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PROMOTING
HEALTH LITERACY TO
ENCOURAGE PREVENTION
AND WELLNESS
WORKSHOP SUMMARY
Lyla Hernandez and Suzanne Landi, Rapporteurs
Roundtable on Health Literacy
Board on Population Health and Public Health Practice
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Gov-
erning Board of the National Research Council, whose members are drawn from
the councils of the National Academy of Sciences, the National Academy of Engi -
neering, and the Institute of Medicine.
This study was supported by contracts between the National Academy of Sciences
and the Agency for Healthcare Research and Quality, the American College of
Physicians Foundation, GlaxoSmithKline, Johnson & Johnson, Kaiser Permanente,
Merck & Co., and the Missouri Foundation for Health (09-0290-HL-09). Any
opinions, findings, conclusions, or recommendations expressed in this publication
are those of the author(s) and do not necessarily reflect the view of the organiza -
tions or agencies that provided support for this project.
International Standard Book Number-13: 978-0-309-21577-0
International Standard Book Number-10: 0-309-21577-3
Additional copies of this report are available from the National Academies Press,
500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202)
334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page
at: www.iom.edu.
Copyright 2011 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost
all cultures and religions since the beginning of recorded history. The serpent
adopted as a logotype by the Institute of Medicine is a relief carving from ancient
Greece, now held by the Staatliche Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2011. Promoting Health Literacy
to Encourage Prevention and Wellness: Workshop Summary. Washington, DC: The
National Academies Press.
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“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
— Goethe
Advising the Nation. Improving Health.
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The National Academy of Sciences is a private, nonprofit, self-perpetuating
society of distinguished scholars engaged in scientific and engineering research,
dedicated to the furtherance of science and technology and to their use for the
general welfare. Upon the authority of the charter granted to it by the Congress
in 1863, the Academy has a mandate that requires it to advise the federal govern -
ment on scientific and technical matters. Dr. Ralph J. Cicerone is president of the
National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter
of the National Academy of Sciences, as a parallel organization of outstanding
engineers. It is autonomous in its administration and in the selection of its mem -
bers, sharing with the National Academy of Sciences the responsibility for advis -
ing the federal government. The National Academy of Engineering also sponsors
engineering programs aimed at meeting national needs, encourages education
and research, and recognizes the superior achievements of engineers. Dr. Charles
M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions
in the examination of policy matters pertaining to the health of the public. The
Institute acts under the responsibility given to the National Academy of Sciences
by its congressional charter to be an adviser to the federal government and, upon
its own initiative, to identify issues of medical care, research, and education.
Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of
Sciences in 1916 to associate the broad community of science and technology
with the Academy’s purposes of furthering knowledge and advising the federal
government. Functioning in accordance with general policies determined by the
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National Academy of Sciences and the National Academy of Engineering in pro -
viding services to the government, the public, and the scientific and engineering
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Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and
vice chair, respectively, of the National Research Council.
www.national-academies.org
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PLANNING COMMITTEE ON PROMOTING HEALTH LITERACY
TO ENCOURAGE PREVENTION AND WELLNESS: A WORKSHOP1
Cynthia Baur, Ph.D., Director, Health Communication and Marketing,
National Center for Health Marketing, Centers for Disease Control
and Prevention
Benard Dreyer, M.D., Professor of Pediatrics, New York University
School of Medicine, and Chair, American Academy of Pediatrics
Health Literacy Program Advisory Committee
Margaret Loveland, M.D., F.R.C.P., F.C.C.P., Global Medical Affairs,
Merck & Co., Inc.
Scott Ratzan, M.D., Vice President, Global Health, Johnson & Johnson
1 Institute of Medicine planning committees are solely responsible for organizing the
workshop, identifying topics, and choosing speakers. The responsibility for the published
workshop summary rests with the workshop rapporteur and the institution.
v
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ROUNDTABLE ON HEALTH LITERACY
GEORGE ISHAM (Chair), Medical Director and Chief Health Officer,
HealthPartners
SHARON E. BARRETT, Health Literacy Staff Consultant, Association
of Clinicians for the Underserved
CINDY BRACH, Senior Health Policy Researcher, Center for Delivery,
Organization, and Markets, Agency for Healthcare Research and
Quality
CAROLYN COCOTAS, Senior Vice President, Quality and Corporate
Compliance, F.E.G.S. Health and Human Services System
MICHAEL L. DAVIS, Senior Vice President, Human Resources, General
Mills, Inc.
BENARD P. DREYER, Professor of Pediatrics, New York University
School of Medicine, and Chair, American Academy of Pediatrics
Health Literacy Program Advisory Committee
DEBBIE FRITZ, Director, Policy and Standards, Health Management
Innovations Division, GlaxoSmithKline
MARTHA GRAGG, Vice President of Program, Missouri Foundation
for Health
LINDA HARRIS, Team Leader, Health Communication and eHealth
Team, Office of Disease Prevention and Health Promotion, U.S.
Department of Health and Human Services
BETSY L. HUMPHREYS, Deputy Director, National Library of
Medicine, National Institutes of Health
JEAN KRAUSE, Executive Vice President and CEO, American College
of Physicians Foundation
MARGARET LOVELAND, Global Medical Affairs, Merck & Co., Inc.
PATRICK McGARRY, Assistant Division Director, Scientific Activities
Division, American Academy of Family Physicians
RUTH PARKER, Professor of Medicine, Emory University School of
Medicine
YOLANDA PARTIDA, Director, National Program Office, Hablamos
Juntos, University of California, San Francisco, Fresno Center for
Medical Education & Research
SCOTT C. RATZAN, Vice President, Global Health, Johnson & Johnson
WILL ROSS, Associate Dean for Diversity, Associate Professor of
Medicine, Washington University School of Medicine
PAUL M. SCHYVE, Senior Vice President, The Joint Commission
PATRICK WAYTE, Vice President, Marketing and Health Education,
American Heart Association
vi
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AMY WILSON-STRONKS, Project Director, Division of Standards and
Survey Methods, and Principal Investigator, Hospitals, Language,
and Culture Study, The Joint Commission
WINSTON F. WONG, Medical Director, Community Benefit,
Disparities Improvement and Quality Initiatives, Kaiser Permanente
Study Staff
LYLA M. HERNANDEZ, Staff Director
SUZANNE LANDI, Senior Project Assistant (until November 1, 2010)
ANGELA MARTIN, Senior Project Assistant (beginning November 1,
2010)
ROSE MARIE MARTINEZ, Director, Board on Population Health and
Public Health Practice
vii
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Reviewers
This report has been reviewed in draft form by individuals chosen
for their diverse perspectives and technical expertise, in accordance with
procedures approved by the National Research Council’s Report Review
Committee. The purpose of this independent review is to provide candid
and critical comments that will assist the institution in making its pub-
lished report as sound as possible and to ensure that the report meets
institutional standards for objectivity, evidence, and responsiveness to
the study charge. The review comments and draft manuscript remain
confidential to protect the integrity of the process. We wish to thank the
following individuals for their review of this report:
Carolyn Cocotas, F.E.G.S. Health and Human Services System
Norma Kanarek, Johns Hopkins Medical Institute
Michael Villaire, Institute of Healthcare Advancement
Louise Wessel, Association of Clinicians for the Underserved
Although the reviewers listed above have provided many construc-
tive comments and suggestions, they were not asked to endorse the final
draft of the report before its release. The review of this report was overseen
by Harold J. Fallon, University of Alabama at Birmingham. Appointed by
the National Research Council the Institute of Medicine, he was respon -
sible for making certain that an independent examination of this report
was carried out in accordance with institutional procedures and that all
review comments were carefully considered. Responsibility for the final
content of this report rests entirely with the authors and the institution.
ix
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Acknowledgments
The Roundtable on Health Literacy wishes to thank its sponsors for
making it possible to plan and conduct the workshop on integrating
health literacy into prevention programs. Sponsors of the workshop were
the Agency for Healthcare Research and Quality, American College of
Physicians Foundation, GlaxoSmithKline, Johnson & Johnson, Kaiser
Permanente, Merck & Co., and the Missouri Foundation for Health.
The Roundtable expresses its appreciation to Scott Ratzan for prepa -
ration and presentation of the commissioned paper on integrating health
literacy into primary and secondary prevention strategies. Thanks also
go to the expert speakers whose presentations provided insightful infor-
mation and stimulated interesting and thoughtful discussions. These
speakers are Jennifer Cabe, Jennifer Dillaha, W. Douglas Evans, Robert
Gould, Jeffrey Greene, Juli Hermanson, Charles J. Homer, Patricia Molino,
John Montgomery, Linda Neuhauser, Arnold Saperstein, Penelope Slade-
Sawyer, and Mariela Yohe.
The Roundtable also wishes to thank the planning committee mem-
bers for their work in developing an excellent workshop agenda. Members
of the planning committee were Cynthia Baur, Benard Dreyer, Margaret
Loveland, and Scott Ratzan.
xi
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Contents
1 INTRODUCTION 1
2 THE ROLE OF HEALTH LITERACY IN PRIMARY AND
SECONDARY PREVENTION 3
3 COMMISSIONED PAPER ON INTEGRATING HEALTH
LITERACY INTO PRIMARY AND SECONDARY
PREVENTION STRATEGIES 7
4 PANEL REACTIONS 13
Discussion, 19
5 INTERSECTION OF HEALTH LITERACY AND PUBLIC
HEALTH PREVENTION PROGRAMS 27
Incorporating Health Literacy into the Healthy People Focus
on Social Determinants of Health, 27
Integrating Health Literacy into State Prevention, Wellness,
and Health Care Programs, 29
How Have the Concepts of Health Literacy Been Incorporated
into Local Prevention and Wellness Programs? What Are the
Successes and Challenges?, 31
Discussion, 34
xiii
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xiv CONTENTS
6 HOW DO INSURANCE COMPANIES FACTOR HEALTH
LITERACY INTO PREVENTION PROGRAMS AND
INFORMATION FOR ENROLLEES? 37
Discussion, 42
7 INDUSTRY CONTRIBUTIONS TO PROVIDING HEALTH
LITERATE PRIMARY AND SECONDARY PREVENTION 47
Discussion, 53
8 THE POTENTIAL AND CHALLENGES OF HIGHLIGHTING
HEALTH LITERACY 57
REFERENCES 63
APPENDIXES
A WORKSHOP AGENDA 65
B WORKSHOP SPEAKER BIOSKETCHES 69
C COMMISSIONED PAPER 77
FIGURES
3-1 Determinants of health: The 21st century field model, 8
3-2 Health literacy scorecard, 9
4-1 Health literacy framework, 22
5-1 A framework for obesity prevention, 29
5-2 Potential points for intervention in health literacy, 32
C-1 Health literacy framework, 83
