Hi Everyone,

First of all, let me say that you all are one neat community! Look at
what's going on here in the space of two days: the definition of HL,
emotional implications of treatment refusal, compelling research-based
facts to support our work, how to write effectively for "the masses",
plain language Spanish drug information... I feel very lucky to be part
of this!

Now to my point. The recent posts from Rima, Andrew and Bill all had
good points that I agree with and lead me to more questions about the
definition of health literacy (HL). Rima and Andrew talked about how
"disquieting" it is that we blame the patients. We all agree with this.
And when we talk about costs associated with health literacy, I agree
with Rima that we cannot differentiate between costs due to medical
errors and costs due to literacy-related issues. But as Andrew points
out, these are all health literacy issues. (...in my mind, anyway.)

When I use the term "health literacy" these days, I use it in the way
Andrew described: it refers not only to the patients' HL skills, but
also to the providers' and health systems' HL skills. The accountability
to improve HL should absolutely rest on the shoulders of providers and
health systems at least as much (if not more) than on the shoulders of
the patients. 

Bill's expanded definition of HL includes services and communities, and
the word "share" in addition to "obtain, process, understand..." I like
the way this includes health providers as having some responsibility in
the HL burden.

This is a shift in the definition. So far, it has mostly referred to
skills that patients have or don't have ("obtain, undertand, process
information..."). Even though providers need to do these things as well,
the definition was rarely interpreted this way, so it appeared to refer
only to patients' skills. Now we are talking more about a definition
that includes the providers' and systems' skills to "share" and
"communicate" in ways that allow patients to do their part more
effectively. Now many of us want to be able to refer to, evaluate and
improve the HL of providers, systems and communities as well as the HL
of patients.

What do you all think about this shift? 
Should the definition of HL refer to health professionals as well as
patients? 
     (i.e. Should we be able to use the term "The health literacy of the
provider/clinic/hospital/ect."?) 
Does the word "literacy" in the definition confuse this new expanded
meaning, or are we far enough along that we can all get our minds around
it?
When referring to providers, how does HL differ from "communication"?
Should the definition focus on an effective "interaction" rather than
skills of various participants?

Ok, I'll stop now.

Thanks for bearing with my long message... :^)

Julie

Julie McKinney
Health Literacy List Moderator
World Education
jmckinney at worlded.org