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Winds of change:
towards new ways of improving public health in Europe

Ljubljana, Slovenia
28 November - 1 December 2018


Austria Center Vienna (ACV)


Operationalizing health promotion on the life course through the health literacy approach: where we stand 30 years after Ottawa?

The tool kit of the salutogenic blueprint in the operationalization and measurement of health literacy in childhood and adolescence.


Organised by

EUPHA Section on Health promotion

Pre-Conference Organisers

Luis Saboga-Nunes and Christiane Stock – EUPHA Section on Health promotion
Ullrich Bauer, Paulo Pinheiro, Orkan Okan - Bielefeld University, Centre for Prevention and Intervention in Childhood and Adolescence (CPI)
Kristine Sørensen, health consultant and founder of Global Health Literacy Academy
Auke Wiegersma EUPHA Child and Adolescent Public Health vice-president

Guest speakers

Uwe H. Bittlingmayer University of Education Freiburg, Germany
Eva Maria-Bitzer University of Education Freiburg, Germany
Jany Rademakers, NIVEL, Netherlands
Ane Bonde- Steno Diabetes Center A/S Denmark
Geir Arild Espnes, NTNU Center for Health Promotion Research, Norway
Kenneth Yongabi Anchang, Catholic University of Cameroon, Director, Phytobiotechnology Research Foundation Cameroon


08:30-08:45 – Opening remarks: Luis Saboga Nunes (EUPHA Health Promotion Section Presidency); Ullrich Bauer & Paulo Pinheiro & Orkan Okan (German Health Literacy in Childhood and Adolescence Research Consortium (HLCA)

08:45 - 09:00 – Session 1: Key Note
Title: 30 years after Ottawa? Where do we stand? What is the future? Which are the central theories?
Guest Speaker: Geir Arild Espnes

One critique to the Ottawa Charter has often been that it is lacking a fundamental theoretical basis. Salutogenesis was by Aaron Antonovsky thought to offer such a fundamental theory for Health Promotion based in the theoretical and empirical model of Sense of Coherence (SoC). Since then, Salutogenesis have developed further, and have especially through the last years shown a growth in body of evidence. During the fall of 2016 the Handbook of Salutogenesis in presented as a way into the future for HP. This communication explores the thoughts behind the foundation of Health Promotion to explore the health literacy topic.

09:00 - 09:45 – Session 2: Roundtable on HLCA
Moderator: Orkan Okan

09:00 - 09:05 – Short Introduction
Title: The German National Health Literacy in Childhood and Adolescence Research Consortium (HCLA) and the setting up of instruments to measure health literacy
Speaker: Orkan Okan

The HLCA research consortium, launched in 2015, has been funded for a three year period by the German Ministry of Education and Research (BMBF). The aims are to assess the impact of health literacy in childhood and adolescence on primary prevention and health promotion. The consortium is made up of five German academic partners who are in charge of the implementation of ten individual projects on health literacy. One of the main goals of the project is to develop, test and disseminate instruments to evaluate health literacy for children and adolescents.

09:10 - 09:20 – 1st Presentation
Title: Health Literacy in Child and Adolescent Populations
Speaker: Paulo Pinheiro

In the HLCA research consortium, work block 1 focuses on basic research on health literacy. The primary objective is to frame a theoretical and conceptual understanding of health literacy in childhood and adolescence as well as at developing and using instruments to assess health literacy in selected age groups.

09:20 - 09:30 – 2nd Presentation
Title: Mental Health Literacy: Systems and Providers
Speaker: Ullrich Bauer

Work block 2 comprises three projects on mental health literacy that aim to open up new opportunities of health promotion and primary prevention for children of mentally ill parents, a high risk population for developing mental disorders. The projects will approach the health promoting and primary preventive potentials for this disadvantaged target group mainly by addressing the adults who constitute the intra- and extra-familial settings (e.g. parents, teachers, social workers) of these children.

09:30 - 09:35 – 3rd Presentation
Title: Ehealth literacy and Digital Health
Speaker: Uwe H. Bittlingmayer

The eHealth literacy projects of HLCA are located in work block 3 and focus on skills and knowledge that are essential to interact with technology-based health information and services which are provided through internet and related technologies assumed to assist evidence-based health-related decision-making processes.

09:35 - 9:45 – Discussion & Round up

09:45 - 10:00 – Coffee Break

10:00 - 11:00 – Session 3: European Health Literacy Research in Children and Youth
Moderator: Paulo Pinheiro

10:00 - 10:15 – 1st Presentation
Title: Literacy lapses, health disparities and cultural perceptions
Speaker: Kenneth Yongabi Anchang

Approaching health literacy from a systems perspective through building an evolutionary health literacy Learning laboratory

10:15 - 10:25 – 2nd Presentation
Title: Development of Health literacy in youth; beyond formal Health education
Speaker: Jany Rademakers

Health literacy is developed in childhood and adolescence, it is often conceptualized as the outcome of formal Health education (cf. model Nutbeam). However, there are many other channels through which Health literacy is learned. In this conceptual presentation different learning strategies will be presented. The importance of parents, peers and (social) media will be discussed. Health literacy will be defined broad, including cognitive, psychological and social skills.

10:25 - 10:35 – 3rd Presentation
Title: Promoting Health Literacy in the classroom
Speaker: Ane Bonde & Helle Terkildsen Maindal

In a life course perspective, the school’s role is pivotal for children’s health literacy. This presentation will introduce a health education program integrated into maths, implemented at 75 schools in Denmark, and an observational study that identified “physical activity health literacy” as an outcome at functional, interactive and critical level.

10:35 - 10:45 – 4th Presentation
Title: The salutogenic blueprint in the operationalization and measurement of health literacy in childhood and adolescence
Speaker: Luis Saboga Nunes

This communication will explore the “renasceres®” model that articulates salutogenesis and health literacy in a global framework to intervene in the classroom. Data that will be presented is based in the preliminary utilization of HLS-EU-PT questionnaire in a school setting exploring its pros and cons.

10:45 - 11:00 – Discussion & Round up

11:00 - 11:20 – Session 4: EUPHA Section Child and Adolescent Public Health on Health Literacy
Title: Teaching Organized Scepticism in the Curriculum
Speaker: Auke Wiegersma CAPH vice-president

As health literacy triangulates health care, preventive aspects and health promotion, a sound curriculum in the class room should consider Risk Literacy. This provocative exposé by Auke Wiegersma, CAPH vice-president (EUPHA Child and Adolescent Public Health section) will increase awareness so that people are better equipped to critically assess the value of especially preventive activities and above all the plethora of screening activities that by now is inundating the public at huge cost based on faulty assumptions about their effectiveness (e.g. breast cancer, prostate cancer, colorectal cancer, total body scans).

11:20 - 11:55 – Session 5: Audience Round Table and Interactive Participation
Title: Ask your question, tell your story
Moderator: Luis Saboga-Nunes

In this session the audience is invited and encouraged to introduce themselves, to ask question on the presentations or other topics of interest, to introduce their work and research, and debate with the each other as well as with the speakers.

11:55 - 12:00 – Closing Remark
Luis Saboga-Nunes

The discussion that was ignited 30 years ago with the Ottawa Charter on how to operationalize Health Promotion is still today a fundamental topic; but with better theories - and through the last years - a strong body of research. From Nairobi the health literacy add-on was brought to the main stream of this discussion. Compared to adult health literacy studies, the scientific literature targeting child and adolescent/youth health literacy still provides a huge gap concerning conceptual, methodological, and empirical data based publications. This is contradicting with the importance given to the early years and early education for the development of health skills, health knowledge and sustainable health behaviour and practice. The relevance of childhood years and adolescents stage to any health promotion action arises from the life course and developmental approach that this proposal wants to mitigate while exploring recent developments in health literacy research, practice and policy relevant to health promotion action (e.g. a strong urge to pay more attention on mental health promotion.

This pre-conference aims at discussing how health promoting research at large is developing, how health literacy is established, developed and measured within the boundaries of specific age groups like children and adolescents/youth as a modus faciendi to operationalize health promotion today. Different instruments studies will be introduced and discussed with regard to their strengths, weaknesses, and opportunities they provide. As a secondary objective we aim to mediate the role of the underlying health model to the health literacy framework, and how it affects and changes both the perception and construction of health literacy itself. Thereby we aim to deepen the understanding of health literacy in the realm of health paradigms such as salutogenesis which is among the central concepts within health promotion research, and how theoretical concepts holds promises for future studies and practice.

Main Message of the Pre-Conference
1. This pre-conference will enable participants to actively participate in and contribute to the discussion about general HP research. More specifically, on anchoring the operationalization of HL into both the concept of health promotion (including salutogenesis as its health framework) explore the tools and instruments to measure health literacy at the adolescent and children’s level.
2. The participants will get an overview of the state of science in the development, construction and application of measurement tools to evaluate health literacy in child and adolescent populations.

- Dynamic based on round table discussions triggered by provocative communications
- With 4 slots with presentations and ample time for audience interaction
- Open transparent science framework: open-up to discussion, participant activation and interactive, multi-method approach, two-way-communication processes

Health literacy as a tool of health promotion is an integrative topic to health promotion action areas. With this pre-conference we do not reflect on health literacy measurement tools for children and adolescents only but with respect to the conference theme of this year`s EUPHA conference we will highlight the role of health literacy to the five WHO health promotion strategies. (1) Developing healthy public policy - Health in all policies: the need for health literacy governance and health literacy in policy action and programmes as means of health promotion; (2) Creating supportive environments: the need for supportive health literate infrastructure, and support and promotion of the health literacy of organisations, professionals, and practitioners engaged with health; (3) Strengthening community action: the need for common approaches, networking, socially and culturally sensitive, easy to reach, including disadvantaged populations; (4) Developing personal skills and knowledge: the need for strengthening health literacy of citizens; (5) Re-orientation of health services: the need for shaping medical care, disease prevention and health promotion along the needs of the society and its citizens. When translating these five action areas into the Jakarta philosophy we see that action leads to building resources in (1) social responsibility for health, (2) increasing health investment for health development, (3) partnerships and networks for health, (4) community capacity building and individual empowerment, and (5) building sustainable infrastructure for health promotion. The WHO acknowledged the need for new health knowledge concerning risks, assets, treatments and new ways to maintain health. Education and health learning became necessary components of health promoting approaches. The strategy on developing personal health skills and health knowledge does not only reflect on the educational and learning-based approaches but health literacy, too, was introduced to a wider audience as both the greater framework and indicator to these skills and knowledge as well as the outcome to formal and informal education and learning. Health literacy measurement and monitoring are getting greater attention in research, policy and practice, and are among the preconditions to generate evidence-based data on the health literacy levels as well as on the development, implementation, and evaluation of evidence-based interventions to raise health literacy in individuals and systems.

Conference Tracks the pre-conference is related to
The topics of this pre-conference are linked mainly to health promotion but a specific focus is given on health data, central theory, methodology, monitoring and reporting (HL measurement tools, including general HL child measure; general HL adolescents measure, digital health literacy measure), mental health (mental health literacy projects of HLCA), and child and adolescent public health (target population the pre-conference is aiming at). Further, the conference track on lifestyle and life choices is linked secondarily.

Registration fee

The registration fee is € 70 which includes buffet lunch and refreshments.