George Isham, senior advisor at HealthPartners and senior fellow at the HealthPartners Institute for Education and Research, opened the workshop with a brief history. In 2004, the Institute of Medicine (IOM) released Health Literacy: A Prescription to End Confusion, a report on the then-underappreciated challenge of “enabling patients to comprehend their condition and treatment, to make the best decisions for their care, and to take the right medications at the right time in the intended dose” (IOM, 2004, p. xi). In that report, the IOM’s Committee on Health Literacy documented the problems, origins, and consequences of the fact that tens of millions of U.S. adults are unable to read complex texts, including many health-related materials, and it proposed possible solutions to those problems. The committee stated the importance of health literacy—the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions—and it laid out a comprehensive strategy to improve health literacy in America.
In that same year, the Agency for Healthcare Research and Quality (AHRQ) published a systematic review and analysis of evidence about the relationship between health literacy and health outcomes and the effective-
1 The planning committee’s role was limited to planning the workshop, and this summary has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the IOM, nor should they be construed as reflecting any group consensus.
ness of interventions to mitigate the impact of low literacy (AHRQ, 2004). In that same year, the National Institutes of Health (NIH) and AHRQ announced the availability of funding for research on health literacy concepts, theory and interventions as they related to the U.S. Department of Health and Human Services (HHS) and public health priorities.
One outcome from newfound attention being paid to health literacy was the IOM’s decision in 2006 to create the Roundtable on Health Literacy as a means of holding ongoing, regular discussions on the challenges facing health literacy research and practice, and identifying approaches to promote health literacy through mechanisms and partnerships in both the public and private sectors. To commemorate the anniversary of the release of the report that led to its inception, the Roundtable convened a 1-day public workshop to assess the progress made in the field of health literacy over the past decade, the current state of the field, and the future of health literacy at the local, national, and international levels (see Box 1-1). Isham noted, “The field has moved a considerable amount in this last decade, some of it as a result of our activity. It is very appropriate for us to pause and take note, see where we have come, and to reflect upon on what we hear today and talk about the future challenges and future opportunities.”
Victor Dzau, the recently inaugurated president of the IOM, remarked from his perspective as a cardiologist and the former chancellor for health affairs at Duke University and the president and chief executive officer (CEO) of the Duke University Health System, how important health literacy is for addressing the social determinants of health and the health disparities that exist in the U.S. health care system. He also pointed out that the lack of health literacy costs the United States more than $100 billion annually and that efforts to reduce this astounding number must focus not just on helping patients learn more, but also on aligning health systems so that they communicate information in a health-literate manner. “We need to make sure that we respect people’s skills, abilities, and values so they can maximize the learning they can have and understand the choices they need to make,” said Dzau.
Research, he added, has illuminated the nature of the relationship between health literacy and health outcomes. He observed that U.S. health care organizations have responded to the challenge of increasing health literacy, thanks in part to the efforts of the Roundtable to increase awareness of these issues. He noted that in the 10 years since the release of the IOM’s report on health literacy that drug and food labels have improved, that health professionals have been exploring creative ways of communicating with patients, and that academic medical centers are increasing their focus on health literacy, particularly in the way they train health professionals. He also cited how technology is now being used to measure and assess whether patients are processing health information.
Workshop Statement of Task
An ad hoc committee will plan and conduct a public workshop to commemorate the 2004 release of the Institute of Medicine report Health Literacy: A Prescription to End Confusion. The workshop will feature invited presentations and discussions of the field of health literacy since the release of the report. The topics may include the progress made in the field of health literacy in the past 10 years, the current state of the field, and the future of health literacy at the local, national, and international level. The committee will define the specific topics to be addressed, develop the agenda, select and invite speakers and other participants, and moderate the discussions. An individually authored summary of the presentations and discussions at the workshop will be prepared by a designated rapporteur in accordance with institutional guidelines.
Examples of the topics the workshop covered included health literacy at HHS and the U.S. Food and Drug Administration (FDA); the progress made and challenges remaining with regard to creating health-literate health care delivery and medication orders; the role of education in health literacy; the impact of the Affordable Care Act (ACA) on health literacy; and the future of health literacy. In planning and convening this workshop, the Roundtable hoped to expand the network of those involved in health literacy research and practice and to explore areas in which the nation needs to redouble its efforts to making all communications between health care professionals and their patients and families understandable and actionable.
The workshop (see Appendix A for the agenda) was organized by an independent planning committee in accordance with the procedures of the National Academy of Sciences. The planning committee included Luis Bravo from the Office of the Commissioner at FDA and designated federal officer on the Risk Communication Advisory Committee; Terry Davis, professor of medicine and pediatrics at the Louisiana State University Health Sciences Center in Shreveport; George Isham; Michael Paasche-Orlow, associate professor of medicine at the Boston University School of Medicine; Scott Ratzan, vice president for global corporate affairs at Anheuser-Busch InBev; Rima Rudd, senior lecturer on health literacy, education, and policy at the Harvard School of Public Health; and Winston Wong, medical director for Community Benefit and director of Disparities Improvement and Quality Initiatives at Kaiser Permanente. This publication summarizes
the discussions that occurred throughout the workshop, highlighting the key lessons presented, practical strategies, and the needs and opportunities for improving health literacy in the United States. Chapter 2 provides an overview of health literacy activities at HHS. Chapter 3 discusses health literacy and medications; Chapter 4 discusses the role that health literacy plays in delivering high-quality, patient-centered health care; and Chapter 5 reviews what has been happening in the area of education and health literacy. Chapter 6 recounts the panel discussion that looked at the future of health literacy, and Chapter 7 covers the Roundtable’s discussions of where the field of health literacy needs to go and its reflections on the key lessons learned at this workshop.
In accordance with the policies of the IOM, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the organizing committee’s role was limited to planning the workshop. The workshop summary has been prepared by workshop rapporteur Joe Alper as a factual summary of what occurred at the workshop.