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NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This activity was supported by contracts between the National Academy of Sciences and Aetna Foundation; the Agency for Healthcare Research and Quality (HHSP233200900537P); America’s Health Insurance Plans; California Dental Association; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Resources and Services Administration (HHSH25034004T); Humana; Johnson & Johnson; Merck and Co., Inc.; North Shore–Long Island Jewish Health System; Office of Disease Prevention and Health Promotion; and UnitedHealth Group. The views presented in this publication are those of the rapporteur and do not necessarily reflect the views of the organizations or agencies that provided support for the activity.
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Suggested citation: IOM (Institute of Medicine). 2014. Implications of health literacy for public health: Workshop summary. Washington, DC: The National Academies Press.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.
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 given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.
PLANNING COMMITTEE ON IMPLICATIONS OF HEALTH LITERACY FOR PUBLIC HEALTH1
OLIVIA CARTER-POKRAS, Associate Professor, University of Maryland, College Park, School of Public Health
JENNIFER DILLAHA, Director, Department of Health, Center for Health Advancement
PATRICK McGARRY, Senior Manager, Health Activities and Programs, American Academy of Family Physicians
TERRI ANN PARNELL, President of Health Literacy and Patient Education, North Shore–Long Island Jewish Health System
ANDREW PLEASANT, Health Literacy and Research Director, Canyon Ranch Institute
LINDSEY ROBINSON, President, California Dental Association
RIMA RUDD, Senior Lecturer on Health Literacy, Education, and Policy, Harvard School of Public Health
STEVEN RUSH, Director, Health Literacy Innovations, UnitedHealth Group
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1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
ROUNDTABLE ON HEALTH LITERACY1
GEORGE ISHAM (Chair), Medical Director and Chief Health Officer, HealthPartners
WILMA ALVARADO-LITTLE, Director, Community Engagement/Outreach Center for the Elimination of Minority Health Disparities, University of Albany
CINDY BRACH, Senior Health Policy Researcher, Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality
GEMIRALD DAUS, Public Health Analyst, Health Resources and Services Administration, Office of Health Equity
DARREN DEWALT, Associate Professor of Medicine, University of North Carolina at Chapel Hill
BENARD P. DREYER, Professor of Pediatrics, New York University School of Medicine, and Chair, American Academy of Pediatrics Health Literacy Program Advisory Committee
ELIZABETH FOWLER, Vice President, Global Health Policy, Johnson & Johnson Co.
LAURIE FRANCIS, Senior Director of Clinic Operations and Quality, Oregon Primary Care Association
LORI HALL, Consultant, Health Education, Eli Lilly and Company
LINDA HARRIS, Team Leader, Health Communication and eHealth Team, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services
BETSY L. HUMPHREYS, Deputy Director, National Library of Medicine
MARGARET LOVELAND, Global Medical Affairs, Merck & Co., Inc.
PATRICK MCGARRY, Assistant Division Director, Scientific Activities Division, American Academy of Family Physicians
RUTH PARKER, Professor of Medicine, Emory University School of Medicine
TERRI ANN PARNELL, Vice President, Health Literacy and Patient Education, North Shore–Long Island Jewish Health System
KIM PARSON, Consumer Experience, Humana, Inc.
KAVITA PATEL, Managing Director for Clinical Transformation and Delivery, The Brookings Institution
CLARENCE PEARSON, Consultant, Global Health Leadership and Management
____________
1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
SUSAN PISANO, Vice President of Communications, America’s Health Insurance Plans
ANDREW PLEASANT, Health Literacy and Research Director, Canyon Ranch Institute
LINDSEY ROBINSON, President, California Dental Association
RIMA RUDD, Department of Society, Human Development and Health, Harvard School of Public Health
STEVEN RUSH, Director, Health Literacy Innovations Program, UnitedHealth Group
PAUL M. SCHYVE, Senior Vice President, The Joint Commission
PATRICK WAYTE, Vice President, Marketing and Health Education, American Heart Association
WINSTON F. WONG, Medical Director, Community Benefit, Disparities Improvement and Quality Initiatives, Kaiser Permanente
Study Staff
LYLA M. HERNANDEZ, Roundtable Director
MELISSA FRENCH, Associate Program Officer
ANDREW LEMERISE, Research Associate
ANGELA MARTIN, Senior Program Assistant
ROSE MARIE MARTINEZ, Director, Board on Population Health and Public Health Practice
Reviewers
This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:
Helen Osborne, Health Literacy Consulting
Dionne J. Richardson, Mississippi State Department of Health
Steven Rush, UnitedHealth Group
Carol Teutsch, Health Care Institute
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Hugh Tilson, University of North Carolina School of Public Health. Appointed by the Institute of Medicine, he was responsible for
making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution.
Acknowledgments
Without the support of the sponsors of the Institute of Medicine Roundtable on Health Literacy it would not have been possible to plan and conduct the workshop on health literacy and public health which this report summarizes. Sponsorship for the Roundtable comes from Aetna Foundation, the Agency for Healthcare Research and Quality, America’s Health Insurance Plans, California Dental Association, East Bay Community Foundation (Kaiser Permanente), Eli Lilly and Company, Health Resources and Services Administration, Humana, Johnson & Johnson, Merck and Co., Inc., North Shore–Long Island Jewish Health System, Office of Disease Prevention and Health Promotion, and UnitedHealth Group.
The Roundtable wishes to express its appreciation to the speakers at the workshop who provided presentations that stimulated discussion and encouraged exploration of issues surrounding the use of health literacy to facilitate public health interventions. The speakers are Chloe E. Bird, Don Bishop, Susan Bockrath, Jennifer Cabe, Olivia Carter-Pokras, Gabriel M. Cortez, Jennifer Dillaha, Torrie T. Harris, Alice Horowitz, Linda Neuhauser, Andrew Pleasant, Rima Rudd, Dean Schillinger, and Jose Vadi.
The Roundtable would also like to thank the members of the planning committee for their efforts in developing an excellent workshop agenda. Members of the planning committee were Olivia Carter-Pokras, Jennifer Dillaha, Patrick McGarry, Terri Ann Parnell, Andrew Pleasant, Lindsey Robinson, Rima Rudd, and Steven Rush.
Contents
Reframing Health Literacy as a Public Health Issue
Presentation of Commissioned Paper
3 CURRENT HEALTH DEPARTMENT EFFORTS IN HEALTH LITERACY
4 HEALTH LITERACY FACILITATES PUBLIC HEALTH EFFORTS
Applying Health Literacy Principles to Public Health Efforts in Preparedness and Nutrition
The Bigger Picture: Harnessing Youth Voices to Improve Public Health Literacy in Diabetes
5 SUPPORTING PUBLIC HEALTH IMPLEMENTATION AND RESEARCH
Departments of Public Health: Workforce Development
Academia: Professional Training and Certification
6 REFLECTIONS ON THE PRESENTATIONS AND DISCUSSION
C Commissioned Paper: A Prescription Is Not Enough: Improving Public Health with Health Literacy
Boxes, Figures, and Tables
BOXES
3-1 Behavioral Risk Factor Surveillance Survey Health Literacy Items
4-1 Seven Steps to Create Public Health “Clear Communication,”
5-1 Center for Health Promotion Health Literacy Workshop Agenda
5-2 Accreditation Standards for Public Health Agencies
FIGURES
2-1 Essential public health services
2-3 Percentage of population with “above basic” health literacy
2-4 Missing information can lead you in the wrong direction
2-5 Health literacy within state departments of public health
3-1 Arkansas Department of Health strategic map
4-3 Poster providing guidance on preventive dental care
5-1 Status of accreditation of public health departments
TABLES
2-1 Actions Needed in the Provision of Public Health’s Essential Services
2-2 Perceived Relevance of the 10 Attributes of a Health-Literate Organization
2-3 Health Literacy Activities Within Public Health Departments