Board on Population Health and Public Health Practice Roundtable on Health Literacy The First 5 Years: 2006 2011
Message from the Chair George Isham A little more than a decade ago, health literacy was largely unrecognized as a foundational element for high-quality, patient-centered care. Since that time, great strides have been made in research and measurement of health literacy, in engaging multiple stakeholders to mount efforts to improve health literacy, and in understanding that health literacy encompasses more than the skills and abilities of individuals; it also includes the demands and complexities of the health care system with which individuals must interact. However, low health literacy remains a significant problem in the United States, with more than 80 million adults having poor health literacy. The Institute of Medicine Roundtable on Health Literacy was established to bring together leaders from academia, industry, government, foundations, and associations, and representatives of patient and consumer interests who have an interest and role in improving health literacy. The mission of the Roundtable is to engage each sector in actively participating in developing policies, sharing knowledge, and building the skills necessary to create a health literate society by providing a forum for discussion and exchange of knowledge and expertise. Since its first workshop in 2006, the Roundtable has held 14 workshops and published 11 reports. Reports have addressed a range of health literacy issues, including medication labeling, the Food and Drug Administration Safe Use Initiative, use of electronic health records, health care reform, and the integration of health literacy with disparities reduction and quality improvement. The Roundtable has established working groups to explore and develop activities addressing health literacy and health insurance reform, international health literacy, what makes an organization health literate, and public health literacy.
As stated in the Roundtable s discussion paper Attributes of a Health Literate Organization, addressing health literacy is critical to transforming health care quality. Goals for safe, patient-centered, and equitable care cannot be achieved if consumers cannot access services or make informed health care decisions. We look forward to another year during which the Roundtable will develop activities aimed at improving health literacy and equitable, patient-centered health interventions. George Isham Chair
Roundtable Activities The Roundtable on Health Literacy brings together experts from academia, private companies, state and local governments, foundations, and nonprofit groups to discuss the challenges facing health literacy research and practice and identify approaches to promote health literacy through mechanisms and partnerships in both the public and private sectors. Since its inception in 2006, the Roundtable has held 14 meetings, produced 9 workshop summaries, authored 2 discussion papers, and commissioned 4 papers by experts in the field. A wide variety of topics has been covered, including the standardization of medication labels, electronic health communication, measures of health literacy, and the attributes of a health literate organization. The most recent workshops are discussed below. Oral Health Literacy Workshop (Washington, DC, March 2012) Oral health is essential to general health and well-being and can be achieved by all Americans, yet the public and many health care providers are largely unaware of the basic risk factors and preventive regimens for many oral diseases and often do not recognize the connection between good oral health and overall health and well-being. Furthermore, there are profound disparities that tend to be concentrated among the most vulnerable that is, those who are poor, have a limited level Oct. 12 Workshop Standardizing Medication Labels: Confusing Patients Less ROUNDTABLE ACTIVITIES TIMELINE 2007 2008
of education, racial and ethnic minorities, and the elderly. These are essentially the same individuals who have low levels of health literacy. The Roundtable held a workshop examining the importance of oral health literacy, the role of health literacy in promoting oral health, effective oral health literacy programs, and state and national activities on oral health literacy. The workshop will be summarized in Oral Health Literacy: (forthcoming, 2012). Roundtable Activities Attributes of a Health Literate Organization (November 2011) Health literacy research has focused primarily on individual skills and abilities, and on the relationship between a patient s health literacy and health outcomes. However, health literacy depends not only on individual factors, but also on health care system demands and complexity. Organizations can play a large role in improving health literacy by addressing system-level factors that place demands on all patients. At the request of the Roundtable, Dr. Dean Schillinger and Dr. Debra Keller of the University of California, San Francisco, prepared a paper on the attributes of a health literate organization. Following the presentation of this paper, providers from different types of health care organizations offered feedback, as did individuals from organizations that can or do provide incentives for action. Using Schillinger and Keller s paper and the feedback of workshop attendees, a workgroup from the Roundtable published two discussion papers: Attributes of a Health Literate Organization and Ten Attributes of Health Literate Health Care Organizations. The workshop will be summarized in the publication How Can a Health Care Organization Become More Health Literate?: (forthcoming, 2012). March 17 Workshop Health Literacy, ehealth, and Communication: Putting the Consumer First April 22 Publication Standardizing Medication Labels: Confusing Patients Less:
Facilitating State Health Exchange Communication Through the Use of Health Literate Practices (July 2011) The Patient Protection and Affordable Care Act (ACA) of 2010 will extend coverage to millions of uninsured Americans through a variety of methods, including state health exchanges, where small businesses and people not covered by their employer can shop for insurance at competitive rates. Many of the people eligible for insurance through the exchanges have low health literacy. The Roundtable held a workshop focused on the ways health literacy practices can help facilitate state health exchange communication. The workshop examined lessons learned from existing state insurance exchanges, the impact of exchanges on consumers, the relevance of health literacy to exchanges, and current best practices in developing materials and communicating with consumers. The workshop is summarized in the publication Facilitating State Health Exchange Communication Through the Use of Health Literate Practices:. Understanding What Works in Improving Health Literacy Across a State (November 2010) More than 90 million American adults have difficulty understanding and using health information. The Roundtable collaborated with the University of California, Los Angeles, Anderson School of Management to sponsor a workshop in Los Angeles on improving health literacy within a state. Workshop presentations and discussions focused on the clinical and economic impacts of health literacy interventions, and on the role of various stakeholders in improving health literacy. The workshop is summarized in the publication Improving Health Literacy Within a State:. Feb. 26 Workshop Measures of Health Literacy 2009 March 24 Publication Health Literacy, ehealth, and Communication:
Roundtable Activities Health Literacy and Health Care Reform (November 2010) The ACA is groundbreaking legislation that extends health care access to 32 million previously uninsured Americans. While health literacy is referenced in only four provisions of the law, the goals of the ACA cannot be achieved without addressing health literacy issues. The Roundtable commissioned a paper on the implications of health literacy for health care reform, then held a workshop at which the both the paper and reactions to it were presented to explore opportunities. Participants in the workshop examined ways to improve health literacy alongside efforts to expand coverage, provide equitable care, and improve health care quality. The workshop is summarized in the publication Health Literacy Implications for Health Care Reform:. Sept. 15 Workshop Integrating Health Literacy in Prevention Programs April 27 Workshop The Safe Use Initiative and Health Literacy 2010 Dec. 8 Publication Measures of Health Literacy:
What s New in Health Literacy Research (May 2010) The problems of low health literacy are recognized and researchers are now trying to determine how best to address those problems. The Roundtable held a workshop that explored ways to build the health literacy research field, the relationship of health literacy research to research on health disparities, and applications of health literacy in building health information technology systems. The workshop also included the public release of the National Action Plan to Improve Health Literacy. The publication Innovations in Health Literacy Research: summarizes the workshop. The Safe Use Initiative and Health Literacy (April 2010) Millions of people take prescription and over-the-counter medications, but when used improperly, these medications can result in illness, injury, or death. To help combat medication errors and adverse effects, the Food and Drug Administration developed the Safe Use Initiative. The Roundtable held a workshop to discuss the health literacy implications of the Safe Use Initiative. Presentations and discussion focused on the challenges in educating consumers about over-the-counter medications and current drug safety efforts undertaken by numerous stakeholders. Participants also suggested ways to improve the Safe Use Initiative. The workshop is summarized in the publication The Safe Use Initiative and Health Literacy:. May 27 Workshop What s New in Health Literacy Research Nov. 10 Workshop Health Literacy and Health Care Reform Dec. 1 Publication The Safe Use Initiative and Health Literacy: 2011 Nov. 30 Workshop Understanding What Works in Improving Health Literacy Across a State
Integrating Health Literacy into Prevention and Wellness Programs (September 2009) Prevention is an effective way to improve health while reducing health care costs, and several studies show that increased health literacy results in an increased use of preventive services. The Roundtable met in Washington, DC, to discuss effective methods to integrate health literacy in primary and secondary prevention. A commissioned paper on the topic was written by Dr. Scott C. Ratzan and presented at the workshop. Reactions to the paper were provided, as were presentations on the intersection of health literacy and public health prevention programs, insurance organization approaches to integrating health literacy into prevention programs, and industry contributions to providing health literate primary and secondary prevention. The workshop is summarized in the publication Promoting Health Literacy to Encourage Prevention and Wellness:. Roundtable Activities March 10 Publication Innovations in Health Literacy: July 15 Publication Health Literacy Implications for Health Care Reform: July 19 Workshop Facilitating State Health Exchange Communication Through the Use of Health Literate Practices
The Roundtable on Health Literacy Measures of Health Literacy (February 2009) Measuring health literacy is difficult for a variety of reasons. For example, health literacy is more than the ability to read and process information and is affected by system-level complexities and demands. A workshop was held to explore the issue of measures of health literacy. The workshop included presentations on the current status of measures of health literacy (including those used in health care settings), surrogate measures that might be used, and ways in which health literacy measures can be used to assess patient-centered approaches to care. The workshop is summarized in the publication Measures of Health Literacy:. The Roundtable on Health Literacy ehealth and Health Literacy (March 2008) Innovation has made it easier to create interactive health information technologies. These ehealth technologies improve access to personal health records and care and make it easier to create health education tools. However, not all people have equal access to the Internet or the requisite abilities to find and understand health information, which can exacerbate or create disparities. To identify and examine these issues, the Roundtable sponsored a workshop on ehealth and health literacy. Presenters provided a broad overview of current health communication technologies, particularly focused on electronic health record systems. They also examined the challenges of technology use for populations with low health literacy and strategies to increase the benefit of health communication technologies for underserved populations. The workshop is summarized in the publication Health Literacy, ehealth, and Communication: Putting the Consumer First:. Nov. 1 Publication Promoting Health Literacy to Encourage Prevention and Wellness: Nov. 16 Workshop Attributes of a Health Literate Organization March 29 Workshop Oral Health Literacy 2012 Nov. 14 Publication Improving Health Literacy Within a State: Feb. 14 Publication Facilitating State Health Exchange Communication Through the Use of Health Literate Practices:
Changing Prescription Medication Use Container Instructions to Improve Health Literacy and Medication Safety (October 2007) Medication labels are a patient s main source of information on the drug that has been prescribed and its proper use, but labels are often confusing and poorly written. Directions can be ambiguous and the dose amounts are often listed in one measurement system while the dosing device is calibrated in another. Confusion about labels contributes to misuse of medication, which causes more than 1 million hospitalizations annually and can lead to death. People with low health literacy are more likely to make dangerous errors when reading a prescription label. The Roundtable organized a workshop to examine what is known about how medication container labeling affects patient safety and to discuss approaches to addressing identified problems. The workshop is summarized in the publication Standardizing Medication Labels: Confusing Patients Less:. Roundtable Activities
Future Activities International Health Literacy (New York, NY, September 24, 2012) Traditionally, the Roundtable has focused its efforts on health literacy in the United States, but there are many strong health literacy programs and research efforts worldwide. International collaboration can harness the United States efforts, Europe s multilingual and multinational experience, and developing nations community-based programs to create robust programs and research that reach people, based not on language or nationality, but on need and value. The Roundtable will explore ways to bring international health literacy programs together and share experiences and best practices.
Workshop Summaries Released by the Roundtable Future Activities Standardizing Medication Labels: Confusing Patients Less: Released: April 22, 2008 Health Literacy, ehealth, and Communication: Putting the Consumer First: Released: March 24, 2009 Measures of Health Literacy: Released: December 8, 2009 The Safe Use Initiative and Health Literacy: Released: December 1, 2010 Innovations in Health Literacy Research: Released: March 10, 2011 Health Literacy Implications for Health Care Reform: Released: July 15, 2011 Promoting Health Literacy to Encourage Prevention and Wellness: Released: November 1, 2011 Improving Health Literacy Within a State: Released: November 14, 2011 Facilitating State Health Exchange Communication Through the Use of Health Literate Practices: Released: February 14, 2012
Roundtable Members George Isham (Chair) HealthPartners, Inc. Wilma Alvarado-Little University at Albany Cindy Brach Agency for Healthcare Research and Quality Benard Dreyer New York University School of Medicine Leonard Epstein Health Resources and Services Administration Laurie Francis Association of Clinicians for the Underserved/Oregon Primary Care Association Deborah Fritz GlaxoSmithKline Martha Gragg Missouri Foundation for Health Jill Griffiths Aetna Foundation Linda Harris U.S. Department of Health and Human Services Betsy Humphreys National Library of Medicine Joan Kelly Humana Jean Krause American College of Physicians Foundation Margaret Loveland Merck & Co., Inc. Patrick McGarry American Academy of Family Physicians Ruth Parker Emory University School of Medicine Kavita Patel The Brookings Institution Clarence Pearson Independent Consultant Susan Pisano America s Health Insurance Plans Andrew Pleasant Canyon Ranch Institute Scott Ratzan Johnson & Johnson Will Ross Washington University School of Medicine Rima Rudd Harvard School of Public Health Steven Rush UnitedHealth Group Paul Schyve Joint Commission on Accreditation of Healthcare Organizations Patrick Wayte American Heart Association Winston Wong Kaiser Permanente
Roundtable Sponsors Aetna Foundation Agency for Healthcare Research and Quality American College of Physicians Foundation America s Health Insurance Plans GlaxoSmithKline Health Resources and Services Administration Humana Johnson & Johnson Pharmaceutical Research and Development, LLC Kaiser Permanente (East Bay Foundation) Merck & Co., Inc. Missouri Foundation for Health UnitedHealth Group Alliances Roundtable Members and Sponsors Federal 10% Nonprofit 39% 51% Industry
About the Roundtable The Roundtable on Health Literacy brings together leaders from academia, industry, government, foundations, and associations, and representatives of patient and consumer interests who work to improve health literacy. To achieve its mission, the Roundtable discusses challenges facing health literacy practice and research, and identifies approaches to promote health literacy through mechanisms and partnerships in both the public and private sectors. About the Institute of Medicine The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility assigned to the National Academy of Sciences by its congressional charter to serve as an adviser to the federal government and, upon its own initiative, to identify issues needing attention in the areas of medical care, research, and education. Roundtable Staff Lyla M. Hernandez Roundtable Director Angela Martin Senior Program Assistant Andrew Lemerise Research Associate Rose Marie Martinez Director, Board on Population Health and Public Health Practices The Institute of Medicine serves as adviser to the nation to improve health. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policy makers, health professionals, the private sector, and the public. The mission of the Institute of Medicine embraces the health of people everywhere.