Watch your language

Library Trends, Fall, 2004 by Heidi T. Sandstrom

ABSTRACT

The Pacific Southwest Regional Medical Library of the National Network of Libraries of Medicine (NN/LM) hosted a one-day educational symposium entitled "Stake Your Claim to Health Literacy" in January 2004. The symposium focused on the practical knowledge and tools needed to participate in health literacy initiatives within the health care and health information environments. It provided a unique opportunity for the participants--medical librarians, public librarians, health care interpreters, and health educators--to hear from experts and to learn about potential health literacy partners. The event, cosponsored by three regional chapters of the Medical Library Association, preceded their joint meeting in Sacramento, California. An advisory group of library and literacy professionals from the NN/LM Pacific Northwest and Pacific Southwest Regions, along with a second-year National Library of Medicine associate fellow, planned, implemented, and evaluated the symposium.

INTRODUCTION

In January 2004 the Pacific Southwest Regional Medical Library of the National Network of Libraries of Medicine (NN/LM) hosted a one-day educational symposium entitled "Stake Your Claim to Health Literacy." The symposium focused on the practical knowledge and tools needed to participate in health literacy initiatives within the health care and health information environments. It provided a unique opportunity for the participants--medical librarians, public librarians, health care interpreters, and health educators--to hear from experts and to learn about potential health literacy partners. This article provides an overview of developments in health literacy over the past few decades and discusses the symposium, from planning to evaluation.

OVERVIEW OF HEALTH LITERACY

Language is defined as "the method of human communication, either spoken or written, consisting of the use of words in an agreed way; a professional or specialized vocabulary" (Abate, 1998, p. 456). For many years public librarians and adult educators have been involved in the written aspect of communication (that is, the ability to read and write) through various literacy programs. More recently, health professionals have become aware of the work of adult educators and have begun working with them to enhance the public's health literacy and to develop readable health information resources. In 2003 the medical library community began to take steps to define its role in lowering the barriers of language and culture for those trying to access health information.

The term health literacy was first used in 1974 (Simonds, 1974), and links between illiteracy and health were subsequently noted in articles written in the decades that followed. According to Rima Rudd, a Harvard researcher and principal investigator for the National Center for the Study of Adult Learning and Literacy (NCSALL), "Dozens of articles in the 1980s and scores of articles in the early 1990s offered evidence that written documents in the health field were very demanding and were often assessed at reading levels beyond high school" (NCSALL, 2002). But with several key publications health literacy began to garner national attention. The U.S. Department of Health and Human Services (HHS) Centers for Disease Control and Prevention published Literacy and Health in the United States in 1991, stressing the importance of literacy to health. In 1993 findings from the National Adult Literacy Survey (NALS) were published, indicating that half of the U.S. adult population, representing approximately 90 million adults, has limited literacy skills. The NALS measured functional literacy, defined as "an individual's ability to read, write and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one's goals, and to develop one's knowledge and potential" (Kirsch, Jungeblut, Jenkins, & Kolstad, 1993, p. 3). In 2000 the U.S. Department of Health and Human Services launched Healthy People 2010, a set of health objectives for the nation to achieve over the first decade of the new century (U.S. Department of Health and Human Services, 2000). For the first time a health communication focus area was included in the specific objective to "Improve the health literacy of persons with inadequate or marginal literacy skills" (U.S. Department of Health and Human Services, 2000). Healthy People 2010 built on the definition of functional literacy by relating it to health tasks. It defined health literacy as, "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (U.S. Department of Health and Human Services, 2000).

In that same year, 2000, it is notable that the National Library of Medicine published "Health Literacy" in its Current Bibliographies in Medicine (CBM) series (National Library of Medicine, 2000). Since the mid-1990s Pfizer, a U.S. pharmaceutical company, has been committed to raising awareness of the health literacy issue and developing solutions for addressing this public health problem. Pfizer has defined health literacy as "the ability to read, understand, and act on health information" (Pfizer, 2004). In 1998 the American Medical Association (AMA) "became the first national medical organization to adopt a policy recognizing that limited patient literacy affects medical diagnosis and treatment. The AMA Foundation has since been working to raise awareness of health literacy within the health care community" (AMA Foundation, n.d.). Finally, in 2003 the Medical Library Association (MLA) formed a Health Information Literacy Task Force to formulate an organizational response to health literacy (MLA Net, 2003a).