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2
Keynote Address
OPENING REMARKS AND INTRODUCTION
OF KEYNOTE SPEAKER
Alfred E. Osborne, Jr., Ph.D., M.B.A., M.A.
Anderson School of Management
Osborne emphasized the importance of health literacy and noted
that the U.S. Department of Health and Human Services (HHS) has made
improving the nation’s health literacy a national priority. In his view,
having the Anderson School of Management cosponsor a workshop on
health literacy with the Institute of Medicine (IOM) is consistent with the
school’s mission of enhancing the administrative skills of leaders within
organizations that are addressing the needs of underserved communi -
ties. For example, the school’s Health Care Institute (HCI) has experience
training Head Start Program leadership, staff, and participants. HCI also
has a relationship with the Health Resources and Services Administration
(HRSA) in its work with community health centers. Osborne welcomed
roundtable members, speakers, and the audience to the UCLA campus
and introduced the keynote speaker, Eugene Washington.
3
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4 IMPROVING HEALTH LITERACY WITHIN A STATE
OVERVIEW OF THE ROLE OF THE UNIVERSITY IN
IMPROVING HEALTH LITERACY STATEWIDE
Eugene Washington, M.D., M.Sc.
UCLA Health Sciences and
David Geffen School of Medicine at UCLA
Washington addressed four questions pertaining to health literacy
in his presentation: Why is health literacy important? Who must under-
stand its importance? How can its importance best be conveyed? What
is the role of the academic community in addressing the needs of health
literacy? Washington pointed out that the focus of the workshop is state-
based approaches to health literacy, but he emphasized the global nature
of the problem of low health literacy. He suggested that what is learned
from local and statewide efforts could be translated to affect care around
the world.
The transitive property states that, “If a = b and b = c, then a = c.” This
formula is used in philosophy, especially in the understanding of logic.
Using the transitive property in the context of health literacy and quality
health care means that if the quality of health care (a) depends on effective
patient provider communication (b) and effective provider communica -
tion depends on understanding the health literacy level of the patient (c),
then the quality of care depends on understanding the patient’s health
literacy level. In short, the quality of care depends on both the patient’s
level of literacy and the effectiveness of provider communication. This
transitive property can also be applied in the context of population health.
The ability to improve the overall health status of a population or a com -
munity depends on the effectiveness of communication with the entire
community. And that, in turn, depends on understanding the health lit-
eracy level of the population.
The IOM report, Crossing the Quality Chasm, stated that health care
should be safe, effective, patient centered, timely, efficient, and equitable
(IOM, 2001). If care is patient centered, individuals leave their clinical
encounter with the understanding that their specific needs have been
met. Timely care means that necessary interventions are available and the
processes of care are efficient. Washington observed that poor communi-
cation is often what leads to medication errors. A clinician may choose the
wrong therapy for a patient because he or she did not understand what
the patient was saying. Alternatively, a patient may not take medications
appropriately because the clinician did not give specific instructions.
In early research that examined the elements of patient-provider com-
munication and shared decision making, episodes of care were video -
taped with the provider knowing that the encounter was being recorded.
Patients and providers rated the encounters in terms of whether “part-
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5
KEYNOTE ADDRESS
TABLE 2-1 Experience of Collaboration in Decision Making,
Simulated Model
Shared Decision Making Positive Negative
Present True partnering False partnering
22% 38%
Absent Assumed partnering Unwilling partnering
21% 19%
SOURCE: Adapted from Saba et al., 2006.
nering” in care occurred. True shared decision making occurred only
22 percent of the time while simulated shared decision making occurred
38 percent of the time (Table 2-1).
When thinking about improving health literacy, Washington said, it is
important to understand the perspectives of the various parties that listen
to health literacy messages. The reaction to the message will depend on
the role in which the recipient views him or herself. Yet the deliverer of
the message often views the recipients as uniform. Various roles of the
recipient are those of audience, customer, constituent, partner, and stake -
holder (Table 2-2).
Those that need to be engaged to effectively understand and com-
municate the importance of health literacy include patients, providers,
employers, payers, policy makers, communities and populations, com -
munity leaders, researchers, educators, and communicators and dissemi -
nators. When developing messages it is important to distinguish who is
the primary audience, customer, constituent, partner, or stakeholder. It
may also be necessary to think about whether particular groups are the
primary, secondary, or tertiary audience.
There is value in partnering with the communications industry
because of its great expertise in using media to communicate effectively,
Washington said. This key group, which has not been given sufficient
attention, should be viewed as a principal partner and a major stake -
holder in both education and research efforts. Members of this group can
also be involved in efforts to intervene and improve health status.
In terms of the academic community, health sciences centers, schools
of education, and schools of communication have a major role to play in
conveying the importance of health literacy and furthering health literacy
practice. The academic community more broadly has a key role to play in
teaching and expanding the relevant workforce and in advancing research
methods and knowledge of what works.
Projections of health professional shortages in California made by
HRSA can provide opportunities insofar as they represent positions for
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6 IMPROVING HEALTH LITERACY WITHIN A STATE
TABLE 2-2 Groups Involved in Health Literacy: Definitions
Audience The group of spectators at a public event; listeners or viewers
collectively, as in attendance at a theater or concert. A regular
public that manifests interest, support, enthusiasm, or the like; a
following
Constituent A person who authorizes another to act on his or her behalf, as a
voter in a district represented by an elected official
Customer A person who purchases goods or services from another; buyer;
patron
Partner A person who shares or is associated with another in some action
or endeavor; sharer; associate. A player on the same side or team
as another
Stakeholder A person or group not owning shares in an enterprise, but
affected by, or having an interest in its operations, such as the
employees, customers, and local community
SOURCE: Dictionary.com.
which individuals will have to be trained. Newly trained health personnel
should be educated to understand the importance of health literacy and
provide care that is linguistically appropriate, Washington said.
Educational institutions have played an important role in furthering
the use of multidisciplinary, community-based, participatory research.
Such research should include schools of business, engineering, education,
and communication, along with the traditional disciplines in health sci -
ences. Another area for involvement of the academic community relates
to interventions to improve health literacy. Researchers in academic insti -
tutions are furthering the science of establishing what interventions are
most effective. Interventions include communication strategies both at the
individual level, and for populations at large. The development of meth -
ods, measurements, and standards are critical to understanding what
works and to determine whether or not providers, institutions, organiza -
tions, and communities are providing care and messages that are at the
appropriate health literacy level.
The educational enterprise must embrace the idea of a continuum of
lifelong learning, not only for individuals and patients, but also for health-
care providers. Such an approach is needed in order to fully appreciate the
dimensions of low health literacy and the opportunities to intervene and
ensure high-quality health care. Low health literacy is not simply a local,
state, or even a national problem. It is a global problem. The outcomes
of forums such as the IOM workshop have broad implications with the
potential for improving health worldwide, he concluded.
