Having been on the IOM committee with Rima I want to emphasis the
importance of this finding from the report.  Health literacy is not a
function of an individual in our minds - but of individuals,
organizations, and communities.  I wish many times now that we had found
a way to put that in the definition and not in an explanatory note. 
 
The definition as it stands, as all of you know is: 
 
Health literacy is the degree to which individuals have the capacity to
obtain,process, and understand health information and services needed to
make appropriate health decisions.
 
It is just as important to ask-  Do I work in a health literate
organization?    Is my community health literate?  Is my program health
literate?  Rima and I, at least the two of us perhaps others, have been
working on measurement tools to measure an organization/community's
health literacy. Despite the rhetoric we continue to rely on
measurements that focus only on the individual. 
 
In the definition we used the word "individuals"  and everyone
interprets that to be patients.  Again we failed to clarify that a
physician is an individual. Nurses, pharmacists, family members,
pharmaceutical executives are also "individuals" who require "the
capacity to obtain, process, and understand basic health
information....."  A physician who does not have the capacity to illicit
useful information from a patient, to understand what impact information
he gives a patient will have on that patient's compliance, is not health
literate.  This is equally true for those us working in prevention - we
too are individuals who require the capacity to obtain, process and
understand health information about our audiences if we are ever to have
a health literate America.  
 
There is a second aspect of the definition which is often overlooked. 
It is the word "services".  Too much of our energy is going into making
written materials clear and in  training disadvantaged groups to
understand the stupid things we tell them.  The services word places
emphasis not on what we say, but on what we do to help people make
appropriate health decisions.  I would love to see a marketing study of
the service aspect of health literacy as well as the information
aspect.
 
We should have done a better job of making this clear in the definition
itself.  For me today, after speaking to dozens of groups, health
literacy is the: 
 
"capacity of individuals, organizations and communities to obtain,
process, understand and share basic health information and services
needed to make appropriate health decisions. "
 
Discussion of photonovels is interesting, but the real pay-off is the
re-structuring of our health care system so people can protect
themselves from disease and it consequences. 
 
 
Wm. Smith
Executive Vice President
Academy for Educational Development
1825 Connecticut Ave., NW
Washington, D.C. 20009

Organize policy until self-interest
does what justice requires.
Phone: 202-884-8750
Fax: 202-884-8752
e-mail: bsmith at aed.org 


>>> "Rima Rudd" <RRUDD at hsph.harvard.edu> 12/3/2008 3:59 PM >>>

Hello... 
I will certainly think of my 'favorite' fact but I cannot resist
commenting on the one just posted.

It is not correct to state that people cannot do any of the tasks
noted. A more appropriate way to say this is "people below level X have
difficulty completing this task with accuracy and consistency" .

What is missing from this insight [and it is valuable measure and an
important insight] is the critical finding from over 800 published
studies that health materials are generally poorly written and
designed.

so... this does lead to my favorite assertion taken from the IOM
report:

Health literacy is a shared function of social and individual factors.
page 4
or
Health literacy is a shared function of cultural, social, and
individual factors. Both the causes and the remedies for limited health
literacy rest with our cultural and social framework, the health and
education system that serve it, and the interactions between these
factors. page 32


in addition: 
The cost research is not firmly established nor uniformly accepted. It
is not possible, for example, to differentiate between costs due to
medical errors [errors made by professionals] and costs due to literacy
related errors [errors made by patients]. I am very disquieted by the
assumption that costs are due to patient error or to patient deficits. 

Rima

Rima E. Rudd, ScD, MSPH
Department of Society, Human Development & Health
Harvard School of Public Health
677 Huntington Avenue
Boston MA 02115
Phone: 617 432 1135
fax:     617 432 3123
web:    www.hsph.harvard.edu/healthliteracy 
www.hsph.harvard.edu/sisterstogether 
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