strategies targeted at each of these levels of a child’s environment. Health literacy can be promoted for its benefits in the same way that healthy eating or not smoking are promoted for their benefits.

What is needed, Evans said, is to build a social movement around increasing health literacy that would be modeled on other successful movements. To make health literacy omnipresent, he suggested building health literacy as a lifestyle brand, modeling the idea that being health literate is desirable. For example, the social environment surrounding tobacco control has changed drastically in recent history and this required more than warnings about shortened life spans and other health risks of smoking. Social marketing techniques that worked at multiple levels helped change the environment to make it harder to smoke in certain locations, to increase prices, to tax cigarettes, and generally to make it more inconvenient to smoke. Social marketing has also helped build breast cancer awareness and prevention through Race for the Cure, a movement that did not exist 25 years ago.

Healthy People has been making strides in refocusing its efforts to include working not only the public health community, Evans said, but also with the many other groups and individuals who are key to improving the health of the U.S. population. Healthy People 2020 is attempting to build a brand around Healthy People in order to reach previously unaddressed audiences such as the general public, very few of whom know what Healthy People is, and in particular, members of groups suffering from disparities who could benefit the most if Healthy People information were made easily accessible to them and if they were motivated to want to actually use it. Evans presented a framework for obesity prevention (Figure 5-1) as an example of a plan that takes into account the socio-ecological mode.

Evans proposed a scenario for building a movement around health literacy. At the policy level, he said, one could develop advocacy campaigns to promote people becoming health literate—for example, by telling people they can become health literate by doing five simple things in their communities. At the community level access points could be provided for people to enact or engage in those behaviors that are being promoted at the policy level. There could be individual- or family-level activities in which families worked together to become more health literate and to realize the potential benefits for the family.

Healthy People 2020 is focused on building health equity by constructing a multilevel approach to health using communication and marketing both to promote stakeholder buy-in and as an intervention strategy. Social marketing interventions can focus on health literacy as a critical health equity issue for the next decade, thereby being a useful strategy for engaging health literacy stakeholders, Evans concluded.



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