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2 Background and Overview
Pages 3-30

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From page 3...
... Health literacy researchers can broaden their research focus to examine public health activities and to consider how existing research findings in the medical encounter can inform public health communication needs. In so doing, researchers can partner with public health professionals to help them integrate health literate approaches into their ongoing work.
From page 4...
... The consequences of having a mismatch between health system demands and population literacy skills include limited access to information, barriers to services and care, and difficulties navigating health and social service institutions -- all of which can contribute to profound disparities in health, she said. Rudd suggested that not all relationships between health literacy and outcomes have been clearly documented yet, but that the field is advancing.
From page 5...
... She added that these organizational issues are relevant to both social service and public health institutions. Rudd described some of health literacy's tested approaches that can be of interest.
From page 6...
... Rudd concluded her remarks about multiple layers of risk with the social science finding that those with limited resources and limited social capital may also have diminished collective efficacy.1 To reduce disparities, Rudd outlined four areas where health literacy insights could be applied to public health services 1. Enhance the awareness and skills of the workforce.
From page 7...
... However, most of the work has focused on health care rather than on public health contexts. Rudd used a "connect the dots" exercise (see Figure 2-2)
From page 8...
... Thus, Rudd noted, additional health literacy work is needed in the areas of health promotion, protection, prevention, and systems navigation. Rudd suggested that partnerships between those working in health literacy be formed with public health practitioners so that a public health perspective to health literacy can be brought to bear on a diverse set of topics, such as water quality, emergency response, food safety, air quality, civic engagement, and policy decisions.
From page 9...
... She reiterated the potential for health literacy to play an important role in supporting public health goals and outlined several health literacy actions that could support the 10 essential public health services:   1. Monitor health status to identify community health problems.
From page 10...
... Bird described health literacy as a critical pathway through which education, income, and other resources, including community capital resources, affect health care quality, disparities, and outcomes. Identifying people with low health literacy is challenging and potentially very stigmatizing.
From page 11...
... This additional input has helped her deal with different health crises around aging and other concerns. Bird said this same person, were she living in an area with very low health literacy, would be more likely to receive information that is dated, incorrect, or aimed at solving other kinds of problems, such as how to balance the expense of medication with paying rent.
From page 12...
... When the health literacy map was overlaid with the prevalence map, low health literacy hotspots were identified with a relatively high prevalence. These areas could be targeted for public health interventions.
From page 13...
... This could occur if the intervention is not targeted appropriately and the most advantaged groups in a community benefit from the intervention, but the intended audience is missed. Figure 2-4 illustrates an example of this mismatch of intervention to target popu FIGURE 2-4  Missing information can lead you in the wrong direction.
From page 14...
... The focus of the commissioned paper is on local, state, tribal, and territorial public health organizations. To gauge the status of health literacy within state public health departments, the investigators used two main methods.
From page 15...
... Despite contacting each health department at least three times, only 24 of 51 health departments responded to the survey. Among the participants from state health departments: • Seven reported having a designated point of contact or someone whose responsibilities include health literacy (Arkansas, Delaware, Florida, Georgia, Kentucky, Oklahoma, Texas)
From page 16...
... Health Literacy Staff Member 16 No Formal Healh Literacy Efforts Reported Health Literacy Part of Work Health Literacy Point of Contact No Response FIGURE 2-5  Health literacy within state departments of public health. SOURCE: Pleasant, 2013.
From page 17...
... • Require public health agencies to report on the health literacy sta tus of the populations they serve on an annual basis. • Create incentives through policy, funding, and regulations for pub lic health organizations at all levels to engage with and demonstrate
From page 18...
... - Higher Than Relevant to the 2.5 Indicates More Agreement Than Average Organization's Disagreement n Response Mission Has leadership that makes health 61 2.9 0 literacy integral to its mission, structure, and operations Integrates health literacy into planning, 61 3.0 0 evaluation measures, patient safety, and quality improvement Prepares the workforce to be health 61 3.0 2 literate and monitors progress Includes populations served in the 61 2.9 0 design, implementation, and evaluation of health information and services Meets the needs of populations with 60 2.9 0 a range of health literacy skills while avoiding stigmatization Uses health literacy strategies in 59 2.7 2 interpersonal communications and confirms understanding at all points of contact Provides easy access to health 59 3.0 0 information and services and navigation assistance Designs and distributes print, 58 3.1 1 audiovisual, and social media content that is easy to act on and understand Addresses health literacy in high-risk 59 2.9 7 situations, including care transitions and communications about medicines Communicates clearly what health plans 59 2.8 19 cover and what individuals will have to pay for services SOURCE: Pleasant, 2013.
From page 19...
... (29.2%) members of intended audience Using health topics 46 1.9 13 15 18 to teach literacy (28.3%)
From page 20...
... Pleasant said that while the United States has conducted national assessments of literacy that sometimes include health literacy, there has never been a national literacy campaign. He noted that other nations have adopted health literacy policies within all public health organizations.
From page 21...
... McGarry asked the panel to comment on this situation and indicated that substantive advances could not be expected if public health practitioners and organizations are not held to health literacy standards. Panelist and roundtable member Rima Rudd commented that the process of diffusion of innovation is slow and that similar lags in adopting evidence-based practices can be seen in medicine, dentistry, and any of the social service fields.
From page 22...
... said that public health departments operate under severe constraints, including the public's lack of understanding of public health and its role in health promotion and disease prevention. He suggested that reframing how the public thinks about public health is an important health literacy challenge.
From page 23...
... Linda Neuhauser from the Health Research for Action Center at the School of Public Health at the University of California, Berkeley, in commenting on the results of the survey conducted by Pleasant, said that although there is usually no one person in most state health departments who can be identified as the health literacy champion or most knowledgeable person, she believes there are likely many health literacy–related activities going on in states, but it is very hard to get that information using a survey approach. Alice Horowitz from the University of Maryland School of Public Health agreed, saying that although Maryland shows up on that map as not reporting any formal efforts to address health literacy, in fact there is a lot of activity at the State Health Department.
From page 24...
... Wong recounted how the guidelines relied on a risk calculator that, when applied to the American population, would put a large percentage of the American public on these medications to lower the risk of heart disease. Wong asked the panel to reflect on how a public health department could help in communicating the complex issues that underlie this controversy.
From page 25...
... She also cited an example of the incorporation of health literacy into public health communications, a webinar, and print materials developed by AARP in collaboration with the American Occupational Therapy Association. The topic related to the need for adult children to talk to their parents about safe driving.
From page 26...
... Likewise, valuable health care resources are lost when patients do not understand how they were supposed to prepare for an expensive test or procedure. When providers experience these consequences of low health literacy and problematic areas can be mapped, then health plans can see the value of investing in resources to, for example, target follow-up phone calls to these areas to go over orally with a patient how they plan on getting to the appointment and what it means to come to the appointment prepared.
From page 27...
... In response to Rudd's comment on the need to use available tools, Schillinger described his experience completing his medical training during the peak of the AIDS epidemic. He witnessed how a health department effectively partnered with an empowered citizenry.
From page 28...
... . The reports conclude that public health is underfunded and make several recommendations, including that • an additional $12 billion be spent on public health incrementally; • a mechanism for raising that revenue be devised; and • a minimum set of essential services available through public health agencies be established.
From page 29...
... 2012a. Ten attributes of health literate health care organizations.
From page 30...
... ": Improving health literacy to protect patient safety. Oakbrook Terrace, IL: The Joint Commission.


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