Jo Ivey Boufford, M.D.
President, New York Academy of Medicine
Foreign Secretary, Institute of Medicine
The New York Academy of Medicine was established in 1847 by a group of physicians in New York who wanted to improve the quality of health care, Boufford said. The academy then moved to address public health issues (e.g., infant immunization and feeding practices) and was instrumental in establishing the Board of Health in New York City at the end of the 19th century. Following the events of September 11, 2001, the academy became involved in working with schoolchildren suffering from posttraumatic stress syndrome. Current priorities are urban health and healthy aging, prevention, and eliminating health disparities.
The New York Academy of Medicine works on the kind of continuum represented by this meeting, Boufford said—the continuum of local to global. For example, using the World Health Organization (WHO) model for an age-friendly city,1 the academy has been working with the East
1 “The WHO Age-friendly Environments Programme is an international effort to address the environmental and social factors that contribute to active and healthy ageing. The Programme helps cities and communities become more supportive of older people by addressing their needs across eight dimensions: the built environment, transport, housing, social participation, respect and social inclusion, civic participation and employment,
Harlem community as well as four other parts of the city to develop aging-improvement districts. It is also working with colleagues in Philadelphia, Chicago, and Oakland and has presented the New York experience with those age-friendly cities to Tokyo and Taiwan. There is a global network of cities learning from each other how to apply the principles for the development of age-friendly cities and communities in their own contexts.
Health literacy is fundamental to age-friendly cities, Boufford said. It involves starting with the voices of older persons, asking simple questions such as “What makes it harder or easier for you to live an active and engaged life in your community?” This approach has led to major policy changes in New York City over the last 2 to 3 years: things such as benches on sidewalks, traffic lights with slower timers so older persons can get across the street before the light changes, and senior hours at city pools. Asking people what they want and need is fundamental to the Affordable Care Act, both at the patient level and at the community-based prevention level.
Boufford also described efforts at the Institute of Medicine (IOM) to include a more global perspective. Recently, the IOM council voted to increase the number of new foreign associate members from 5 per year to 10 per year. There will also be increased effort to add international scholars as presenters at workshops and members of roundtables and peer-reviewed studies. The IOM is also working with academies in other countries to apply the reports and other products of the IOM in their own contexts.
The New York Academy of Medicine is pleased to be the venue selected for the beginning of efforts on the part of the IOM Roundtable on Health Literacy to develop a global health literacy community, Boufford said. Such a community can provide the opportunity to learn from each other and to move health literacy forward.
Steven J. Hoffman
Executive Office of the United Nations Secretary-General
Hoffman said that it is an exciting moment in New York City with the United Nations General Assembly beginning the next day and world leaders arriving to debate some of the greatest issues facing the United Nations. There is no better time or place for the IOM Roundtable on Health Literacy, he said, because health literacy is fundamental to attain-
communication, and community support and health services” (http://www.who.int/ageing/age_friendly_cities/en [accessed November 15, 2012]).
ing the best possible health status and mitigating health inequalities around the world.
From a global perspective, improving health literacy is essential for making progress on the Millennium Development Goals (MDGs),2 Hoffman said. The manner in which health literacy affects the three health-related MDGs is clear, he continued, because it is known that health literate people are healthier people, especially when they are empowered to act upon the social determinants of health and to demand the fulfillments of their health rights.
But health literacy also affects the other MDGs—for without a sufficient level of health literacy it will be impossible to fully eradicate poverty, to achieve universal primary education, and to promote gender equality, Hoffman said. Given increases in cross-border trade and travel that exposes people to new threats and diseases, health literacy becomes more important than ever before. In addition, he said, noncommunicable diseases are increasingly taking the spotlight on the global agenda, with the top six causes of mortality worldwide being high blood pressure, tobacco use, high blood glucose, physical inactivity, obesity, and high cholesterol.
The United Nations is serious about promoting health literacy, Hoffman said. For example, the Joint United Nations Programme on HIV/AIDS (UNAIDS); United Nations Educational, Scientific and Cultural Organization (UNESCO); and other key stakeholders launched EDU-KIDS in 2004 This is an initiative focusing on preventing the spread of HIV through education. Another example is the United Nations Children’s Fund (UNICEF)-supported skills-based health education efforts that focus on the development of knowledge, attitudes, values, and life skills that children need to make the best health decisions possible. The WHO is helping member states use new e-health technologies, and the Pan American Health Organization is implementing a regional e-health strategy and plan for action for all countries in its region.
The Secretary-General is also serious about health literacy, Hoffman said. For example, last week, instead of meeting prime ministers or presidents for his first bilateral meeting of this General Assembly session, the Secretary-General chose to meet Kami, an HIV-positive Muppet from Sesame Street. He did this to raise global awareness of HIV among children and the challenges facing people who live with HIV, Hoffman said.
Improving health literacy among women and children is particu-
2 “The eight Millennium Development Goals (MDGs)—which range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education, all by the target date of 2015—form a blueprint agreed to by all the world’s countries and all the world’s leading development institutions. They have galvanized unprecedented efforts to meet the needs of the world’s poorest” (http://www.un.org/millenniumgoals/bkgd.shtml [accessed November 15, 2012]).
larly important, Hoffman said, and the Secretary-General, guided by the MDGs, has focused a great deal of his efforts on the Every Woman Every Child initiative.3 Women and children are the most vulnerable members of society, face the greatest levels of poverty and discrimination, have the fewest opportunities, have the most to gain from health literacy initiatives, and are where the greatest successes for health and other goals might be achieved, Hoffman said. He then quoted the Secretary-General as often saying: “Where women and children are empowered and educated, economies are productive and strong. Where women and children are more fully represented, societies are more peaceful and stable.” And, Hoffman added, women and children probably represent our world’s greatest untapped resource.
But, Hoffman said, one cannot think only about how health literacy may change the world. One must also think about what the changes in our world mean for how we deliver health literacy initiatives. For example, with the largest proportion of young people ever on the face of the planet, it is important to think creatively about how to reach this group, to appeal to their tech-savvy ways, and to empower them with choice. Technology will no doubt be a key facilitator of health literacy, Hoffman said, since three-quarters of the world’s inhabitants have access to a mobile phone, a greater proportion than that of people with access to essential medicines (World Bank, 2012).
Concluding his presentation, Hoffman said that bridging the gap between what is known about health issues and how the media reports them is important. He advocated for the potential of Web 2.0, the blogosphere, Twitter, and other online spaces for the promotion of health. It is important to think about how these technologies and platforms can be used to improve health literacy and accelerate progress in global health, Hoffman said.
World Bank. 2012. Information and communications for development: Maximizing mobile. http://siteresources.worldbank.org/EXTINFORMATIONANDCOMMUNICATIONANDTECHNOLOGIES/Resources/IC4D-2012-Report.pdf (accessed November 15, 2012).
3 Every Woman Every Child, led by UN Secretary-General Ban Ki-moon, aims “to mobilize and intensify global action to improve the health of women and children around the world. Working with leaders from governments, multilateral organizations, the private sector and civil society, Every Woman Every Child aims to save the lives of 16 million women and children and improve the lives of millions more” (http://www.everywomaneverychild.org/ [accessed November 15, 2012]).