Hi Ian, your question is a tough one to answer because it has multiple dimensions, and they deal with also, with class, knowledge and skills. Let me see if I can articulate what I mean.
 
first, in terms of the relationship between health and health literacy, there is a strong connection. A person with high literacy levels will probably score high in traditional health literacy tasks. However, performing well in the NAALs does not necessarily mean that the person with high health literacy marks will engage in healthier behaviors than a person with lower literacy. 
 
Health literacy behaviors depend a lot on context. So, a rocket scientist or an endocrinologist, may know that s/he needs to eat lots whole grains and veggies and less meat and saturated fats. Yet, s/he may not have the skills to do this. So, if someone doesn't cook for him/her, she may be eating pepperoni pizza. OTOH, many of my students who are homemakers are barely taking the GED, but they already cook fairly healthy. Yet, they don't know much about the food pyramid, nutritional content, etc. 
 
Class, together with context are very influential on healthy behaviors. In "Nickeled and dimmed" Barbara E. describes this woman that lives in a poor neighborhood. She wakes up very early to get to the bus stop. On the way to the bus station she buys 4 Twinkies 2 for breakfast and two for lunch. she eats two in the bus on the way to work. she eats two at lunch-time and she gets two more for the way back home. Barbara E. argues that many poor people don't have access to whole food stores and sometimes even supermarkets. So, for some, nutrition comes from 7-11. It doesn't matter if it is Twinkies or Twix. 
 
There are reports that Latin immigrants start eating worse when they come into the US. This is not because they became less health literate, but because their contexts may have changed. So, while many of my students who live in El Paso may have access to supermarkets, can buy veggies and prepare nutritious meals. Many are having less and less access to spaces for practicing healthy behaviors. So, in exploring the relationship between health and literacy, we need to add culture, social class and context. 
 
There is a big high school a few blocks from my house. With the increase in popularity of health literacy the schools are developing programs that address nutrition, pe, etc. But, around the school there is a Krispy-Cream doughnuts, a McDonalds, Burger King, Applebee's, Taco Bell, sonic, as well as tons of convenience stores. There is also one salad place, but I've never seen HS kids eating there. 
 
I hope that this makes sense,
 
Andres  

________________________________

From: healthliteracy-bounces at nifl.gov on behalf of Bennett, Ian
Sent: Tue 9/18/2007 1:12 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 1221] Re: (no subject)


Great point Andres - I think this is an excellent way to get to the question that I have had regarding the measurement of health literacy versus general literacy. I fully agree that contextual literacy is a powerful component of navigating a "context" and that health literacy is an example of contextual literacy. What I wonder about is simply whether we have ever come up with a measure of health literacy skill that is distinguishable from general literacy. I am not even sure how you would do it actually and I'm not sure we want to. I know I am personally more interested in how general literacy relates to health through direct and indirect ways but I would be interested to hear anyone's thoughts about why it would be important to have a measure of health literacy that covered a distinct domain form the general case.
 
I wonder if Dr. Kutner has more to say on the subject?
 
Thanks,
 
Ian Bennett
 
-----Original Message-----
From: healthliteracy-bounces at nifl.gov [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Muro, Andres
Sent: Tuesday, September 18, 2007 11:50 AM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 1216] Re: (no subject)



	Here is a little anecdote that I always share when I do health literacy workshops. 

	 

	I often travel to DC with colleagues to do workshops, attend conferences, etc. Most of my colleagues have post graduate degrees. In other words, we are on top of the food chain when it comes to educational achievement. Upon descending from the plane we head to the subway station were I always perform my "anthropological" observation of contextual literacy practices. Many of my colleagues go into a panic when they have to interact with the ticket purchasing and dispensing machine. They don't want to stand out. They don't want to hold the line and they don't want to be left behind. In fact, it is common for people traveling alone to get the much more expensive and inconvenient taxis to avoid the "unfamiliar" literacy encounter. 

	 

	Fortunately, subway stations have a person that helps travelers interact with these machines and explain maps and routes. In fact, these helpers prefer to give oral directions to passengers rather than just refer them to the written instructions. See, while I doubt that any of them studied anthropology, they have figured out that we are still basically an oral society when it comes to getting directions. Even the most literate people prefer oral instructions when it comes to encounters with new forms of literacy. Once they master the context, then they perform fine within the print realm.   

	 

	We don't have to go to DC to experience this. Airplane tickets are now dispensed by machines. Most grocery stores have electronic cash registers. While most of us are proficient with these and realize that they require basic literacy skills to operate, we can probably remember our first encounters with this type of technology. Businesses, like subway helpers know that we are still an oral society and always have a person ready to verbally assist shoppers navigate these literacy environments. Unfortunately, the much more sophisticated medical establishment is catching on a little too late. At Walmart the airport and the subway station, if you hesitate with the literacy task, an aid shows up to assist you. Or, you have the option to go through the human cash register. 

	 

	If we, highly educated people have difficulty getting a subway ticket, and reading a subway map, you can imagine what a less educated person must feel when they have to navigate through insurance documents, patient intake forms, medication information, etc. 

	 

	Andres

	
________________________________


	From: healthliteracy-bounces at nifl.gov [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Barbara Duffy
	Sent: Monday, September 17, 2007 7:36 PM
	To: 'The Health and Literacy Discussion List'
	Subject: [HealthLiteracy 1206] Re: (no subject)

	 

	I study health literacy and teach it  --- but I never personally felt what it must be like to be 'illiterate' until yesterday when I tried to read a computer manual. I can only assume the parallels with health literacy must be similar. Way too many assumptions were made by the authors of the computer manual for it to have much meaning for me.... And like much of the written materials we give to our patients to 'go home and read - it explains everything'  there was no one I could ask questions of - no one I felt had the time or patience for my stupid inquiries, so I just muddle through and hope for the best.

	 

	Literacy issues are not confined to health care --- I have a feeling it is epidemic and contagious. English may be but one language that we speak with many, very foreign words.

	 

	Barbara Duffy

	 

	
________________________________


	From: healthliteracy-bounces at nifl.gov [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Kutner, Mark
	Sent: Monday, September 17, 2007 12:06 PM
	To: The Health and Literacy Discussion List
	Subject: [HealthLiteracy 1198] (no subject)

	 

	Good morning all.  Cynthia Baur and I are very much looking forward to answering any questions or issues that you might have related to the health literacy component and report of the National Assessment of Adult Literacy (NAAL).  Just as way of introduction, from 1999 through last December I was the project director for the design, analysis, and reporting component of NAAL.  In that role, I worked with Cynthia in developing the health literacy component of NAAL.  The health literacy items also had to be prose, document, and quantitative items so that they could also be placed on the NAAL scale.  The health literacy items were field tested before being included on the national study.  As we discuss the health literacy component, it is important to remember that the NAAL was administered in the homes of individuals, not in a doctor's office or emergency room.

	 

	In case folks are shy, I want to pose a couple of questions to all of you: 

	 

	1. As an individual who has been involved in adult literacy and assessment for almost 20 years, I am curious to hear you perspectives about the difference between measuring literacy and health literacy, especially when the definition of health literacy (which we used from HHS) does not indicate any prior substantive knowledge of health-related issues (such as I take aspirin for headaches).  

	 

	2. Also, NAAL highlights the challenges of improving health literacy for adults whose first language is not English.  What evidence do we have about successful approaches to ensure that the health literacy for these adults improves?

	 

	 

	As we begin these discussions, I want to clearly acknowledge that there would never have been a health literacy component of NAAL if it was not for the hard work, perseverance,  stubbornness of Cynthia Baur. For me, working with Cynthia on the health literacy component has been a real joy.  The field is quite fortunate to be able to benefit from her leadership!.

	 


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