Chapter 22: Future Perfect

By Helen Osborne

People across the world are working hard to communicate health information more clearly. Strategies run the gamut from "low-tech" techniques such as writing in plain language and using pictures to "high-tech" options including audio and video teaching tools, interactive websites, and technology-based self-care devices.

That article signalled an "Aha!" moment for me. Armed with this new perspective, I critically examined my worksheets, which I had thought were well written. I realised to my dismay that many of my patients who came from different cultures and educational levels might have a hard time making sense of them. I didnt need more convincing that health literacy mattered. Indeed, I was part of the problem. Now, I wanted to be part of the solution.

But what could I do? At the time there was little guidance. Other than this one research article, the only other resource I could find was the (ever-excellent) book by Doak, Doak, and Root, Teaching Patients with Low Literacy Skills (@ http://www.hsph.harvard.edu/healthliteracy/resources/doak-book/)

Nonetheless, I forged ahead. I introduced my healthcare colleagues to the concept of health literacy. I introduced myself to those outside of healthcare who knew a lot about literacy, teaching, and communication. And I met fellow health literacy advocates who came from many sectors including public health, academia, adult education, and pharmaceutical companies.

But outside this group, health literacy was still not widely-known. So in 1999 I posted a message on a health literacy listserv (an online discussion group) asking what others thought about creating an awareness-raising campaign. Honestly, I expected little response. I was stunned when many replied "Great idea. What are YOU going to do?" And so Health Literacy Month began. This annual awareness-raising event has been celebrated worldwide ever since (@ http://www.healthliteracymonth.org).

In the last decade especially, there have been thousands of peer-reviewed research studies confirming that health literacy is a serious and pervasive problem with costly consequences. You can find links to many of these studies at the US National Network of Libraries of Medicine website, @http://nnlm.gov/outreach/consumer/hlt hlit.html.

Government leaders, too, are getting more involved in health literacy campaigns. Starting in 2010, the US is at what some refer to as a health literacy "tipping point" with the enactment of several significant laws and policy recommendations. These include:

• National Action Plan to Improve Health Literacy, with seven goals to improve health literacy and suggested strategies for achieving them. @http://www. health.gov/communication/hlactionplan/
• Plain Writing Act of 2010. A law requiring that federal agencies communicate in ways that the public can understand and use. @http://www.plainlanguage. gov/plLaw/index.cfm
• Patient Protection and Affordable Care Act (often referred to as "healthcare reform"). This includes several direct and indirect references to health literacy. @ http://www.iom.edu/Reports/2011/Health-Literacy-Implications-for-HealthCare-Reform.aspx )
• Health Literacy Universal Precautions Toolkit, commissioned by the federal Agency for Healthcare Research and Quality (AHRQ). @http://www.ahrq.gov/ qual/literacy/ You can hear Dr. Howard Koh, Assistant Secretary for the US Department of Health and Human Services, discuss these and other health literacy milestones at @ http://healthliteracy.com/hlol-koh

Health literacy is also getting worldwide attention. In September 2012, the Institute of Medicines Health Literacy Roundtable commissioned a report by Andrew Pleasant PhD of Canyon Ranch Institute that summarises international health literacy activities. Learn more @http://www.iom.edu/~/media/Files/Activity%20 Files/PublicHealth/HealthLiteracy/2012-SEP-24/WorldHealthLit.pdf

Whats next for health literacy? While of course the future is unknown, I foresee the development of many more strategies to improve how we communicate about health. I also hope that research will focus more of its attention on the economic benefits of communicating clearly rather than just looking at the costs of misunderstanding. Once we establish the business case for investing in health literacy, the movement can grow exponentially. And given the growing amount of international interest, I anticipate many exciting opportunities for worldwide partnerships, collaborations, and innovation. Indeed, we all truly are part of health literacy solutions.