Public Health Literacy

Public Health Literacy Implications of Health Literacy for Public Health IOM Round Table on Health Literacy Workshop Rima E. Rudd, Sc.D. MSPH Harvard School of Public Health

Public Health Mission & Goals Challenge: Address vulnerable & high risk populations & communities Health promotion Health protection Environmental health Occupational health Disease prevention & screening Disaster preparedness Mobilization Health Policy Data Collection & Dissemination Actions: Monitor Diagnose Inform Mobilize Develop Enforce Link Assure Evaluate Research Workforce Training & Development

Role of Health Literacy Consider: Applicable research findings Lessons learned Focus Added burden or Fit Partners for integration and expansion

Insights from Health Literacy Studies Patients literacy skills & links to health outcomes: effects on knowledge, behaviors, health measures, morbidity, mortality Access to health information: problems with health materials, documents, displays Health professionals actions: problems re: writing, speaking, exchanges Health care environments: tools for identifying barriers, calls for shame-free environments, articulation of health literate attributes

Insights from Health Literacy Studies Research Findings Limited literacy linked to health outcomes. Consequences: Differential participation in health promotion, disease prevention & screening Differential ability to manage a chronic disease Increased morbidity & mortality Mismatch between health system demands and population literacy skills. Consequences: Limited access to information Barriers to services and care Difficulties navigating institutions

Insights from Health Literacy Studies Studies Underway Current Examinations: Listening & speaking skills [of patients, of health care professionals] and links to health outcomes and action/advocacy. Needed change: remove barriers. Math skills and concepts [among patients, among health care professionals] and links to decision making, action, health activities. Needed change: do the math Institutional characteristics and barriers [Joint Commission, Environmental Assessments, IOM Roundtable] Needed Change: remove barriers, create shame free environments & literacy friendly exchanges

Insights from Health Literacy Studies Tested Approaches Tools for development & assessment of Information in print and on-line Procedures: formative research & piloting Language Organization Structure Techniques for improving interpersonal exchanges Question asking Teach-back Decision aids Value of increased participation and engagement [in clinic, in community] for decision making and action

Insights from Health Literacy Studies Needed Change Health information language, content, organization, structure, format In print On-line For speech Interpersonal exchanges Media Professional education & training Institutional norms & demands Processes & Procedures Assumptions Materials Assessment Tools Labels Data gathering instruments Media messaging

Insights from Health Literacy Studies Lessons Learned Action to enhance health literacy has to focus on both improving individual skills & making health service, education and information systems more health literacy friendly. Health literacy friendly systems and settings are ones which actively measure, monitor, evaluate and adjust their communications to meet the needs (and skills) of their users. Is there a fit with Public Health?

Fit Hygeia: Public Health Theoretical Foundation Social Ecological Model: Public Health derives from community concerns with the environment and the interaction between societies and their environment [human ecology] Epidemiology: Reciprocal relationship between persons & environment Social, Economic. Political Context Individuals Families Agencies Institutions Physical Environments Communities Multilevel Intersections & Interactions

Fit Public Health Mandate: Address Vulnerable Populations Limited literacy Limited access to information Limited ability to navigate Populations in Triple Jeopardy * Limited civic engagement Limited employment opportunities Limited Income Limited income background & income future Diminished Social Status and Marginalization Elders Minority populations Immigrants Environmental Exposures Poor housing stock Housing in areas of environmental degradation Hazardous work environments Limited Resources / Social Capitol Limited services Narrow opportunities Under-resourced neighborhoods Diminished collective efficacy Insights from Adult Literacy Surveys & analyses

Fit Public Health Mandate: Reduce Disparities Activities Work force development: raise awareness, enhance communication skills Reduce barriers to information in print, on line, media, interpersonal exchanges, contractual regulations [production of materials] Improve data collection & dissemination Enhance partnership developments

Integration Apply Health Literacy Insights Essential Public Health Services: Assessment Policy Development Assurance Research

Expansion: Contexts

Expansion Health Contexts Context as Metaphor

Exercise: Connect All 9 Dots Use only 4 lines Do not lift pen from paper

Context Imposed Parameters? Solution: Go Outside the Box

Contexts Health Care Settings Self Care & Maintenance Patients self care & follow-up Management of chronic disease Use of tools including labels & Rx

Health Settings: Health & Social Services Home Work Community Policy Arena Self Care & Maintenance Patients self care & follow-up Management of chronic disease Use of tools including labels & Rx

Health Activities: Promotion Protection Prevention Systems Navigation Health Settings: Health & Social Services Home Work Community Policy Arena Self Care & Maintenance Patients self care & follow-up Management of chronic disease Use of tools including labels & Rx

Health Activities: Promotion Protection Prevention Care Systems Navigation Health Settings: Health & Social Services Home Work Community Policy Arena Self-care & Maintenance Patients self care & follow-up Management of chronic disease Use of tools including labels & Rx Public Health Contexts

Home Safety Community Action Work Conditions & Exposures Commerce Regulation Water Quality Emergency Response Health Care Access & Quality Civic Engagement & Policy Decisions Food Safety Leisure Activities Air Quality Disaster Environmental Exposures Health Literacy Applications & Explorations

Public Health Literacy Public Health, an interdisciplinary field, is concerned with social organization and the culture that promotes and supports the survival of the group [Rene Dubos] Research & Practice Questions: How can public health efforts remove literacy related barriers to information, services, care, and action? How can public health literacy efforts support and encourage the capacity of communities to develop and engage in health promoting/enhancing action?

Applying Insights & Lessons Learned Consider: the policy and communication skills which determine the capability of health systems and the ability of health professionals to support and actively encourage effective social, political, and individual action for health Rudd. 2010 Rudd, McCray, Nutbeam. 2012

Public Health Literacy Challenges Implement/Evaluate professional CE/training programs Integrate applicable HL lessons learned Enhance communication efforts Contracting Development & design Piloting & modification Assessment procedures Develop, monitor, and evaluate health literacy components of community programs Test efficacious action Develop gold standards for practice

Time for Action Documented: Limited literacy skills of adults in many industrialized nations [US: 1992, 2003, 2006, 2012] Documented: Links between literacy and health outcomes Documented: Mismatch between demands and skills Business as usual is no longer possible /ethical Inequities/ Inequalities / Disparities Social Justice

Health promotion Health protection Disease prevention & screening Occupational health Environmental health Health Policy Mobilization Disaster preparedness Data Collection & Dissemination Reduce Disparities Address vulnerable & high risk populations & communities Health Literacy To Support Public Health Goals

Health Literacy to Support Essential Public Health Services Monitor health status to identify community health problems Diagnose and investigate health problems and health hazards in the community Inform, educate, and empower people about health issues Mobilize community partnerships to identify and solve health problems Develop policies and plans that support individual and community health efforts Enforce laws and regulations that protect health and ensure safety Link people to needed personal health services and assure the provision of health care when otherwise unavailable Assure a competent public health and personal health care workforce Evaluate effectiveness, accessibility, and quality of personal and population-based health services Research for new insights and innovative solutions to health problems

Health Literacy for Public Health Professionals Resource: CDC s on line health literacy course Http://www.cdc.gov/healthliteracy/gettrainingce.html