Health Literacy
Past, Present, and Future
Workshop Summary
Joe Alper, Rapporteur
Roundtable on Health Literacy
Board on Population Health and Public Health Practice
Institute of Medicine
The National Academies of
SCIENCES • ENGINEERING • MEDICINE
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by contracts between the National Academy of Sciences and the Aetna Foundation; the Agency for Healthcare Research and Quality (HHSP233200900537P); the California Dental Association; the East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Missouri; Health Resources and Services Administration (HHSH25034004T); Humana; the Institute for Healthcare Advancement; Merck & Co., Inc; National Institutes of Health; North Shore–Long Island Jewish Health System; Office of Disease Prevention and Health Promotion; and UnitedHealth Group. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.
International Standard Book Number-13: 978-0-309-37154-4
International Standard Book Number-10: 0-309-37154-6
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Suggested citation: The National Academies of Sciences, Engineering, and Medicine. 2015. Health literacy: Past, present, and future: Workshop summary. Washington, DC: The National Academies Press.
The National Academies of
SCIENCES • ENGINEERING • MEDICINE
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.
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PLANNING COMMITTEE ON HEALTH LITERACY:
PAST, PRESENT, AND FUTURE1
LUIS BRAVO, Designated Federal Official, Risk Communication Advisory Committee, Office of Planning, Office of the Commissioner, U.S. Food and Drug Administration
TERRY DAVIS, Professor of Medicine and Pediatrics, Louisiana State University Health Sciences Center in Shreveport
GEORGE J. ISHAM, Senior Advisor, HealthPartners, Senior Fellow, HealthPartners Institute for Education and Research
MICHAEL PAASCHE-ORLOW, Associate Professor of Medicine, Boston University School of Medicine
SCOTT RATZAN, Vice President, Global Corporate Affairs, Anheuser-Busch InBev; Editor-in-Chief, Journal of Health Communication: International Perspectives
RIMA RUDD, Senior Lecturer on Health Literacy, Education, and Policy, Harvard School of Public Health
WINSTON F. WONG, Medical Director, Community Benefit, Director, Disparities Improvement and Quality Initiatives, Kaiser Permanente
____________________
1Institute 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 rapporteur and the institution.
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ROUNDTABLE ON HEALTH LITERACY1
GEORGE J. ISHAM (Chair), Senior Advisor, HealthPartners, Senior Fellow, HealthPartners Institute for Education and Research
MARIN P. ALLEN, Deputy Associate Director for Communications and Public Liaison and Director of Public Information, National Institutes of Health
WILMA ALVARADO-LITTLE, Director, Community Engagement/ Outreach, University at Albany
CINDY BRACH, Senior Health Policy Researcher, Agency for Healthcare Research and Quality
GEM DAUS, Public Health Analyst, Health Resources and Services Administration
LAURIE FRANCIS, Senior Director of Clinic Operations and Quality, Oregon Primary Care Association
GARTH GRAHAM, President, Aetna Founation
LORI HALL, Consultant, Health Education, Eli Lilly and Company
LINDA HARRIS, Division Director, Health Communication and eHealth Team, U.S. Department of Health and Human Services
BETSY L. HUMPHREYS, Deputy Director, National Library of Medicine
MARGARET LOVELAND, Senior Director, Global Medical Affairs, Merck & Co., Inc.
LAURIE MYERS, Leader of Health Care Disparities and Health Literacy Strategy, Merck & Co., Inc.
CATINA O’LEARY, President and Chief Executive Officer, Health Literacy Missouri
RUTH PARKER, Professor of Medicine, Pediatrics, and Public Health, Emory University School of Medicine
KIM PARSON, Consumer Experience Center of Excellence, Humana
KAVITA PATEL, Managing Director for Clinical Transformation and Delivery, The Brookings Institution
ANDREW PLEASANT, Senior Director for Health Literacy and Research, Canyon Ranch Institute
LINDSEY A. ROBINSON, President, California Dental Association
STACEY ROSEN, Associate Professor of Cardiology and Vice President, Women’s Health, The Katz Institute for Women’s Health, Hofstra North Shore–LIJ School of Medicine
____________________
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 rapporteur and the institution.
BERNARD ROSOF, Professor of Medicine, Hofstra North Shore–LIJ School of Medicine
RIMA RUDD, Senior Lecturer on Health Literacy, Education, and Policy, Harvard School of Public Health
STEVEN RUSH, Director, Health Literacy Innovations, UnitedHealth Group
PAUL M. SCHYVE, Senior Advisor, Quality Improvement, The Joint Commission
MICHAEL VILLAIRE, Chief Executive Officer, Institute for Healthcare Advancement
PATRICK WAYTE, Vice President, Marketing and Health Education, American Heart Association
WINSTON WONG, Medical Director, Community Benefit, Director, Disparities Improvement and Quality Initiatives, Kaiser Permanente
IOM Staff
LYLA M. HERNANDEZ, Roundtable Director
MELISSA FRENCH, Associate Program Officer
ANDREW LEMERISE, Research Associate
EMILY VOLLBRECHT, Senior Program Assistant (beginning April 6, 2015)
ANGELA MARTIN, Senior Program Assistant (through April 3, 2015)
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:
Jennifer Dillaha, Arkansas Department of Health
Alice Horowitz, University of Maryland
Terri Ann Parnell, Health Literacy Partners, LLC
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 Harold J. Fallon, School of Medicine, University of Alabama at Birmingham. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this workshop sum-
mary 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 rapporteur and the institution.
Acknowledgments
The sponsors of the Roundtable on Health Literacy have made it possible to plan and conduct the workshop Health Literacy: Past, Present, and Future, which this report summarizes. Sponsors from the U.S. Department of Health and Human Services are the Agency for Healthcare Research and Quality, Health Resources and Services Administration, the National Institutes of Health, and the Office of Disease Prevention and Health Promotion. Non-federal sponsorship was provided by the Aetna Foundation, the California Dental Association, the East Bay Community Foundation (Kaiser Permanente), Eli Lilly and Company, Health Literacy Missouri, Humana, the Institute for Healthcare Advancement, Merck & Co., Inc., North Shore–Long Island Jewish Health System, and UnitedHealth Group.
The Roundtable wishes to express its appreciation to the following speakers at the workshop for their interesting and stimulating presentations: Terry Davis, Victor Dzau, Betsy Humphreys, George Isham, Howard Koh, Gerald McEvoy, Theresa Michele, Michael Paasche-Orlow, Ruth Parker, Scott Ratzan, Lindsey Robinson, Russell Rothman, Rima Rudd, Barbara Schuster, Steven Teutsch, Michael Wolf, Winston Wong, and Victor Wu.
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Contents
2 HEALTH LITERACY AT THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES: PROGRESS AND POSSIBILITIES
3 HEALTH LITERACY AND MEDICATIONS
Creating a Standard and Best Practices for Medication Prescription Labels
Health Literacy at the Food and Drug Administration
4 USE AND DELIVERY OF HEALTH CARE
Creating Health-Literate Health Care Delivery
Box and Figures
BOX
1-1 Workshop Statement of Task
FIGURES
3-1 Examples of the confusing array of warning labels on prescription pill bottles
3-2 A reprogrammed prescription label
3-3 A simpler, more straightforward medication instruction sheet
4-1 Many factors beyond those provided in the clinic impact health outcomes
4-2 Ten attributes of a health-literate organization
4-3 Measures with five or more attributes of a health-literate organization
ACA | Patient Protection and Affordable Care Act (Affordable Care Act) |
ACGME | Accreditation Council for Graduate Medical Education |
ACO | accountable care organization |
ACP | American College of Physicians |
ADA | American Dental Association |
AHRQ | Agency for Healthcare Research and Quality |
ASHP | American Society of Health-System Pharmacists |
CAMBRA | Caries Management by Risk Assessment |
CDA | California Dental Association |
CDC | Centers for Disease Control and Prevention |
CMI | Consumer Medication Information |
CMS | Centers for Medicare & Medicaid Services |
DOE | U.S. Department of Education |
EHR | electronic health record |
FDA | U.S. Food and Drug Administration |
HHS | U.S. Department of Health and Human Services |
HIPAA | Health Insurance Portability and Accountability Act |
HRSA | Health Resources and Services Administration |
IHA | Institute for Healthcare Advancement |
IOM | Institute of Medicine |
LCME | Liaison Committee for Medical Education |
LGBTQ | lesbian, gay, bisexual, transgender, and queer |
NCPDP | National Council for Prescription Drug Programs |
NICHD | National Institute of Child Health and Human Development |
NLM | National Library of Medicine |
NSURE | Nonprescription Safe Use Regulatory Expansion |
OTC | over-the-counter (such as medications) |
PCORI | Patient-Centered Outcomes Research Institute |
PMI | Patient Medical Information document |
UMS | Universal Medication Schedule |
USP | U.S. Pharmacopeia |