obtain input about the important problems? Is it the clinical part of the researcher’s day that informs those questions? Is it the institution in which the researcher sits? Is there a way to look at a clinical problem in terms of consistently delivering excellent services to a broad population?

As the health care system becomes more sophisticated, with automated recording tools and processes, it inevitably leads to the conclusion that it is important to help individuals cope with the system and its output, Isham said. As the process and consistency of recommendations for delivering care improve, it becomes increasingly important to understand the issues of the patient, how he or she understands and communicates regarding these issues and the system. Health literacy is absolutely central to that, Isham stated. Profoundly understanding people’s needs, preferences and values, and how science, health care, and medicine interface with those, is becoming more prominent.

The National Action Plan (NAP) is exciting and offers a coherent approach that will spawn a whole set of productive questions about next steps. It is a rich start for several conversations on implementing the plan, Isham concluded.

Culbert emphasized the role of the community, particularly, in the need for increased community-based participatory research so that the findings can be more easily translated back into the community. Ross called for a focus on the more vulnerable populations. Health literacy needs be viewed in a social construct, acknowledging the social and economic components, Ross said, which requires expanding the number of partners to include those in education, finance, health, and policy. Dreyer stated that thinking about disparities, health literacy, and the role of universal versus targeted interventions is key. Are there universal interventions that will be intensive enough to be given to all, or are targeted interventions the way to go? Do we know, he asked?

Rudd’s discussion of the education system was particularly useful, Dreyer said. The education system is broken. When so many students do not learn math or writing or any of the other academic subjects, how can we expect them to learn anything about health? The NAP calls for teaching children from preschool through university about managing their own health. Are there specific interventions that can be used to promote education, he asked?

Barrett shared her appreciation for movement away from looking at an individual’s deficits and moving to evaluate organizations and the environment in which health care delivery occurs. How can the health care system better communicate with patients? Other stakeholders need to be brought to the table; the silos need to come down. Health literacy should begin to disperse into the environment in which people live and work, broadening beyond the health care system.