Health Literacy Summit National Institute for Literacy Panel Discussion of Statewide Initiatives

1. Health Literacy SummitNational Institute for LiteracyPanel Discussion of Statewide Initiatives The Wellmark Foundation Matt McGarvey, Director mcgarveym@wellmark.com 515.245.4819 March 26, 2008 Indianapolis, IN

2. Health Literacy Realities • 90 million+ adults with limited health literacy cannot fully benefit from much that health and health-care systems offer • According to the 2003 National Assessment of Adult Literacy (NAAL), ~45% of the United States population have only basic or below basic literacy skills • Health literacy does not discriminate • Health literacy is more than reading • Low health literacy is risky • Impacting health literacy requires partnerships The Wellmark Foundation

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4. Possible Areas for Action to Implement a Vision for a Health-Literate America Health Care System -Access to care/provider -Access to reliable, understandable information and materials -Infrastructure support for good patient-provider interaction -Clear communication at all levels -Health law, patient rights and responsibilities -Technology Society -Community-based supports and infrastructure, engagement with other sectors (education, healthcare, etc) -Support for individuals’ role in home-based health care Government -Health plan purchasing -Drug labeling and advertising -Regulatory role -Health education/promotion role Improved Health Literacy and Health Outcomes Media -Access to reliable, understandable information through variety of media channels Business -Employee health and safety and literacy programs -Health plans -Partnership with other sectors -Role of pharmacy in health literacy Education -Literacy Education -Health & science in K-12 curriculum -Adult education -Health professionals education The Wellmark Foundation

5. Health LiteracyOur Philanthropic Funding Framework • Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. The American Medical Association Council of Scientific America more specifically defines functional health literacy as “the ability to read and comprehend prescription bottles, appointment slips, and other essential health-related materials required to successfully function as a patient.” • Similar to a traditional understanding of literacy, health literacy incorporates a range of abilities to: • Read, comprehend, and analyze information; • Decode instructions, symbols, charts, and diagrams; • Weigh risks and benefits; and, ultimately, • Make decisions and take action. The Wellmark Foundation

6. Health LiteracyOur Philanthropic Funding Framework • The concept of health literacy extends to the materials, environments, and challenges specifically associated with disease prevention and health promotion. Examples of interventions that could be considered responsive to our request for proposals include, but are not limited to: • Modeling and measuring the nature and scope of health literacy with a target population or community. • Determining variation in health literacy over the life course or among native and non-native speakers of English. • Determining the impact of low health literacy on health outcomes, diseases, behaviors and treatments, including the contribution of health literacy skills to informed decision-making and adherence to preventative regimens and/or risk avoidance strategies. The Wellmark Foundation

7. Health LiteracyOur Philanthropic Funding Framework • Identifying effective preventive and other community-based support to improve health literacy among populations and to enable the health and public health systems to communicate effectively across different health literacy levels. • Developing projects that recognize that health literacy is a complex phenomenon that involves individuals, families, communities and systems. Consumers, patients, caregivers, and other laypersons may vary with respect to access, skills, knowledge, or abilities. Utilizing health literacy approaches to mitigate these realities is an ideal use of philanthropy in this area. • Developing and testing tools to measure health literacy at patients’ point of care to facilitate appropriate patient-provider communication. The Wellmark Foundation

8. Health LiteracyOur Philanthropic Funding Framework • Implementing strategies to empower patients and their families to seek information and to demonstrate actions to improve their health. • Redesigning current systems to more effectively consider health literacy when developing outreach materials, educational materials, and social marketing efforts. • Incorporating and testing educational strategies to develop health literacy skills in children. The Wellmark Foundation

9. Health LiteracyLessons learned from our funding • Find local champions; early adapters that have a vision and tenacity to pursue HL interventions • “Spread" of health literacy concepts does not proceed in a linear fashion, and may follow unanticipated, beneficial paths. Using frameworks like Ask Me 3 can prove beneficial. • While the initial focus of many of our funded projects was on identifying local and state partnerships, it is beneficial to partner with national organizations (e.g., AMA, IHI, AAP) to share unifying concepts more broadly, using local data for support. • Health departments and public health generally can play an important role in addressing health literacy through promotion of tools and resources. The Wellmark Foundation

10. Health LiteracyLessons learned from our funding • Work with natural advocates (adult learners/literacy, public health, professional associations, primary care associations, etc.) to build your health literacy efforts with kindred souls. • Advance efforts to create a shame-free environment in which patients feel comfortable asking questions or acknowledging that they don't understand information. • Problems associated with health literacy can involve culture, language, and sensory processing. This calls for multifaceted interventions that address the care environment, interpersonal interactions between patients and care navigators, and written materials for patients and their families. • Cultural competence plays a role in health literacy. The IOM report found that culturally influenced perceptions, definitions, and barriers have an impact on "how people interact with the health care system and help to determine the adequacy of health literacy skills in different settings." The Wellmark Foundation

11. Health Literacy Places to visit.... Resources if you are just starting: • AMA Foundation Health Literacy [ama.foundation.healthlit@enews.ama-assn.org] • IOM Roundtable on Health Literacy [http://www.iom.edu/CMS/3793/31487.aspx] • Harvard Health Literacy Studies [http://www.hsph.harvard.edu/healthliteracy/] Finding funders: • Forum of Regional Association of Grantmakers [http://www.givingforum.org/s_forum/sec.asp?CID=575&DID=2625#IN] • Grantmakers in Health [http://www.gih.org/link_no_cat2664/link_no_cat.htm?requesttimeout=500] • Foundation Center [http://foundationcenter.org/findfunders/statistics/gm_financial_state.html] • LINCS [http://www.nifl.gov/cgi-bin/lincs/search/gsearch/dbsearch.cgi?action=Show%20Results] The Wellmark Foundation

12. Health Literacy Gaining initiative/project support.... • All too few foundations have this as an explicit funding priority (Missouri Foundation for Health, Paso del Norte Health Foundation, Sisters of Charity Foundation of Cleveland) • Given that reality, approach funders in their areas of health interest and take advantage of the cross-cutting nature of health literacy to weave their agenda into your own (don’t chase money, but find mission matches and be creative). • There is much that can be done with little or no money – begin to do that work (health literacy concepts in job descriptions, HL in new employee orientation, competency standards for performance evaluation – teach back techniques) and you’ll begin to have a story for yourself to show initiative that funders are seeking. • Pilot efforts locally, but have a plan to take them to scale or spread. Have someone in your collaborative thinking two or three project iterations down the line that can each be segregated into their own grant. The Wellmark Foundation

13. Community-Responsive Foundation-Initiated Funding ContinuumThink about funding/funders in a different light... Responsive Proactive The Wellmark Foundation

14. Community-Responsive Foundation-Initiated Consider leveraging your coalition and this topic here Funding ContinuumWhere coalitions might consider going Foundations are historically here The Wellmark Foundation