Category Archives: Barriers to care: language and literacy

Feb 21 2014

Faces of Public Health: Nadine Gracia, HHS Office of Minority Health


Last year, the U.S. Department of Health and Human Services released updated national Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care to help health organizations improve care in diverse communities.

When the updated standards were released, Howard K. Koh, MD, MPH, the Assistant Secretary for Health in the U.S. Department of Health and Human Services (HHS), said “the enhanced CLAS Standards provide a platform for all persons to reach their full health potential.” Koh added that the updated CLAS Standards provide a framework for the delivery of culturally respectful and linguistically responsive care and services. By adopting the framework, health professionals will be better able to meet the needs of all individuals at all points of contact.

“As our nation becomes increasingly diverse, improving cultural and linguistic competency across public health and our health care system can be one of our most powerful levers for advancing health equity,” said Nadine Gracia, MD, MSCE, and Deputy Assistant Secretary for Minority Health and Director of the HHS Office of Minority Health.

NewPublicHealth recently spoke with Gracia about the updated standards and opportunities that efforts to increase health equity can bring to the health of individuals and communities.

NewPublicHealth: How does cultural respect help improve health in diverse communities?

Nadine Gracia: As we see the growing diversity of our country and the persistence of health disparities, really having everyone engaged in the discussion of health equity and the attainment of the highest level of health for all people is vital. Culture and cultural respect are really important when we talk about health equity as well as quality of care, and that’s because culture really influences health beliefs and practices. It influences one’s health-seeking behaviors and attitudes and the experience that someone may have in a health care setting.

So, it is essential that providers and health care delivery institutions understand the critical role that they play in providing culturally and linguistically appropriate services. We define those services as ones that are respectful of and responsive to an individual’s cultural health beliefs, their preferred languages, their health literacy levels and their communication needs. They are really applied by and employed by all members of an organization at every point of contact.

Culturally and linguistically appropriate services are essential when we talk about the health care encounter because they are increasingly recognized as being effective in improving the quality of services and increasing patient safety by preventing miscommunication; facilitating accurate assessment and diagnosis of a patient’s condition; and enabling everyone engaged in health services to truly develop an accurate and effective treatment plan.

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Apr 30 2012

Public Health News Roundup: April 30

CDC Says Plane Scare Unlikely to Have Been Monkey Pox

Investigators from The Centers for Disease Control and Prevention boarded a plane to examine—and then release—a woman with a rash who arrived back in the US from Uganda late last week. The immediate concern had been monkey pox, a sometimes fatal infectious disease that is similar to smallpox, but CDC investigators say her symptoms were not consistent with the illness. News sources say her rash was likely the result of bed bug bites

Read an interview with the screen writer and an advisor to the film “Contagion”

Low Literacy in Math and Reading Can Lead to Medication Dosing Errors by Parents

Parents with math skills at the third grade level or below were five times more likely to measure the wrong dose of medication for their child than those with skills at the sixth grade level or higher, according to a study presented at the Pediatric Academic Societies (PAS) annual meeting in Boston.

Researchers say dosing liquid medications correctly can be especially confusing because parents have to read and understand dosing for different ages and weights and understand the measurement markings on dosing cups, droppers and syringes.

Read more on health literacy.

Text Messaging May Help Increase Immunization Rates

A new study by researchers at the Columbia University Mailman School of Public Health found that text message reminders to parents about flu vaccinations may help boost the number of children vaccinated. The study was published in the Journal of the American Medical Association and followed 9,213 children and adolescents ages six months to 18 years—primarily from minority households. Parents of children assigned to the text-message intervention received up to five weekly texts providing educational information and instructions on where the vaccinations were administered. Everyone in the study received an automated telephone reminder, and access to informational flyers posted at the study sites.

At the end of the study, a higher proportion of children and adolescents in the intervention group (43.6 percent) than in the control group (39.9 percent) had been vaccinated against the flu.

Read about text messaging interventions in public health.

Jan 19 2012

Up to the Challenge?

Todd-Park Todd Park, HHS Chief Technology Officer

Got a good idea for a health app or health innovation? The health agencies of the U.S. government want to know. Since 2009, the U.S. Department of Health and Human Services has invited citizens and tech and health experts, to submit their ideas for new health apps or strategies to help improve population health outcomes through open "challenges."

A recent challenge, still open to contestants, comes from the Office of the Surgeon General, deemed the Healthy Apps Challenge, to help provide tailored health information and empower users to engage in healthy behaviors. (Read about the Surgeon General's announcement of the challenge here.) Another challenge from the Office of the National Coordinator for Health Information Technology asks entrants to create a video of two minutes or shorter on how to use technology to achieve a New Year’s health resolution.

Ashoka Changemakers and the Robert Wood Johnson Foundation’s Pioneer Portfolio have created a challenge called Innovations for Health: Solutions that Cross Borders, with a goal of finding “health care innovations that have the potential to be adapted and applied in different countries experiencing similar barriers to health” – with a focus on both individual health and prevention at a population level. The challenge is particularly looking for new approaches or unique models of change that demonstrate a substantial difference from other initiatives in the field, and for solutions that have demonstrated impact and help vulnerable and under-served populations. The cash prize for the challenge is $10,000 each for up to three winners, and the deadline for ideas is February 13. (From among the entries, the Foundation will also be looking for ideas that show potential to help produce significant improvement in health and health care in the United States).

Why issue a challenge rather than a request for proposals in order to find solutions to so many critical health problems? NewPublicHealth recently asked just that of Todd Park, Chief Technology Officer of the U.S. Department of Health and Human Services.

NewPublicHealth: Health challenges are garnering quite a few contestants, judging by the traffic on the websites. Why are they such a good option for exploring new health solutions?

Todd Park: The challenges are a terrific way to engender innovation for a variety of reasons. One, they tend to attract both usual suspects and unusual suspects. So folks who may have highly complementary expertise or experience in other sectors are now applying their expertise for the first time to help solve a health or health care problem. In fact, the emerging academic literature on challenges in general indicate that the people who win the challenges tend to be, the majority of the time, folks who are unusual suspects; folks who actually come from other sectors who are applying their expertise for the first time to a problem in the sector from which the challenge is being issued.

[Check out health solutions we've heard from other sectors, from housing to transportation to education.]

And another reason why they tend to be – when done well – very successful engenders of innovation is that it’s a very broad-based response that you get. So as opposed to say a procurement where you ask a single organization to come up with the answer to a given question, you’re basically asking the planet for an answer to a question or a solution to a problem, so you get many more responses that are much more diverse than you would get from a narrow solicitation.

NPH: Is there a challenge winner from a non-health sector whose submission blew you away?

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Jan 19 2012

Recommended Reading: Health Literacy

The journal Health Affairs has released a new report on health literacy. The article authors include U.S. Department of Health and Human Services Assistant Secretary for Health Howard Koh, former Center for Medicare and Medicaid Services Director Donald Berwick, and Carolyn Clancy, Director of the Agency for Health Research and Quality. The authors conclude, “the promises of medical research, health information technology, and advances in health care coverage and delivery cannot be realized if our nation does not simultaneously address the challenge of limited health literacy. The federal initiatives of the past few years, combined with a growing commitment to health literate organizations and systems change, can help the nation tackle health literacy and ultimately help us all lead longer, healthier lives.”

According to the report, tens of millions of Americans have limited health literacy—a health issue, that the authors say has, until recently, been relegated to the sidelines. Federal policy initiatives include the National Action Plan to Improve Health Literacy, released in 2010 and the Plain Writing Act of 2010.

Several organizations and government agencies have created useful health literacy resources:

>>Read our earlier Q&A with HHS's Linda Harris and ARHQ's Cindy Brach, also two of the study authors, on efforts to improve health literacy.

Oct 13 2011

Health Literacy: Reducing the Burden of a Complex Healthcare System

CindyBrach_ LindaHarris Cindy Brach, Agency for Healthcare Research and Quality and Linda Harris, Office of Disease Prevention and Health Promotion

Nearly 9 out of 10 adults have difficulty using the health information from doctor’s offices, hospitals, online and in the media, according to background in the National Action Plan to Improve Health Literacy. People with low health literacy are more likely to skip medical screenings, end up in the emergency room and struggle with chronic conditions. As more people gain access to preventive services through the Affordable Care Act (ACA), now is a critical time to reduce the burden of complexity in the healthcare system and beyond.

NewPublicHealth spoke with Linda Harris, Ph.D., Health Communication and eHealth Team Lead in the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion (ODPHP) and Cindy Brach, MPP., Senior Health Policy Researcher for the Agency for Healthcare Research and Quality (AHRQ) about efforts to improve health literacy. ODPHP will co-host a Health Literacy Month Twitter chat on health literacy’s role in promoting prevention provisions in the health care reform law. Learn more about the chat and join the discussion on October 20 at 2 p.m. EST, using the hashtag #healthlit.

NewPublicHealth: Tell us about the burden of health literacy and the impact it has on the health of our nation.

Cindy Brach: We have a population that does, by and large, not have the skills needed to function in the current healthcare environment. Only about 12% of Americans, according to national data, are proficient in health literacy. In fact, all of us struggle at one time or another; it may be because we’re sick or we’re stressed or it may be because we have trouble reading or understanding medical concepts, but we struggle with the health information that’s presented to us.

There is a mismatch between the skills that American adults have and the demands the healthcare environment makes on people – to navigate the system, to parse out what is being said to them [by healthcare providers], and to read those dense documents that have critical medical instructions. What we strive to do when we talk about improving health literacy is to not only try and raise individual’s abilities and skills through adult education and other programs, but also to reduce the complexity of the health information and the navigation that is required for patients to be able to get the healthcare they need.

Linda Harris: I would remind us that related to the ACA, about 32 million Americans, half of whom have limited health literacy, will be eligible for free preventive services through ACA coverage in 2014. It’s a very specific population that we’re aiming to assist in reducing their burden, if possible, before the coverage begins.

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