Adult Education and Public Health Partner to Address Health Literacy Needs

The 1993 publication of findings from the first National Adult Literacy Survey (NALS) drew the attention of the nation. Among health researchers, the realization that almost half of U.S. adults have difficulty using common texts to complete everyday tasks spurred interest in health-related consequences. Subsequently, improving health literacy was listed among the objectives of "Healthy People 2010," the Department of Health and Human Services' (HHS) document, which articulates the health goals and objectives of the nation. The action plan for this objective, contained in Communicating Health: Priorities and Strategies for Progress, notes that partnerships will be required to marshal the necessary resources to make progress (HHS, 2003). A partnership between the health sectors and the adult education sectors is a highlighted goal, and adult educators are called on to augment students' abilities to access and navigate the difficult pathways of health information for themselves, their families and their communities (HHS, 2003). Similarly, the National Academies' Institute of Medicine report, Health Literacy: A Prescription to End Confusion (2004) recommends that adult educators augment their students' abilities to access and navigate the health information and health services. Many health researchers and practitioners awaited the 2005 analyses, in part, because research studies established a link between reading skills and a variety of health-related outcomes (Berkman et al., 2004; Rudd, Soricone, & Santos, 2000) and the hope of documented improvements in literacy skills. Unfortunately, the initial findings from the 2003 National Assessment of Adult Literacy (NAAL), announced at the end of 2005, indicated little or no improvement over the 1993 survey findings (Rutner, Greenberg, & Baer, 2005). The need for collaborative work articulated at the beginning of the century becomes even more essential in the face of a growing body of literature that documents health consequences of limited literacy, Since the publication of the NALS, many partnership programs engaged health educators and adult educators in a variety of funded programs focused on health information. Although a focus on health topics is not really the business of ABE, ESOL, or GED programs, health subjects can be incorporated in lessons to enrich discussion and engage students, as long as the focus remains on improving reading, writing, math, and oral language skills. This article reports on collaborative efforts to focus attention, not on health content, but instead on the critical literacy skills needed for everyday life, and most especially for a wide variety of health-related activities and tasks. Background Health literacy is often defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (HHS, 2003, [paragraph] 15). However, the definition has evolved beyond a focus on individuals and is considered to be the interaction of the demands of health systems and the skills of individuals (HHS, 2003; Institute of Medicine, 2004). Assessments indicate that the demands of health systems are high, and that many materials and tools are prepared at reading levels that exceed the average reading skills of U.S. adults. In addition, findings indicate that individuals entering health services are not able to access information, act on information, or understand and follow directions as presented. Studies have firmly linked limited reading skills with higher rates of hospitalization, less understanding of one's disease or regimen, and less control over chronic disease (Berkmann et al., 2004; Institute of Medicine Committee on Health Literacy, 2004; Rudd, Moeykens, & Colton, 2000). Focus on Critical Health Issues In light of these suggestions and findings from policy makers and health literacy research studies, colleagues from public health and adult education fields developed a conceptual model and a professional development approach to address issues of health literacy in adult education instruction. …