For everyone's reference, Healthy People 2010 includes not only the
health literacy objective (11-2) but also the objective to increase high
school completion rates (7-1). 
 
Cynthia

________________________________

From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Bertha Mo
Sent: Friday, September 21, 2007 4:30 PM
To: The Health and Literacy Discussion List
Cc: Diane Downing
Subject: [HealthLiteracy 1274] Re: NAAL-health literacy and leadership


Here is an interesting article from the 1848 List serve:

1848 Readers might be interested in the following article in the 
latest issue of Preventing Chronic Disease available at 
http://www.cdc. gov/pcd/issues/ 2007/oct/ 07_0063.htm
<http://www.cdc.gov/pcd/issues/2007/oct/07_0063.htm> 

Reframing School Dropout as a Public Health Issue Nicholas 
Freudenberg, DrPH, Jessica Ruglis

Abstract
Good education predicts good health, and disparities in health and in 
educational achievement are closely linked. Despite these 
connections, public health professionals rarely make reducing the 
number of students who drop out of school a priority, although nearly 
one-third of all students in the United States and half of black, 
Latino, and American Indian students do not graduate from high school 
on time. In this article, we summarize knowledge on the health 
benefits of high school graduation and discuss the pathways by which 
graduating from high school contributes to good health. We examine 
strategies for reducing school dropout rates with a focus on 
interventions that improve school completion rates by improving 
students' health. Finally, we recommend actions health professionals 
can take to reframe the school dropout rate as a public health issue 
and to improve school completion rates in the United States.

Freudenberg N, Ruglis J. Reframing school dropout as a public health 
issue. Prev Chronic Dis 2007;4(4). 
<http://www.cdc. gov/pcd/issues/ 2007/oct/ 07_0063.htm
<http://www.cdc.gov/pcd/issues/2007/oct/07_0063.htm> >http://www.cdc.
gov/pcd/issues/ 2007/ <http://www.cdc.gov/pcd/issues/2007/> 
oct/07_0063. htm. 

Bertie Mo


William Smith <BSMITH at smtp.aed.org> wrote: 

	one of my favorite quotes of Thomas Pynchon is 
	 
	If they get you asking the wrong question, it doesn't matter how
good the answers are. 
	 
	I think we need to stop asking ourselves -  "How many health
literate people tare there are in America", and ask instead, Is America
a health literate society - a society where people can, as we say at the
Center for Plain Language:
	 

		*	find what they need 
		*	understand what they find 
		*	use it to accomplish their goals. 

	 
	 
	 
	 
	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
	
	>>> "Jeanne Matthews" <Jmatthews at arlingtonva.us> 9/21/2007 7:39
AM >>>
	
	While health literacy may be an individual characteristic, it is
clear that it could also be a determinant of health in populations. Some
good research exists to support the impact of low health literacy in
individuals--but looked at for the impact in populations (diabetics, for
example). 
	 
	Many of you have highlighted the important issues of health in
the community that are key to understanding how communities do or don't
support health. The IOM's 2003 report on the future of the public's
health addressed the key issue of the public health system. All of the
players in a community (business, media, politicians, consumers, health
care, education) need to value health in its broadest sense and come
together to create a community the produces health not just consumes
health care. The MAPP process is just one way to facilitate this
(http://mapp.naccho.org/mapp_introduction.asp). There is plenty in the
literature on the NACCHO site to give you assistance.
	 
	Each of you and your colleagues--in your own communities--can do
something to help move this along so that some of the issues identified
by Andres are turned around. Participate in boards, committees that work
on health issues and encourage broad participation among community
members and organizations. If you are not in a public health agency,
encourage your organization to strengthen the connections that exist.
For example, most organizations have a mechanism to report certain
communicable diseases to the local public health agency--leverage that
partnership to create others. 
	 
	While the process is a lot of work, the potential benefits are
great. We need to encourage the larger system--that includes far more
than health care organizations--to work like one. Issues like health
literacy need to be in the forefront so that our communities are better
able to create environments where people can be healthy. 
	 
	Thanks for a great discussion!
	Jeanne
	 
	 
	Jeanne A. Matthews, PhD, RN
	Public Health Program Specialist/Nurse Manager
	Arlington County Department of Human Services
	Public Health Division Administration
	800 S. Walter Reed Drive
	Arlington, VA 22204
	jmatthews at arlingtonva.us
	703-228-5584 (phone)
	703-228-5233 (fax)
	
	This e-mail may contain information that is protected by law.
The use
	of this information by unauthorized persons is strictly
prohibited.  If
	you have received this e-mail in error, please notify the sender
	immediately by telephone or reply by e-mail and permanently
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________________________________

	From: healthliteracy-bounces at nifl.gov on behalf of Julie
McKinney
	Sent: Thu 9/20/2007 7:54 PM
	To: healthliteracy at nifl.gov
	Subject: [HealthLiteracy 1267] Re: NAAL-health literacy and
leadership
	
	
	Andres,
	
	I agree that we should keep pushing the definition of health
literacy to apply to institutions, systems and communities and not just
individuals. We have discussed the "blame" issue, and I think we all
agree that we do need to work hard to counteract blaming patients for
communication failures, and to hold systems, health care agencies, and
communities more accountable.
	
	But I do not think that a focus on NAAL and these results will
have a negative impact on our efforts. Quite the reverse, in fact. In
the past decade, the results of the last literacy survey seems to have
have had a tremendous effect on support for health literacy efforts, and
funding for new initiatives.  When the results of the 1993 NALS came
out, (which only included literacy skills and did not even attempt to
assess health literacy) the figure of 90 million Americans with marginal
to poor literacy skills was cited in numerous medical and health reports
and galvanized support for many new health literacy initiatives.
	
	We have seen more plain language information coming out of NIH
and the National Library of Medicine, we have seen JCAHO requirements
addressing health literacy, we have seen the American Medical
Association supporting the cause, and health literacy resources
developed by the U.S. Deptartment of Health and Human Services, among
other things. I think that the "90 million" figure was instrumental in
achieving this kind of progress. What do others think?
	
	So my question now is: what have we learned from this new data
that can continue to support our efforts?
	
	Julie
	
	Julie McKinney
	Discussion List Moderator
	World Education/NCSALL
	jmckinney at worlded.org
	
	>>> "Muro, Andres" <amuro5 at epcc.edu> 09/20/07 12:28 PM >>>
	Ok, here I go with my rant, but I cannot take full
responsibility for
	it. Dr. Ian Bennett got me thinking about this with his posts.
	
	
	
	I think that the focus on the NAAL and on how we define literacy
could
	have a negative impact on what we hope to accomplish if we are
not
	careful. Health literacy is often defined as something like
individuals
	having the knowledge to be able to make informed decisions about
health.
	The NAAL tells us that many don't have this knowledge. So the
task for
	us becomes figuring out how to provide the lacking knowledge to
	individuals.
	
	
	
	Presumably, if we provide this knowledge, individuals will do
better on
	the NAALS and also they will engage in healthier behaviors. I
don't know
	if anyone sees a problem with this sort of thinking, but I find
it to be
	individualistic and archaic thinking and contradictory to the
idea that
	health is a community responsibility. We don't think like this
by
	accident. We inherited this from 18 century British thinking
pandering
	to special interest. But, while the Brits have gotten over this
	mentality, In America, this form of thinking has become very
ingrained,
	particularly since the 1980s.
	
	
	
	So, let's suppose that we increase an individual's health
literacy
	knowledge and the person knows that it is important to eat
fruits,
	veggies and grain and exercise every day, get dental checkups,
etc. That
	does not mean that the person will have the skill or ability to
eat
	healthier and exercise, get dental checkups, mammograms, etc. If
the
	person lives next to a smelting plan, near a polluted river in a
	neighborhood were there is taco bell, pizza hut and lots of
convenience
	stores, the person will likely not go jogging every day and will
not eat
	hydroponic lettuce salad with watercress, dried cranberries and
olive
	oil. So, increasing an individual's knowledge does not guarantee
	healthier behaviors and lifestyles.
	
	
	
	As long as we define health literacy as an individual skill and
measure
	it as such, we will be promoting this sort of thinking. I have
been
	making the argument that health literacy should be defined not
just as a
	person's knowledge, but at the community's ability to provide
spaces for
	people to participate in healthy lifestyles and to provide
opportunity
	for clear communication among all members. So, it is not just my
	responsibility to cook healthy and go running. It is also the
	community's responsibility to create inviting open spaces, to
increase
	access to healthy stores, to provide places where people can get
	checkups, etc.
	
	
	
	Right wing groups are pretty good at developing agendas that
create
	spaces that they favor. So, for example, in my community, they
have
	managed to reduce healthy sex education in the public schools
and
	increase sex abstention education. At the same time, they have
driven
	away naked women bars to a certain distance from public schools
and
	forced most stores to keep condoms behind counters.
	
	
	
	So, if communities have the ability to do this, why not force
businesses
	to be required to only sell healthy foods near schools and force
the
	creating of clean healthy spaces. If the definition of health
literacy
	were modified as I propose, then HHS can come up with tools to
measure
	the health literacy of a community and promote community health
	literacy. A way to measure this could be to develop health
literacy
	indicators and promote policies that require communities to
demonstrate
	this.
	
	
	
	For example, health literacy indicators could be a certain
number of
	stores that only serve a certain type of menu within x many
miles from a
	public school or the number of open spaces and health food
stores that
	are accessible in each neighborhood. So, for example, Mc
Donald's serves
	healthy stuff now. A community could say that near a school, Mc
Donald's
	can only sell certain foods.
	
	
	
	We need more definitions that lead towards this, more tools to
measure
	this and policies that lead to this, and less effort in trying
to
	measure an individual's knowledge.
	
	
	
	What do you all think?
	
	
	
	Andres  
	
	
	
	
	
	
	
	
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