communities for more than a century, and many of them are the largest employers in their areas. HHC provides a safety net not only for health care, but many times also for financial counseling, legal issues, and family support. This is important because if a patient does not know where he is going to sleep that night or isn’t sure whether he will eat, he is not listening to instructions about such things as weighing himself every day.

Health literacy includes more than just health information and health services, Johnston said. It is about helping people live their lives. For example, about two years ago the contractor handling the HHC health information system experienced a breach in the security of information for about 150,000 people. That contractor offered the 150,000 patients a toll-free number to call for information and free credit reports for a year. But the offer was all in English. Of course, the patients immediately came to HHC staff with the letter—an entire page all written in legalese and barely understandable to English speakers—and said, What are we supposed to do with this?

HHC set up a system to help the patients. Staff members explained what the letter meant and provided telephone support because the contractor was unaware of the patients’ language needs and only offered telephone support in English. Then, when the credit reports were delivered, the patients brought them in to HHC to find out what those reports meant. That is an example of health care literacy, Johnston said.

HHC has attempted to address many of the attributes described in the commissioned paper. Although not fully successful, the organization is on the path described. HHC sees the following attributes as top priorities:

•   Establish promoting health literacy as an organizational responsibility.

•   Foster an augmented and prepared workforce to promote health literacy.

•   Distribute resources to better meet the needs of the populations served.

Several initiatives are important as the base from which HHC will help provide the support patients need to become health literate, including initiatives aimed at transparency and patient-centeredness. One of HHC’s cornerstones is transparency, Johnston said. In 2007 HHC president Alan Aviles wrote an article explaining why HHC publishes patient outcomes and patient satisfaction results on its website—it is part of becoming a transparent organization, to which HHC is fully committed. Furthermore, all of the ambulatory care sites are approved by the National Committee for Quality Assurance at Level 3, the highest level of approval, as patient-centered medical homes, delivering high-quality primary care.

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