Greetings, Dr. Smith!
Thank you very much for the clarification and additional background
information on that specific definition.  Asking as a third year grad
student working on her dissertation , may I  please quote you for your
"revised" definition of health literacy?
~~~ Denise
 
Denise H. Britigan, MA, CHES

Doctoral candidate, Health Promotion & Education  

College of Education, Criminal Justice, and Human Services (CECH)

Division of Human Services 

ML #0068

University of Cincinnati

Cincinnati, OH 45221-0068

FAX: 513-556-3898

britigdh at email.uc.edu


  _____  

From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of William Smith
Sent: Thursday, December 04, 2008 7:06 AM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 2551] Re: WednesdayQuestion: Lookingfor
CompellingHealth Literacy Facts


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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