Hi all,

Julie, I absolutely agree with your recommendations about broadening the 
concept of health literacy and including health care providers and 
systems as part of the change process. I have long been an advocate of 
removing the "labels" applied to certain individuals, groups, 
communities, populations, etc.

Here's the dilemma that I see. Labeling has served an important historic 
function to draw attention to "less visible" populations. When I 
established a communications program for people with "limited literacy" 
skills at the National Cancer Institute back in the early 1990's, it was 
designed to draw attention to a terribly underserved population. At the 
time, the vast majority of NCI publications and research interventions 
were targeting populations with strong reading skills. Part of the 
reason for using terms like "limited literacy" or "low literacy" was to 
draw attention to populations who typically were not on the radar screen 
of public health officials and practitioners. It often seemed to me that 
many health researchers, professionals, and practitioners didn't see or 
acknowledge the existence of people who had different skill levels from 
their own.

I see how labeling continues today. The Health Literacy Research 
Conference in Washington, DC this past October featured a number of 
presentations about research into new methods to measure health literacy 
skills of patients. Many of these efforts are funded by NIH. The issue 
is that the "labeling process" is part of what generates a funding 
stream. My question is how can we remove the labels and stigmas attached 
to those labels and still ensure funding of important research that 
looks at the need for improving the health literacy skills of our health 
care professionals and access to and navigability of our health care 
systems?

Wendy

Wendy Mettger, M.A.
President, Mettger Communications
Co-founder and Principal, Clear Language Group

Julie McKinney wrote:


>Hello Everyone,

>

>Thanks for this discussion. It is very cool to see this diverse group of

>people weighing in to advance the field of health literacy in this way.

>(Look at the signature lines of those involved for the variety of fields

>and backgrounds and perspectives you all bring!) Please excuse me for

>getting a bit "rah-rah!", but I do think this is an exciting time for

>health literacy, and we are all part of it. 

>

>As Archie pointed out, we do keep coming back to this: that the burden

>of improving health literacy does not lie only on the shoulders of the

>patients, but also on the shoulders of all who deliver health care and

>health information, AND on the shoulders of the systems that drive this

>delivery. We also keep coming back to the fact that it is not only those

>with literacy challenges who have trouble staying healthy.

>

>For years on this list and elsewhere, this double-sided concept of

>health literacy has been evolving, and I think we should adopt it as a

>given. 

>

>  * Can we now talk about health care providers as also "needing to

>improve their health literacy"? Yes! 

>

>  * Should we now let go of the concept of testing patients to see who

>is "at risk", and instead realize that in the current system we are ALL

>"at risk", and so aim to provide clear, simple and appropriate

>communication and non-intimidating access for everyone? Yes!

>

>  * Should we develop rigorous measures of the health literacy of health

>providers and systems so we can create and evaluate effective

>interventions for them as well as for patients? Yes!

>

>When the Institute of Medicine released their report in 2004, they

>mobilized the medical community by publicizing the fact that 90 million

>Americans "have difficulty understanding and acting on health

>information". This was tremendously useful in creating widespread

>awareness and work toward more understandable health information. But it

>was based on a narrower definition of health literacy, which focused on

>(as Rima said) "the capacities of individuals."

>

>Thanks, Linda, for announcing the Calgary Charter, because I think this

>could become the new definition and set of core principles, which we can

>use to mobilize support for the new broader concept of health literacy.

>I know that those who collaborated to develop this charter worked hard

>to acknowledge the concepts that we have all been discussing in this

>recent conversation on this list. If we agree, perhaps we can talk about

>how to make this understanding more widespread? (And if we don't agree,

>that would also be an interesting discussion!)

>

>I would love to hear what you all think about this. And I am sorry for

>going on so long!

>

>All the best,

>Julie

>

>

>

>Julie McKinney

>Health Literacy List Moderator

>World Education

>jmckinney at worlded.org

>  

>

>>>>"Linda Shohet" <lshohet at dawsoncollege.qc.ca> 11/05/09 4:19 PM >>>

>>>>        

>>>>

>Hello all

>

>In the context of the stimulating discussion over the last few days

>regarding 

>labeling of “at-risk” patients, I would like to share the most recent

>version 

>of The Calgary Charter on Health Literacy: Rationale and Core Principles

>for 

>the Development of Health Literacy Curricula, posted at 

>http://www.centreforliteracy.qc.ca/Healthlitinst/Calgary_Charter_Oct_09.pdf.

>

>This document was drafted and revised over the past year by six

>individuals* 

>who attended the October 2008 Institute on Health Literacy Curricula in 

>Calgary, co-hosted by The Centre for Literacy of Quebec.  The Charter 

>proposes a definition and understanding of health literacy and a set of

>core 

>principles to support the development of curricula and evaluation tools

>that 

>improve the health literacy for diverse audiences and purposes.  It 

>specifically avoids labeling any groups and assumes that health literacy

>

>touches individuals and health systems, and while expressed differently

>in 

>different contexts, is always based on the same underlying skills and 

>abilities.  There is considerable consistency between these principles

>and 

>the ones in a proposed US Health Literacy Natiopresented by Cynthia Baur last week at the Georgia Health Literacy

>Symposium. 

>

>We have shared earlier drafts with this list and with participants at 

>selected conferences and events, and have incorporated the feedback we 

>received.  We will give anyone interested the chance to sign on to the 

>Charter in the coming days.  In the meantime, we welcome your thoughts

>about 

>if or how you might use these principles in your own curriculum or

>evaluation 

>work.  

>

>* Charter authors, alphabetically

>•	Clifford Coleman, M.D.    colemanc at ohsu.edu

>Oregon Health & Science University

>

>•	Sabrina Kurtz-Rossi, M.Ed.sabrina_kurtz-rossi at comcast.net

>Kurtz-Rossi & Associates

>

>•	Julie McKinney, M.S.      julie_mcKinney at worlded.org

>World Education, Inc.

>

>•	Andrew Pleasant, Ph.D.     pleasant at AESOP.Rutgers.edu

>Canyon Ranch Institute & Rutgers University

>

>•	Irving Rootman, Ph.D.      irootman at telus.net

>University of Victoria, British Columbia

>

>•	Linda Shohet, Ph.D.       ed at centreforliteracy.qc.ca

>The Centre for Literacy of Quebec

>

>

>

>Linda Shohet

>

>

>--

>Linda Shohet, PhD

>Executive Director

>The Centre for Literacy of Quebec

>2100 Marlowe Avenue, Suite 236

>Montreal, Quebec

>Canada, H4A 3L5

>Tel.:(514) 798-5601, ext. 24

>Fax: (514) 798-5602

>E-mail: ed at centreforliteracy.qc.ca

>Web site: www.centreforliteracy.qc.ca

>

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