School Education Needs Change to Bridge Gaps in Health Literacy

"Neither age nor grade level were significant predictors of health literacy."

Students carry a heavy school burden – yet are insufficiently prepared for the overwhelming health information they face outside.

School education is meant to equip young people with the knowledge and skills they need to thrive in society. But our society has changed dramatically in recent decades – raising the question of whether our education system has adequately adapted to the new challenges today’s youth face.

One pressing challenge is navigating the modern health information landscape. From an early age, children are exposed to a flood of unfiltered health information from a variety of sources – ranging from commercial websites and influencers to industry messaging and pseudo-experts. To make informed decisions, they need strong health literacy skills.

Unfortunately, a recent study revealed that three-quarters of the German population have inadequate levels of health literacy – an increase from previous years [1]. Because health literacy was assessed with self-assessment questions, this change doesn’t necessarily mean that people have become less capable. Rather, it may also reflect the increasing complexity of today’s health information ecosystem, with more strategic actors – like social media influencers – and growing awareness that not all sources are trustworthy.

In any case, these numbers are deeply concerning. Gaps in health literacy contribute to unequal health outcomes and reinforce existing social determinants of health [2]. The study also highlights that certain vulnerable groups are especially affected: younger people, individuals with lower levels of education, socio-economically disadvantaged populations, and migrants.

These findings point to a systemic failure: schools are not effectively delivering health literacy education. This is particularly problematic because schools have the potential to compensate for social disparities by providing equal access to essential knowledge. So what is happening in our education system? How is health currently addressed in schools – and are students being adequately prepared?

To explore these questions, a team of researchers from my institution (MCI), the Austrian Public Health Agency (GÖG), and the University College of Teacher Education Tyrol (PHT) conducted a health literacy study. We developed a performance-based test for Austrian students aged 9-13, assessing their ability to find, appraise, understand, and apply health information across three domains: nutrition, physical health, and psychosocial health [3].

The results were sobering. Neither age nor grade level were significant predictors of health literacy. In other words, students did not seem to build health literacy skills as they progressed through school or grew older during this critical phase of development (see Figure).

Variation in Health Literacy Scores by Grade. This figure presents health literacy scores ranging from 0 to 100 across different grade levels, divided into three domains. a Nutrition (n = 718), b Physical Activity (n = 751), and c Psychosocial Health (n = 701). Thick points represent mean values with 95% confidence intervals, while the underlying distribution of data is illustrated through violin plots and jittered observations

This raises the question: how are young people expected to become health literate as they approach adulthood? Many students complete lower secondary school at age 14 and enter a pre-vocational school year focused on employability and practical skills. Others transition to academic high schools, where health topics are more likely to be addressed – potentially further deepening existing disparities.

So where do we go from here? The responsibility cannot fall solely on individual teachers. What’s needed are structural reforms to integrate health more meaningfully into school curricula. One option is to introduce health as a standalone subject, taught by trained and well-equipped educators.

Alternatively, the cross-curricular approach, which is currently pursued in Austria and embeds health topics across various subjects, could be further strengthened. However, this strategy would require significant time allocation – equivalent to that of dedicated subjects – and much greater investment in teacher training and professional development.

Crucially, all interventions must be evaluated based on measurable health literacy outcomes. Only then can we ensure that the next generation is equipped with the skills they need to navigate today's complex and often misleading health information environment.

References:

1. Technische Universität München. (2025, March 12). Gesundheitskompetenz in Deutschland weiter gesunken. https://www.tum.de/aktuelles/alle-meldungen/pressemitteilungen/details/gesundheitskompetenz-in-deutschland-weiter-gesunken

2. World Health Organization. (n.d.). Social determinants of health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

3. Heiss, R., Leuprecht, E., Zoller, C., Schütze, D., Sahling, F., Schamberger, L., Überall, M., Gell, S., & Griebler, R. (2025). Does school education enhance children's health literacy? Zeitschrift für Bildungsforschung. https://doi.org/10.1007/s35834-025-00477-6 

Animated graph is generated with OpenAI's DALL-E.