach for measuring navigational health literacy; – will have heard of current data and developments regarding navigation health literacy in Austria, Germany and Switzerland; – will have exchanged ideas and sustainable strategies to strengthen healthcare systems by developing navigational health literacy. The four panelists will give short presentations on: HLS19, navigational health literacy research, the newly developed instrument measuring navigational health literacy in HLS19, key findings of their respective national health literacy surveys, and recommendations and current navigational health literacy initiatives in their countries. In a panel discussion, the panelists and workshop participants will discuss the presented findings and recommendations as well as the need for action regarding implementation strategies, hands-on initiatives, and sustainable solution approaches. Key messages • Navigating healthcare systems and related information proves difficult for major parts of the general population. • There is a need of health literate healthcare systems and organizations reducing the demands placed on patients by providing guidance and support. Speakers/Panellists Doris Schaeffer Bielefeld University, Bielefeld, Germany Lennert Griese Bielefeld University, Bielefeld, Germany Saskia De Gani Careum Center for Health Literacy, Zürich, Switzerland Robert Griebler Austrian National Public Health Institute, Vienna, Austria


Background and Objective:
Population-based estimates of the socioeconomic burden of multiple sclerosis (MS) are limited, especially regarding primary healthcare. This study aimed to estimate the excess costs of people with MS that could be attributed to MS, including primary healthcare. Methods: An observational study was conducted of the 2806 workingaged people with MS in Stockholm, Sweden and 28,060 propensity score matched references without MS. Registerbased resource use was quantified for 2018. Annual healthcare costs (primary, specialised outpatient, and inpatient healthcare visits along with prescribed drugs) and productivity losses (operationalised by sickness absence and disability pension days) were quantified using bottom-up costing. Costs were compared between the people with MS and references with independent t-tests with bootstrapped 95% confidence intervals (CIs) to isolate the excess costs of MS.

Results:
The mean annual excess costs of MS for healthcare were E7381 (95% CI: 6991-7816) per person with MS with disease modifying therapies as the largest component (E4262, 95% CI: 4026-4497). There was a mean annual excess cost for primary healthcare of E695 (95% CI: 585-832) per person with MS, comprising 9.4% of the excess healthcare costs of MS. The mean annual excess costs of MS for productivity losses were E13,173 (95% CI: 12,325-14,019) per person with MS, predominately from disability pension (79.3%).

Conclusions:
The socioeconomic burden of MS in Sweden from healthcare consumption and productivity losses was quantified, updating knowledge on the cost structure of the substantial excess costs of MS.

Key messages:
Primary healthcare contributes around a tenth of the excess healthcare costs of MS in Sweden, primarily owing to contacts with healthcare professionals other than physicians. Overall, the excess costs of MS in Sweden from lost production are larger in magnitude than the excess costs for healthcare consumption.

Background:
Theoretical and empirical studies indicate that a lack of transparency and highly complexity makes it difficult for patients to navigate healthcare systems. This requires the competence to access, understand, appraise, and apply information about the healthcare system, its organizations and proceedings, i.e., navigational health literacy. Since little is known about navigational health literacy, partly due to a lack of measurement tools, a new instrument measuring navigational health literacy was developed as part of the Health Literacy Population Survey Project 2019-2021 (HLS19). It was applied in national health literacy surveys of the three Germanspeaking countries Austria, Germany and Switzerland among others. The empirical findings obtained in the three Germanspeaking countries and further perspectives on the topic will be presented and discussed in the workshop.

Objectives of the workshop:
The workshop on navigational health literacy has three key objectives: 1) It gives an overview on the newly developed instrument for measuring navigational health literacy in HLS19, its development and validation; 2) it aims to discuss the distribution of navigational health literacy among the Austrian, German, and Swiss population and to highlight barriers and challenges for patients regarding navigation health literacy; and finally 3) it proposes steps to promote and strengthen navigational health literacy.

Added value of the workshop:
The workshop is designed to enhance the understanding of navigational health literacy and to propose future scenarios and steps for action to develop and implement better health literacy outcomes. By the end of the workshop, participants -will have discussed the methodological approach for measuring navigational health literacy; -will have heard of current data and developments regarding navigation health literacy in Austria, Germany and Switzerland; -will have exchanged ideas and sustainable strategies to strengthen healthcare systems by developing navigational health literacy.
Health impact assessment (HIA) is a process, which systematically judges the potential, and sometimes unintended effects of any new proposal (policy, project, program or strategy) on the population health, and the distribution of those effects within the population. It was conceived in 1999 as the supporting tool for the implementation of Health in All Policies (HiAP), but its practical use remains quite partial worldwide, with exceptional regions and countries (e.g. Wales (UK), Australia). Several surveys conducted nationally, but also across Europe by the World Health Organization-Regional Office for Europe identified several barriers that hinder a broader and more extensive practical application of HIA. One of these limitations lies in the lack of understanding and knowledge of professionals from non-health sectors about the benefits that addressing health considerations in the planning process of their projects, strategies or programs may have. In this sense, the HIA is frequently seen as an additional bureaucratic burden. Other common constraints reported refer to inadequate resources (guidelines, tools, evidence) and lack of qualified staff experienced in conducting HIA. Respondents from those surveys also deplored a history of unsatisfactory experiences involving intersectoral collaboration with health professionals, decision makers and other public sector stakeholders. Health agencies, such as national and regional Public Health Institutes (PHIs) can play a critical role in overcoming these limitations. They can act by providing independent advice and support based on the best available evidence to governments and proposal developers (projects, programs, strategies). However, they need to have knowledge, resources and capacity to do so. On the other hand, these basic concepts and procedures related to HiAP or HIA are rarely addressed in depth in the university curricular training of health sectors or other sectors such as environmental science or urbanism. Present workshop intends to analyse different experiences in Europe regarding the role of PHIs and also the academia in overcoming those reported exiting barriers, and reach a more sustainable and healthy societies. The fundamentals of what could be a training program on HIA principles across Europe will be also discussed.

Key messages:
PHIs can demonstrate leadership for HIA and HiAP by providing support to decision makers in better understand the wider health impacts and how they will manifest themselves across the population. HIA practice requires of the design of proper training programs and of certain validation process, which avoids conflicts regarding consultants' impartiality and independence in conducting a HIA. Over the past decades public health research has presented compelling evidence that health is socially determined. To address structural inequalities and inequities in health, public policies require intersectoral development and implementation. Health Impact Assessment (HIA) is an established tool for analysing potentially detrimental health outcomes of policies, programmes and projects. In Ireland, we are presented with a unique opportunity to examine HIA implementation by capitalising on the synergy of recent policy commitments driving HIA implementation. Specifically, the national public health framework Healthy Ireland 2013-2025, and the newly developed all-island Institute of Public Health HIA guidance (2021), have coalesced in steering the strategic direction of HIA. This presentation outlines the current synergistic policy context on the island of Ireland, including the publication of new HIA guidance, which opens opportunities and new possibilities for implementing HIA. Reflections will be made on the potential and reality of current HIA training programmes in Ireland. Learning from the lessons of a dearth of HIA implementation at varying time periods since 2000, this presentation discusses the mechanisms in place, such as the successful World Health organization-led healthy cities projects in Ireland, such as Cork Healthy Cities, and those key drivers that are required to capture policy synergy for meaningful HIA implementation.