Health Literacy Today

For today’s entry I’d like to focus on the issue of health literacy.  “Two decades of research indicate that today's health information is presented in a way that isn't usable by most Americans. Nearly nine out of 10 adults have difficulty using the everyday health information that is routinely available in our health care facilities, retail outlets, media, and communities. Without clear information and an understanding of prevention and self-management of conditions, people are more likely to skip necessary medical tests. They also end up in the emergency room more often, and they have a hard time managing chronic diseases, such as diabetes or high blood pressure,” according to the U.S. Department of Health and Human Services National Action Plan to Improve Health Literacy.

The Herschel S. Horowitz Center for Health Literacy is one of the most distinctive elements of the University of Maryland School of Public Health. The Herschel S. Horowitz Center for Health Literacy was established in Fall 2007 and joins other related organizations and entities such as the Health Literacy Studies Group at the Harvard School of Public Health and Health Literacy Missouri to address the major public health problem of poor health literacy and its effect on health outcomes. The Horowitz Center for Health Literacy is the nation's first academic based health literacy center and is devoted to improving health through the lifespan, with emphasis on closing the health disparities gap. Research is needed to establish the nature of the causal relationships between and among the various factors including culture and society, education systems, health systems and health outcomes and costs and to develop effective interventions and health policy.

Many of us know the phrase health literacy. Its most common definition is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions, according to Healthy People 2020 and IOM 2004. In terms of operational clarity, I prefer this definition as provided by Hassan and colleagues found here – “Health Literacy” emerges when the expectations, preferences and skills of individuals seeking health information and services meet expectations, preferences and skills of those providing information and services.

The National Action Plan to Improve Health Literacy is of critical importance now, and it is something all public health practitioners should read and have some familiarity with.  This national action plan seeks to engage organizations, professionals, policymakers, communities, individuals and families in a linked, multisector effort to improve health literacy. Cynthia Baur, in a presentation made at an Institute of Medicine Workshop entitled "What's New In Health Literacy Research,” outlined the vision for future efforts in this regard:  Provides everyone access to accurate, actionable health information; Delivers person-centered health information and services; and Supports life-long learning and skills to promote good health.

Dr. Baur went on to summarize the seven goals of the national action plan, including to:

1. Develop and disseminate health and safety information that is accurate, accessible and actionable.
2. Promote changes in the health care system that improve health information, communication, informed decision-making and access to health services.
3. Incorporate accurate, standards-based and developmentally appropriate health and science information and curricula in childcare and education through the university level.
4. Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community.
5. Build partnerships, develop guidance and change policies.
6. Increase basic research and the development, implementation and evaluation of practices and interventions to improve health literacy.
7. Increase the dissemination and use of evidence-based health literacy practices and interventions. 

The Office of Disease Prevention and Health Promotion of the U.S. Department of Health and Human Services developed a site called Health Literacy Online. This guide provides guidance on how to create web sites and content for consumers with limited literacy. This website is an important tool. 

I’ll simply add that for those of you who use Twitter, you will find a very active group of entries related to health literacy there as well. To close I’ll reiterate how important the issue of health literacy is to all public health and healthcare professionals and encourage you to send your comments based on your experience in this area.

Applying mHealth

I saw a presentation by a colleague over 20 years ago that included these comments, “Imagine an array of strategies and tools that facilitate the active and systematic engagement of populations in defining and dealing equitably and intersectorally with their real issues and concerns. Imagine also collaborating in real-time with partners anywhere, sharing data and ideas, being able to monitor the thoughts of others in real time, and documenting the processes and content that contribute to our goals. Imagine if we could actually apply the technology capacity we already have available to us.” As a public health practitioner, researcher and teacher, the breadth of this capacity intrigued me.

Ray Kurzweil

Ray Kurzweil, a pioneer in artificial intelligence said, “Now imagine that the computational power of your cell phone is a million times cheaper, and a thousand time more powerful, and about a hundred thousand times smaller than the main computer at MIT in 1965. What was housed in a building in 1965 now fits in your pocket. What fits in your pocket now will fit inside a blood cell in 25 years.” (NPR, Ray Kurzweil, April 3, 2009)

In this entry I’d like to share some of my thinking and items I have been reading about mHealth. The term mHealth refers to the application of mobile technologies such as cell phones to address health problems. Since the 1970s I have been a vocal advocate for the application of advanced communication technologies to the training of public health professionals and to public health interventions designed to address appropriate public health needs. We are in a very unusual position today as a result of the widespread availability of mobile devices, principally smart phones, around the globe. For those unfamiliar with the term mHealth, there is some reasonable background found on Wikipedia, and I recommend a quick review of the material there as a start. This short video on mHealth may be an even better introduction.

Besides the extensive deployment of smart phones and related technologies, there are a few other elements that make this situation particularly opportunistic: 1) Over the last few years there has been an incredible rise in participatory culture around social media; 2) The devices’ incredible power packs an extreme opportunity in a small, portable package; 3) While very sophisticated and powerful, they are easy to use; 4) The programmatic cost for the technology is relatively inexpensive; 5) Their location awareness adds capacity not found in most desktop and laptop computers; and 6) There’s ample evidence that irrespective of culture, age, gender or geography, people are willing and able to use these technologies.

The mHealth Alliance, a partnership hosted by the United Nations Foundation and the Vodafone Foundation that supports research and advocates for broader use of mobile-based or mobile-enhanced solutions to complex maternal and child health issues around the globe, has driven a major effort around mHealth.

Over time I will provide more entries to this blog about the use of mobile technologies for health, but I’d like to recommend two readings before I finish this entry. The first is a United Nations Foundation Report titled mHealth for Development. This report was released near the end of 2009, and it is a detailed overview of the potential for mobile health technologies for promoting health and preventing disease globally with primary attention to maternal and child health issues. The focus of the report is on the developing world, but it is relatively easy to see how the concepts underlying the application of such technologies can be applied anywhere, including in middle and upper income countries.

Brian Dolan

The last piece I’d like to add is based on a presentation made on March 16, 2011 at South by Southwest (SXSW) in Austin, Texas. Four panelists outlined what they called “landmines” in the way current developers and professionals use mobile health technologies. Brian Dolan, editor of MobileHealthNews, did an excellent job of summarizing and critiquing what John DeSouza, president and CEO of MedHelp; BJ Fogg, head of the Stanford Persuasive Technology Lab; Margie Morris, clinical psychologist and senior researcher at Intel Labs; and Jane Sarasohn-Kahn, a health economist at Health 2.0 Advisors, presented at the meeting. You can find Dolan’s summary in the March 16, 2011 edition of mobihealthnews. I suggest that you consider that these “landmines” are not limited to just mhealth interventions but could also be applied to public health interventions in general.

I want to close by referencing a meeting that anyone interested in these issues should consider attending. The mHealthSummit will take place from December 5 to 7, 2011 at the Gaylord National Resort and Convention Center, Washington, DC. Many people in public health may have missed the 2010 mHealthSummit because it overlapped with the annual meeting of the American Public Health Association. This year the organizers have changed the date to allow public health practitioners, researchers and policy-makers to attend. I highly recommended this meeting.

What I'm Reading Now-

Saving the lives of 25 million children

This entry brings together three items that are of particular interest to me. I gained interest in the subject of the first entry in 1987 when I was fortunate to be asked to serve a consultancy at the World Health Organization in Geneva. The U.S. Centers for Disease Control and Prevention’s Division of Adolescent and School Health was interested in becoming a WHO Collaborating Center and some background work needed to be done in Geneva. While there, I was exposed to an emerging theme at UN partner organization UNICEF called the child survival revolution. The child survival revolution was mostly a result of hard work and advocacy by Jim Grant, the executive director of UNICEF from 1980 to 1996. This became a major effort that resulted in significantly reducing child mortality. 

It may be time for us to take another look at an out of print book, Jim Grant – UNICEF Visionary now that it is available for free download in .pdf form. In a recent post to the Bill & Melinda Gates Foundation blog, Bill Gates said, “I recently came across a book that tells the amazing story of Jim Grant, whose influence in making vaccines widely available in the developing world is credited with saving the lives of 25 million children. Because of the work the foundation is doing on vaccine-preventable diseases, I’ve read quite a bit about the history of global immunization. But until I read Jim Grant—UNICEF Visionary, I didn’t appreciate what a remarkable visionary and results-driven leader he was.”

Jim Grant is responsible for the launch of the child survival and development revolution. Former President Jimmy Carter wrote the book’s forward and it contains eight essays written by Grant’s colleagues. Each essay reflects Grant’s achievements in a variety of ways. This book is worth reading, find it here.

Five Fictions About Social Media in Public Health and Health Care

The second piece is about one of my favorite things to tinker with – social media.  More importantly it refers to a blog entry by an exceptional writer and visionary on social marketing.  Craig Lefebvre’s blog entries will frequently be referred to here, and this is a particularly compelling entry because of the extent to which many think social media can overcome some of our most challenging barriers to reaching out to our constituencies.

Craig Lefebvre is a terrific writer and someone who has served as a visionary for the field of social marketing. He is also quite adept around new technologies, particularly social media. There are few others who can give such a considered analysis of the role social media can play in social marketing. Here Lefebvre warns us what social media cannot do by identifying what he calls five fictions: 1) We can reach audiences with social media; 2) We can change people with social media; 3) Health behaviors are the focus of our social media efforts; 4) We have target audiences who use social media; and, 5) To use social media effectively we need to be on Facebook and Twitter. If these “fictions” sound provocative to you (and they should), read Lefebvre’s post here.

The future of Global Health Journalism

I’ll close today with an item that may not be mainstream for those in public health but which is nonetheless a critical concern. I believe that effective public health journalism is essential to the health of our profession. However, as an art and a profession, journalism is struggling. I highly recommend a new report by the Kaiser Family Foundation regarding the current state of public health journalism. 

The report is called “Taking the Temperature: The Future of Global Health Journalism.” Most of us are aware that in recent years journalism has struggled economically – not only in the U.S. but world-wide as well. There have been major workforce and budget reductions that have influenced the ability of journalists and journalism outlets to cover critical stories as they once would have done. This report is based on interviews with 51 stakeholders in global health journalism, including reporters, editors and producers of a wide variety of media. This report “provided a window into what was happening in global health journalism in the U.S. and in select outlets abroad. How were challenges they faced influencing the type and amount of global health coverage available to the public and policymakers? What were the most important trends in reporting global health issues and what could they portend for the future? With mainstream journalism mired in economic trouble, what were the prospects for funding independent journalism going forward?”

If you’re interested in global health you understand the critical contributions of journalism to our efforts. This report summarizes these interviews, outlines some common themes and issues, and raises some critical questions that must be addressed in the coming years. Download the report here.

Exploring a new way of sharing among friends

I'm going to start by recommending several blogs that folks in public health should probably be aware of and read. The first is written by Dr. Barbara Rimer, Dean of the UNC Gillings School of Global Public Health. Her blog is called Monday Morning, and it is a great illustration of how well this technology can be used. It is primarily a chance for Dr. Rimer to reflect on any topic that engages her curiosity or is related in some way to the UNC Gillings School and its constituencies, or public health in a broader sense. It is one that I really look forward to each week.

Another blog that I'd recommend for those interested in social marketing is authored by Craig LeFebvre and called On Social Marketing and Social Change. Dr. LeFebvre focuses his efforts on public health and social change programs - blending empirical research and consumer experience. He has several academic appointments but he's an internationally recognized expert in social marketing and communication. For those of you familiar with Dr. LeFebvre's very creative presentation style at professional meetings, you'll probably also know he's a frequent contributor to slideshare.com - which I'll talk more about in later entries to this blog.

I am going to close this post by sharing a video by Hans Rosling that Dr. Rimer has also referenced in Monday Morning. Hans Rosling is a Professor of Global Health at the Karolinska Institue and Director of Gapminder. He is one of the most creative speakers I've ever seen. He has developed an open source visualization system that illustrates data of any kind in ways most of us have never seen or thought about. If you search Youtube or Ted.com you will find some of the videos that he has produced. I'd like to share this most recent video here. I'm embedding it from it's original source on Youtube. It is called "200 Countries, 200 Years, 4 Minutes - The Joy of Stats."

I hope you've enjoyed the video. Please feel free to comment, suggest, and share your own thoughts and references so that we can all benefit.

Some items on global public health and training for health professionals

What's Next for Disease Eradication?
It has been more than 30 years since the eradication of smallpox - a disease responsible for as many as 2 million deaths a year and many more disfigured. In August approximately 260 of the scientists and public health leaders responsible for this success met in Rio de Janeiro to celebrate. That success 30 years ago bolstered thoughts about eradication of other such diseases responsible for such pain and suffering. Among the targets were polio, guinea worm disease, lymphatic filariasis, measles, river blindness, and malaria. Regretfully, the success with smallpox has not been repeated. Science magazine summarizes some of the issues raised at a meeting in Frankfort, Germany. At this meeting public health experts tried “to try to chart a new path for disease eradication in the 21st century.” Read the full Science article – “What’s Next for Disease Eradication?”

An Interactive Map of U.S. Global Initiatives

The Center for Global Development’s - Rethinking U.S. Foreign Assistance blog has provided access to a terrific interactive tool that allows users to see where four of the current development initiatives operate. These include: Feed the Future, the Global Health Initiative, the Millennium Challenge Corporation, and the United States President’s Emergency Plan for AIDS Relief (PEPFAR). Casey Dunning, in her blog entry “U.S. Development Initiatives: Where in the World Are They?” reports “President Obama’s recent policy directive on U.S. global development called for an increased 'focus of resources, policy tools, and engagement in support of select countries.' But the question as to where this 'enhanced engagement' might occur still remains.”

Infant and Child Feeding - How are we doing?

In 2003 the World Health Organization and UNICEF jointly developed Global Strategy for Infant and Young Child Feeding to “revitalize world attention to the impact that feeding practices have on the nutritional status, growth and development, health, and thus the very survival of infants and young children.” This strategy was the result of a two-year effort designed to alleviate the burden of disease borne by children and to contribute to a reduction in poverty and was guided by two underlying principles: 1) the strategy should be grounded on the best available evidence; and, 2) wherever possible the strategy should result from a truly participatory process. However, a report released in December suggests that 42 million infants out of 78 million born are sub-optimally fed. This report, “The State of Breastfeeding in 33 Countries: 2010, Tracking Infant and Young Child Feeding Policies and Programmes Worldwide” is based on assessments conducted by the World Breastfeeding Trands Initiative (WBTi). WBTi’s press release accompanying this report states “that policies and programmes are lagging behind in all the 10 areas of action highlighted in the W.H.O. ’s Global Strategy for Infant and Young Child Feeding, especially in relation to support to women when they need it most.”

Defining Global Public Health

In 2010 Dean Linda Fried (Mailman School of Public Health) and six colleagues published a comment in Lancet entitled “Global health is public health” partly in response to an earlier viewpoint piece by Professor Jeffrey Koplan and colleagues – Towards a common definition of global health.” I highly recommend both of these articles but I was particularly struck by the seven key tenets of global public health as outlines in Fried and colleagues (page 536). And among these seven, the one that rings clearest for me was “Dedication to better health for all, with particular attention to the needs of the most vulnerable populations, and a basic commitment to health as a human right.” This for me has always been at the core of my understanding of public health’s mission. The need to provide the best state-of-the-art practice in public health at the population level, with the two underlying principles – social justice and equity. The challenge for me has always been how to we effectively train practitioners to this end. The best definition of education I ever heard (and cannot remember its source), is “Education is what’s left over after we forget everything we’ve been taught.”

Educating Health Professionals In The 21st Century

In that light, I am impressed with a Lancet Commissions Report released a couple of months ago. Just as Flexner, Welch-Rose, and Goldmark prepared reports a century ago that transformed education for physicians, public health practitioners, and nurses, this new report re-examines the training of health professionals for the 21^st century. This Lancet Commission report is authored by Professor Julio Frenk, Dean of Harvard School of Public Health, Dr. Lincoln Chen, China Medical Board, and colleagues. A press release, dated Nov. 29, 2010 summarizes the ten suggested reforms found in this landmark report. The full report is available from Lancet. In their executive summary Frenk, Chen and colleagues introduce us to the notion of third-generation reforms in health professions education with this challenge:

“All health professionals in all countries should be educated to mobilise knowledge and to engage in critical reasoning and ethical conduct so that they are competent to participate in patient and population-centered health systems as members of locally responsive and globally connected teams. The ultimate purpose is to assure universal coverage of the high- quality comprehensive services that are essential to advance opportunity for health equity within and between countries” (page 6).

The authors go on to identify the principle barriers and recommendations to help overcome those barriers. I highly recommend this report.

Looking back and ahead: Thoughts at the beginning of 2011

As I look back on 2010, one of the things I’ve seen has been the remarkable increased use of social media in public health settings. Whether Twitter, Facebook, FLICKR, blogging, or some other application the innovative application of these technologies has been quite exciting.

Every morning I spend time on my iPAD reviewing materials from a variety of sources. I do this on an RSS aggregator called Early Edition by Glasshouse Apps. As I review each source and its contents I am able to forward links to colleagues in a variety of settings who I think might enjoy the content or may find it useful in some way. With each passing day I am sending more of these links to more people and thought there must be a new and more efficient way to do this.
My first effort to modify how I did this was to forward the links to Twitter @rsgold so they would be available to anyone. But it seemed even more realistic to share if I took advantage of blogging technology. So, here we are. This is my first post to "Looking at Public Health Today" and I'm excited. I hope I'll be able to share with you some interesting finds. I'm not sure I'll do this every day or even every week, but I do want to share as much as I can - and hope that anyone who follows this blog will contribute other sources of information, data, papers, technology, and other resources that we should all see.

To that end, I regularly read Blog 4 Global Health sponsored by the Global Health Council’s Policy, Research and Advocacy team. Recently, their blog entry included their view of the “Top 10 in 2010 Global Health Communication.” I highly recommend your taking a look at this blog entry if you have an interest in global health.

Also related to global health – the Kaiser Family Foundation released a policy brief analysis on key issues related to the Obama Administration’s Global Health Initiative. This is an excellent primer in short form that identifies the principal components of this initiative. The full policy brief is available from the Kaiser Family Foundation here – U.S. Global Health Policy.

There are several important new publications that I’d like to highlight today that I think offer public health and other related practitioners a critical new set of ideas to add to our thinking. The first was a report released by CDC’s Leading Edge Forum entitled The Future of Healthcare: It's Health, Then Care. CSC is on of the largest providers of information services in the world, but this report identifies five key trends that will influence the future of healthcare – and each is enabled by newly emerging technologies. The five include:

1. E-Power to the patient, driven largely by Smartphone technology and powered by internet accessible applications;
2. Earlier detection made possible by inexpensive supporting technologies that allow for faster, less costly diagnosis;
3. High-tech healing driven by advances in bioengineering allowing for implantable and wearable treatment systems;
4. New resource mixes produced by remote sensing, social networking, and other technologies that influence patient behavior and remote monitoring;
5. The emergence of a global healthcare ecosystem based on sound data.

I’d like to close today’s entry with information about a meeting held on January 10, 2011 by the Center for Strategic & International Studies. The meeting was entitled: “Is the Era of Big Funding for Global Health Over?” Christian Baeza, World Bank Director for Health, Nutrition, and Population lead the discussion on future global health efforts likely over the next decade with particular attention to major challenges, the economic case for investment, and how to build sustainability into our thinking related to global health.

I would like to take this opportunity to wish all a Happy New Year. All the best.

Bob