Mandates for Health Mandates for Health

Literacy in Medicine and Literacy in Medicine and

Education – Education –

the IOM Report and the IOM Report and

Beyond Beyond Lynn Nielsen, Ph.D.Lynn Nielsen, Ph.D.

Assistant Professor of Physiology & Director of ResearchAssistant Professor of Physiology & Director of Research

Lincoln Memorial University DeBusk College of Osteopathic MedicineLincoln Memorial University DeBusk College of Osteopathic Medicine

Health literacy is a shared Health literacy is a shared

function of social and individual function of social and individual

factorsfactors

Individuals’ health literacy skills Individuals’ health literacy skills

and capacities are mediated by and capacities are mediated by

their education, culture, and their education, culture, and

languagelanguage

Potential Intervention Potential Intervention PointsPoints

Intervention points for Intervention points for improving health improving health

literacyliteracy

Health systemsHealth systems

Social marketingSocial marketing

Education systemsEducation systems

PartnershipsPartnerships

Critical to improved Critical to improved health literacyhealth literacy

Repeatedly mandatedRepeatedly mandated but with minimal fundingbut with minimal funding

RareRare

Obstacles to Obstacles to PartnershipPartnership

Lack of follow through on Lack of follow through on Existing science education Existing science education

standardsstandardsMandatesMandates

• Must include recommendations for fundingMust include recommendations for funding• Funding must be provided for mandates to Funding must be provided for mandates to

be carried outbe carried out

Funding of recommended Funding of recommended programsprograms

Lack of awareness across fieldsLack of awareness across fields

Fostering PartnershipsFostering Partnerships

Partnerships wantedPartnerships wanted

Adult education programsAdult education programs

Adult learners Adult learners

Health systemsHealth systems

PractitionersPractitioners

Engage Multiple FieldsEngage Multiple Fields

Health care services Health care services

should be developed in should be developed in

partnerships with the local partnerships with the local

community, organizations, community, organizations,

and institutionsand institutions

Local ResourcesLocal Resources

Health care institutionsHealth care institutions

Adult education programsAdult education programs

LibrariesLibraries

Community leadersCommunity leaders

Example PartnershipsExample Partnerships

Demonstration Demonstration ProjectsProjects

Develop CurriculaDevelop Curricula

Train the TrainerTrain the Trainer

Leadership for Community Leadership for Community Change Change Kellogg Foundation Demonstration ProjectKellogg Foundation Demonstration Project

Classroom trainingClassroom training

MentoringMentoring

NetworkingNetworking

Community-based leadersCommunity-based leaders

Local organizationsLocal organizations

Multiple sitesMultiple sites

Promote cross-Promote cross-discipline discipline relationshipsrelationships

Develop self-Develop self-continuing projectscontinuing projects

Take action on Take action on existing mandatesexisting mandates Lobbying for increased Lobbying for increased

fundingfunding

ReferencesReferences

11 Committee on Health Literacy, Board on Committee on Health Literacy, Board on

Neuroscience and Behavioral Health. Neuroscience and Behavioral Health. Health Health

Literacy: A Prescription to End Confusion.Literacy: A Prescription to End Confusion. L L

Nielsen-Bohlman, AM Panzer, DA Kindig, Eds. Nielsen-Bohlman, AM Panzer, DA Kindig, Eds.

Washington DC: National Academies Press, 2004. Washington DC: National Academies Press, 2004.

http://www.iom.edu/?id=32784http://www.iom.edu/?id=32784

4 4 Committee on the Future of Rural Health Care, Board Committee on the Future of Rural Health Care, Board

on Health Care Services. on Health Care Services. Quality Through Quality Through

Collaboration: The Future of Rural Health CareCollaboration: The Future of Rural Health Care. .

Washington DC: National Academies Press, 2005. Washington DC: National Academies Press, 2005.

http://www.iom.edu/?id=29734http://www.iom.edu/?id=29734

A selection of articles A selection of articles

relevant to health systems relevant to health systems

and adult education and adult education

partnerships to address partnerships to address

health literacyhealth literacy

Further ReadingFurther Reading

Doak LG, Doak CC, Meade CD. 1996. Strategies to improve cancer education materials. Doak LG, Doak CC, Meade CD. 1996. Strategies to improve cancer education materials. Oncology Nursing Oncology Nursing

Forum.Forum. 23(8): 1305–1312. 23(8): 1305–1312.

HHS (U.S. Department of Health and Human Services). 2000. HHS (U.S. Department of Health and Human Services). 2000. Healthy People 2010: Understanding and Healthy People 2010: Understanding and

Improving Health.Improving Health. Washington, DC: U.S. Department of Health and Human Services. [Online]. Available: Washington, DC: U.S. Department of Health and Human Services. [Online]. Available:

http://www.health.gov/healthypeoplehttp://www.health.gov/healthypeople [accessed: January 15, 2003]. [accessed: January 15, 2003].

Jacobson E, Degener S, Purcell-Gates V. 2003. Jacobson E, Degener S, Purcell-Gates V. 2003. Creating Authentic Materials for the Adult Literacy Classroom: Creating Authentic Materials for the Adult Literacy Classroom:

A Handbook for Practitioners.A Handbook for Practitioners. Cambridge, MA: World Education Inc. Cambridge, MA: World Education Inc.

Joint Committee on National Health Education Standards. 1995. Joint Committee on National Health Education Standards. 1995. National Health Education Standards: National Health Education Standards:

Achieving Health Literacy.Achieving Health Literacy. Atlanta, GA: American Cancer Society. Atlanta, GA: American Cancer Society.

Matthews TL, Sewell JC. 2002. Matthews TL, Sewell JC. 2002. State Official’s Guide to Health Literacy.State Official’s Guide to Health Literacy. Lexington, KY: The Council of State Lexington, KY: The Council of State

Governments. Governments.

Morse L. 2002. Morse L. 2002. Improving Health Literacy: An Educational Response to a Public Health Problem.Improving Health Literacy: An Educational Response to a Public Health Problem. Presentation Presentation

given at a workshop of the Institute of Medicine Committee on Health Literacy. December 11, 2002, given at a workshop of the Institute of Medicine Committee on Health Literacy. December 11, 2002,

Washington, DCWashington, DC

Murphy PW, Davis TC, Mayeaux EJ, Sentell T, Arnold C, Rebouche C. 1996. Teaching nutrition education in Murphy PW, Davis TC, Mayeaux EJ, Sentell T, Arnold C, Rebouche C. 1996. Teaching nutrition education in

adult learning centers: Linking literacy, health care, and the community. adult learning centers: Linking literacy, health care, and the community. Journal of Community Health Journal of Community Health

Nursing.Nursing. 13(3): 149–158. 13(3): 149–158.

NRC (National Research Council). 1996. NRC (National Research Council). 1996. National Science Education Standards.National Science Education Standards. Washington, DC: National Washington, DC: National

Academy Press.Academy Press.

Pateman B, Grunbaum JA, Kann L. 1999. Voices from the field—A qualitative analysis of classroom, school, Pateman B, Grunbaum JA, Kann L. 1999. Voices from the field—A qualitative analysis of classroom, school,

district, and state health education policies and programs. district, and state health education policies and programs. Journal of School Health.Journal of School Health. 69(7): 258–263. 69(7): 258–263.

Rudd RE. 2002. A maturing partnership. Rudd RE. 2002. A maturing partnership. Focus on Basics: Connecting Research and Practice.Focus on Basics: Connecting Research and Practice. 5(3). 5(3).

Rudd RE, Moeykens BA. 1999. Rudd RE, Moeykens BA. 1999. Adult educators’ perceptions of health issues and topics in adult basic Adult educators’ perceptions of health issues and topics in adult basic

education. NCSALL Report #8.education. NCSALL Report #8. Cambridge, MA: National Center for the Study of Adult Learning and Literacy. Cambridge, MA: National Center for the Study of Adult Learning and Literacy.

Members of the IOM Committee on Health LiteracyMembers of the IOM Committee on Health Literacy

Dr. Dyanne Affonso, Dr. Dyanne Affonso, Executive Administrative Specialist, Dept. of Pharmacy, University of Executive Administrative Specialist, Dept. of Pharmacy, University of

Hawaii Hilo,Hawaii Hilo, 60 Nowelo St., Ste 101, Hilo, HI 96720 60 Nowelo St., Ste 101, Hilo, HI 96720 daffonso@hawaii.edudaffonso@hawaii.edu (808) 443-5900 (808) 443-5900

Dr. Eric Chudler, Dr. Eric Chudler, Eric H. Chudler, Director of Education and Outreach, Eric H. Chudler, Director of Education and Outreach,

University of Washington Engineered BiomaterialsUniversity of Washington Engineered Biomaterials (UWEB), (UWEB), Department of BioengineeringDepartment of Bioengineering, ,

BOX 355061, BOX 355061, University of University of WashingtonWashingtonSeattleSeattle, WA 98195-5061 , WA 98195-5061

http://faculty.washington.edu/chudler/ehc.htmlhttp://faculty.washington.edu/chudler/ehc.html (206) 616-6899 (206) 616-6899 chudler@u.washington.educhudler@u.washington.edu

Dr. Marilyn Gaston, Assistant Surgeon General of the United States, Retired, Dr. Marilyn Gaston, Assistant Surgeon General of the United States, Retired,

http://www.leadwithexperience.org/prize/finalists/gaston-porter.cfmhttp://www.leadwithexperience.org/prize/finalists/gaston-porter.cfm doctwig@aol.comdoctwig@aol.com

Dr. David Kindig, Committee Chair, PDr. David Kindig, Committee Chair, Professor of Preventive Medicine and Director of the rofessor of Preventive Medicine and Director of the

Wisconsin Network for Health Policy Research, Department of Preventive Medicine, 760 Wisconsin Network for Health Policy Research, Department of Preventive Medicine, 760

WARF Building, 610 N. Walnut St., Madison, Wisconsin 53705-2397 WARF Building, 610 N. Walnut St., Madison, Wisconsin 53705-2397

http://www.medsch.wisc.edu/adminmed/faculty/dkindig.htm http://www.medsch.wisc.edu/adminmed/faculty/dkindig.htm dakindig@facstaff.wisc.edudakindig@facstaff.wisc.edu

(608) 263-4886(608) 263-4886

Dr. Cathy Meade, Dr. Cathy Meade, Director, Education Program, Leader, Cancer, Culture, and Literacy Director, Education Program, Leader, Cancer, Culture, and Literacy

Institute, Institute, Moffit Cancer Center, Univerity of South Florida, Moffit Cancer Center, Univerity of South Florida, H. Lee Moffitt Cancer Center & H. Lee Moffitt Cancer Center &

Research Institute, 12902 Magnolia Drive, Tampa, FL 33612 Research Institute, 12902 Magnolia Drive, Tampa, FL 33612 cdmeade@moffitt.usf.educdmeade@moffitt.usf.edu (813) (813)

745-6730 745-6730

Dr. Lynn Nielsen, Committee Director, Assistant Professor of Physiology & Director of Dr. Lynn Nielsen, Committee Director, Assistant Professor of Physiology & Director of

Research, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 6965 Research, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 6965

Cumberland Gap Parkway Harrogate, Tennessee 37752 Cumberland Gap Parkway Harrogate, Tennessee 37752 http://http://

www.lmunet.edu/DCOM/faculty/nielsen.htmwww.lmunet.edu/DCOM/faculty/nielsen.htm 423-869-7120 423-869-7120 Lynn.Nielsen@lmunet.eduLynn.Nielsen@lmunet.edu

continued next pagecontinued next page

Members of the IOM Committee on Health Literacy, continuedMembers of the IOM Committee on Health Literacy, continued

Allison Panzer, Committee Staff, University of Rochester Medical Center, Allison Panzer, Committee Staff, University of Rochester Medical Center,

allison_panzer@urmc.rochester.eduallison_panzer@urmc.rochester.edu

Dr. Ruth Parker, Professor of Medicine, Dept. of General Medicine, Emory School of Med Dr. Ruth Parker, Professor of Medicine, Dept. of General Medicine, Emory School of Med http://http://

med.emory.edu/faculty/profile_bio.cfm?idmed.emory.edu/faculty/profile_bio.cfm?id=846=846 ruth.parker@emory.eduruth.parker@emory.edu (404) 778-1639 (404) 778-1639

Dr. Victoria Purcall-Gates, Dr. Victoria Purcall-Gates, Canada Research Chair in Early Childhood Literacy, Faculty of Education, Canada Research Chair in Early Childhood Literacy, Faculty of Education,

Department of Language & Literacy, 2125 Main Mall,304 B Scarfe Hall, University of British Columbia, Department of Language & Literacy, 2125 Main Mall,304 B Scarfe Hall, University of British Columbia,

Vancouver, B.C., Canada V6T 1Z4 Vancouver, B.C., Canada V6T 1Z4 http://educ.ubc.ca/faculty/vpurcell-gates/http://educ.ubc.ca/faculty/vpurcell-gates/

victoria.purcell-gates@ubc.cavictoria.purcell-gates@ubc.ca 604.822.0105 604.822.0105

Irv Rootman, Irv Rootman, Centre for Community Health Promotion Research, Box 3060 STN CSC, Victoria B.C. V8W Centre for Community Health Promotion Research, Box 3060 STN CSC, Victoria B.C. V8W

3R4 http://web.uvic.ca/chpc/whoweare/team.htm 3R4 http://web.uvic.ca/chpc/whoweare/team.htm irootman@uvic.cairootman@uvic.ca (250) 472-4102 (250) 472-4102 Dr. Victoria Purcall-Dr. Victoria Purcall-

Gates, Gates, Canada Research Chair in Early Childhood Literacy, Faculty of Education, Department of Canada Research Chair in Early Childhood Literacy, Faculty of Education, Department of

Language & Literacy, 2125 Main Mall,304 B Scarfe Hall, University of British Columbia, Vancouver, B.C., Language & Literacy, 2125 Main Mall,304 B Scarfe Hall, University of British Columbia, Vancouver, B.C.,

Canada V6T 1Z4 Canada V6T 1Z4 http://educ.ubc.ca/faculty/vpurcell-gates/http://educ.ubc.ca/faculty/vpurcell-gates/ victoria.purcell-gates@ubc.cavictoria.purcell-gates@ubc.ca 604.822.0105 604.822.0105

Irv Rootman, Irv Rootman, Centre for Community Health Promotion Research, Box 3060 STN CSC, Victoria B.C. V8W Centre for Community Health Promotion Research, Box 3060 STN CSC, Victoria B.C. V8W

3R4 http://web.uvic.ca/chpc/whoweare/team.htm 3R4 http://web.uvic.ca/chpc/whoweare/team.htm irootman@uvic.cairootman@uvic.ca (250) 472-4102   (250) 472-4102  

Dr. Rima Rudd, Dr. Rima Rudd, Senior Lecturer on Society, Human Development, and Health, Senior Lecturer on Society, Human Development, and Health,

Department of Society, Human Development, and HealthDepartment of Society, Human Development, and Health, Harvard. 677 Huntington Avenue, Kresge , Harvard. 677 Huntington Avenue, Kresge

Building 7th Floor, Boston, MA 02115Building 7th Floor, Boston, MA 02115

http://www.hsph.harvard.edu/faculty/rima-rudd/index.htmlhttp://www.hsph.harvard.edu/faculty/rima-rudd/index.html rrudd@hsph.harvard.edurrudd@hsph.harvard.edu 617-432-3753617-432-3753

Dr. Susan Scrimshaw, Dr. Susan Scrimshaw, President, Simmons College, 300 The Fenwaym Boston, MA 02115 President, Simmons College, 300 The Fenwaym Boston, MA 02115

http://www.simmons.edu/overview/president/index.shtml http://www.simmons.edu/overview/president/index.shtml susan.scrimshaw@simmons.edususan.scrimshaw@simmons.edu 617-521- 617-521-

20702070

Bill Smith, Bill Smith, Senior Scientist and Director, Social Change Group, Senior Scientist and Director, Social Change Group, Academy for Educational Development, Academy for Educational Development,

1825 Connecticut Ave., NW, Washington, D.C. 20009-5721 1825 Connecticut Ave., NW, Washington, D.C. 20009-5721 httphttp://www.aed.org/Experts/smithw.cfm://www.aed.org/Experts/smithw.cfm

bsmith@aed.orgbsmith@aed.org 202-884-8000202-884-8000

Members of the IOM Committee on Health Literacy, continuedMembers of the IOM Committee on Health Literacy, continued

Dr. Rima Rudd, Dr. Rima Rudd, Senior Lecturer on Society, Human Development, and Health, Senior Lecturer on Society, Human Development, and Health,

Department of Society, Human Development, and Health, Harvard. 677 Huntington Department of Society, Human Development, and Health, Harvard. 677 Huntington

Avenue, Kresge Building 7th Floor, Boston, MA 02115Avenue, Kresge Building 7th Floor, Boston, MA 02115

http://www.hsph.harvard.edu/faculty/rima-rudd/index.html rrudd@hsph.harvard.edu http://www.hsph.harvard.edu/faculty/rima-rudd/index.html rrudd@hsph.harvard.edu

617-432-3753617-432-3753

Dr. Susan Scrimshaw, Dr. Susan Scrimshaw, President, Simmons College, 300 The Fenwaym Boston, MA President, Simmons College, 300 The Fenwaym Boston, MA

02115 http://www.simmons.edu/overview/president/index.shtml 02115 http://www.simmons.edu/overview/president/index.shtml

susan.scrimshaw@simmons.edu 617-521-2070susan.scrimshaw@simmons.edu 617-521-2070

Bill Smith, Bill Smith, Senior Scientist and Director, Social Change Group, Senior Scientist and Director, Social Change Group, Academy for Academy for

Educational Development, Educational Development, 1825 Connecticut Ave., NW, Washington, D.C. 20009-5721 1825 Connecticut Ave., NW, Washington, D.C. 20009-5721

http://www.aed.org/Experts/smithw.cfm bsmith@aed.org http://www.aed.org/Experts/smithw.cfm bsmith@aed.org 202-884-8000202-884-8000

Contracted Contributors to the IOM Health Literacy ReportContracted Contributors to the IOM Health Literacy Report

Dr. Terry Davis, Contributor, Dr. Terry Davis, Contributor, Professor of Medicine and Pediatrics , Director of Behavioral Professor of Medicine and Pediatrics , Director of Behavioral

Science Section, Feist-Weiller Cancer Center, LSU Health Sciences Center-Shreveport, 1501 Science Section, Feist-Weiller Cancer Center, LSU Health Sciences Center-Shreveport, 1501

Kings Highway, Shreveport, Louisiana 71130-3932 Kings Highway, Shreveport, Louisiana 71130-3932

http://www.fwcconline.org/db/doctorbio.aspx?doctorID=129http://www.fwcconline.org/db/doctorbio.aspx?doctorID=129 TDavis1@lsuhsc.eduTDavis1@lsuhsc.edu (318) 675- (318) 675-

58135813

Dr. David Howard, Dr. David Howard,  Assistant Professor, Department of Health Policy and Management,  Assistant Professor, Department of Health Policy and Management,

Rollins School of Public Health Room 610, Emory University, 1518 Clifton Road NE Atlanta, GA Rollins School of Public Health Room 610, Emory University, 1518 Clifton Road NE Atlanta, GA

3032230322http://www.sph.emory.edu/~dhhowar/http://www.sph.emory.edu/~dhhowar/  david.howard@emory.edudavid.howard@emory.edu 404-727-3907 404-727-3907

Dr. Dean Schillinger, University of California San Francisco, Dr. Dean Schillinger, University of California San Francisco, San Francisco General Hospital, San Francisco General Hospital,

1001 Potrero Avenue, San Francisco, CA 94110, Box 1364, Bldg 10 1001 Potrero Avenue, San Francisco, CA 94110, Box 1364, Bldg 10

http://dgim.ucsf.edu/sfgh/Faculty/schillinger.htmlhttp://dgim.ucsf.edu/sfgh/Faculty/schillinger.html (415) 206-8940 dean@itsa.ucsf.edu(415) 206-8940 dean@itsa.ucsf.edu

Barry Weiss, Contributor, Professor , Department of Family and Community Medicine, Barry Weiss, Contributor, Professor , Department of Family and Community Medicine,

University of Arizona College of Medicine, 1501 N. Campbell Avenue, PO Box 245017, University of Arizona College of Medicine, 1501 N. Campbell Avenue, PO Box 245017,

Tucson, Arizona 85724 Tucson, Arizona 85724 http://www.fcm.arizona.edu/index.cfm/1,149,320,0,html/Barry-Weisshttp://www.fcm.arizona.edu/index.cfm/1,149,320,0,html/Barry-Weiss

(520) 626-4555 (520) 626-4555