This chapter is concerned with the difference of measuring health literacy of general population for purposes of public health as differentiated from measuring personal health literacy of individuals within health care services. The evolution of concept, measurement and empirical research of health literacy in the last decades is discussed, and the position of measuring comprehensive health literacy in general populations, especially by the European Health Literacy Survey (HLS-EU) study, is defined.

Main features of the HLS-EU conceptual and logic model, definition, instruments and study design are described. General results of the HLS-EU study are presented on the distribution of health literacy, its determinants and health related consequences, for the eight involved European countries as well as the total sample. These results principally confirm findings of earlier studies with somewhat different instruments and other kinds of samples, but also demonstrate considerable differences in distributions of health literacy and its relationships with relevant variables among and between the eight countries in a standardized comparative international study.

Follow-up studies based on the original HLS-EU study are mapped. In addition, the factors for the relative easy and widespread use of the instrument and research methodology by similar studies in other countries in Europe and Asia are discussed. This chapter closes with an outlook on the challenges of further developments and take-ups.