Environmental Health Literacy: Can the public be healthy without it? · 2020-07-11 · case ofcase...

Environmental Health Literacy: Can thepublic be healthy without it?

Christina Zarcadoolas PhD

Dept. of Community and Preventive Medicine Mount Sinai School of Medicine

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We live in an ever changing landscape of health and

environmental risk ( & fear)

Zarcadoolas MSSM 2006

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KATRINA: THE STORM WE'VE ALWAYS FEARED

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AF'I'ER THE DISAS'IER CHAOS AND LAWLESSNESS RULE THE STREETS


Thursday, SeptemberThursday, September 22, 2005;22, 2005; Posted: 6:53 p.m. EDT (22:53Posted: 6:53 p.m. EDT (22:53 GMT)GMT)

Health workers inspect an exoticHealth workers inspect an exotic bird at a bird market in Jakarta,bird at a bird market in Jakarta, Indonesia, earlierIndonesia, earlier this week.this week.

GENEVA (CNN) --GENEVA (CNN) -- The WorldThe World Health Organization hasHealth Organization has announced a thirdannounced a third confirconfir medmed

lcase ofcase of H5N1 avian fH5N1 avian f lu inu in iIndonesIndonesia and warns of more toa and warns of more to

come.come.

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WHO warns of more bird flu casesWHO warns of more bird flu cases


So, what’s the problemSo, what’s the problem with environmental healthwith environmental health outreach / education/ communications?outreach / education/ communications?

��Often top down –Often top down – deficit modeldeficit model

��Rarely start with where people are atRarely start with where people are at

��Seldom mindful of fundamental literacySeldom mindful of fundamental literacy

��Not mindful ofNot mindful of health & environmentalhealth & environmental literacy principles and guidelinesliteracy principles and guidelines


What is health literacy?What is health literacy?

�� TheThe wide range of skills, andwide range of skills, and competencies that people developcompetencies that people develop over their lifetimes to seek out,over their lifetimes to seek out, comprehend, evaluate, and usecomprehend, evaluate, and use healthhealth and environmentaland environmental information and concepts to makeinformation and concepts to make informed choices, reduce healthinformed choices, reduce health risks, and increase quality of liferisks, and increase quality of life..

–– (Zarcadoolas, Pleasant & Greer, 2003; 2006)(Zarcadoolas, Pleasant & Greer, 2003; 2006)


Benefits of health literacyBenefits of health literacy

��A health literate person is ableto useto use health concepts andhealth concepts andinformation generatively –information generatively –applying information to novelapplying information to novelsituationssituations. A health literate. A health literate person is able to participate inperson is able to participate inthe ongoing public and privatethe ongoing public and privatedialogues about health,dialogues about health,medicine, scientific knowledge,medicine, scientific knowledge,and cultural beliefs. and cultural beliefs.

A health literate person is able


Communication seems easierCommunication seems easier than it really is.than it really is.


Op-Art PAL" LA SCI! Ll~

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DEFECTIVE EQUIPMENT: The Palm Beach County Ballot

n. drvidlr lne betY.l!Dn Repubhw:m and Dllmocw ppearj 10 bO PQI111ng IQ 1!10 ~ dOll, CUi1:10$1inf,J

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Tblt Democrats ara bted • d. but lhe alO'Icl punch dot fQr !hem 1$ lhird. Si'oce il I~ loglc:aJ 10 a!151Jme that 01111 punches IIlii li8COOd riot on lhe b~IIQIIO VO'!II lot lht:m ltlls i.'! UOSUCOI.'SSM desi!Jl

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~ ONUNE AD~EI!TlSING ~CONTACT INFORMATION

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Fundamental literacyFundamental literacy

Science literacyScience literacy

Civic literacyCivic literacy

Cultural literacyCultural literacy

��

��

��

��

((Zarcadoolas, Pleasant & Greer, 2003; 2004;Zarcadoolas, Pleasant & Greer, 2003; 2004; 2006)2006)

4 Domains of Health/ Environmental Literacy4 Domains of Health/ Environmental Literacy


Functional literacyFunctional literacy

zz The National Adult Literacy StudyThe National Adult Literacy Study (NALS 1993) 49% (almost half) of all(NALS 1993) 49% (almost half) of all Americans do not have functionalAmericans do not have functional literacy above the 8th grade level.literacy above the 8th grade level.

zz Twenty five percent (25%) areTwenty five percent (25%) are functionally illiterate –functionally illiterate – tthat’s 40 to 44hat’s 40 to 44 million adults. Another 50 million adultsmillion adults. Another 50 million adults are only marginally literate.are only marginally literate.


Policy cont’d …Policy cont’d …

�� Institute of Medicine consensus report on HealthInstitute of Medicine consensus report on Health Literacy (2004)Literacy (2004)

�� Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality (AHRQ) evidence report/ technology assessment(AHRQ) evidence report/ technology assessment (#87) 2004(#87) 2004

�� American Medical AssociationAmerican Medical Association

zz Health literacy toolkit (incl. video)Health literacy toolkit (incl. video)

�� Partnership for Clear Health CommunicationPartnership for Clear Health Communication (AMA, Pfizer, many others)(AMA, Pfizer, many others)


Fundamental LiteracyFundamental Literacy

zz ReadingReading

WritingWriting

SpeakingSpeaking

NumeracyNumeracy

zz

zz

zz


CDC web site definition of anthrax. Definition

What is anthrax? What is the case definition for anthrax?

What is anthrax? Bacillus anthracis, the etiologic agent of anthrax, is a large, gram-positive, non-motile, spore-forming bacterial rod. The three virulence factors of B. anthracis are edema toxin, lethal toxin and a capsular antigen. Human anthrax has three major clinical forms: cutaneous, inhalation, and gastrointestinal. If left untreated, anthrax in all forms can lead to septicemia and death.

What is the case definition for anthrax?

A confirmed case of anthrax is defined as

1. a clinically compatible case of cutaneous, inhalational, or gastrointestinal illness that is laboratory-confirmed by isolation of B. anthracis from an affected tissue or site, or 2. a clinically compatible case of cutaneous, inhalational, or gastrointestinal disease with other laboratory evidence of B. anthracis infection based on at least two supportive laboratory tests.

(Source: http://www.bt.cdc.gov/DocumentsApp/FAQAnthrax.asp)


http://www.bt.cdc.gov/DocumentsApp/FAQAnthrax.asp

Science LiteracyScience Literacy

zz knowledge of fundamental scientificknowledge of fundamental scientific concepts, scientific processconcepts, scientific process

zz comprehend technical complexity,comprehend technical complexity,

zz understand technologyunderstand technology

zz understand scientific uncertainty andunderstand scientific uncertainty and that rapid change in the acceptedthat rapid change in the accepted science is possible.science is possible.


NSF, Public Understanding of ScienceNSF, Public Understanding of Science

��Between 5 and 15% of the public qualifyBetween 5 and 15% of the public qualify as scientifically literate.as scientifically literate.

��18% can be considered an attentive18% can be considered an attentive science public.science public.


Types of anthrax Too aame bactefir..rn t8a.::X.bs artJu&ds} prad!JQ?B toxins. 1hat cause ree 1)•-pe-s of arrtilrax In ce.ses of lUst ex)XISurei cne has a srrH~lJ amCU11 o! bade ria, nttl enc:rt4ll:o I:B.USB the disease. Anfhr.a11; i:B na QOntBgious

lnhala1ion amhrax The mast lilrel~ form far use in ticten"oosm S~m ptonu ; rever. rna !alae. faUgua and strnaU~ a a:*y oough. Then 1hare's often a period .::Xi irrprovement 1hat31011Qwed ey a OOdlne - vo..t+e brealt~irg. sweatlflJ. ~uim disool::ra1iun a/the El6n. The p3 en1ll!Sually ~ 1010 slrodr and Cil~ 24 •o 38 Mw·s anet me !rev-ere :;ympl.oms begn Jl is ~ il e.Qp3roanl ~ 90perrent of caEES unless trea1ad earl~.

rGastrormestiml .ai'Jtl1rax

e)• ~ DiJ mee1 rom ~~ anlnlalS. y{IU edt) ~ a gaslrainLE.lSUr'Lal rm of sJ1hrax. S)'m!ptoms ; vorm o.g ot bklod, aMOfl"'•nat pain. nausea anl diarrhea. lt:s ver'Jlare, Bllsa61 in the USA, ard is :25 perDEf"t1 to 60 percem trual. aocc:t"~ tc. me Ne't.t '¥or k. City Departmen.l! cr Health. N'o C8SefJ he~ b3en reported

saJree: USA TCONf retJe.i!N:h

CIJJtaneous. or skin anthrax

Contitct 1hrou.gh 5er~ Cf o.r!s. ~mptom; lt'W' feilc ,leSions aJ'J:ls . llrg_ll'susuaJ.• east~· deted:6d, bul if unlraated pro'VEIS faiBl up to

20pert:er~1 ~ Cf..ses

Anduax tr&almaent AntlbloUcs; Hefp u1 ooly at the ear ~~Of lil1edC11l'«;aa rse lha~ 'fight baderia, oo1 the ~ !te bed;er'B pra:iuce, ~ination: M anttva>: wcdne was IK;ef!sed fn 1-970 ar. is r~ l'uf mili13ry uae ~ies are miled because o1 ~a)'S gettmg food and Drug A ·nlrustJata'l apfXO\'al u a net.~ p-rxh,ditn faclrly in L.ansirg, P tcll,


Civic LiteracyCivic Literacy

��enable citizens to become aware of publicenable citizens to become aware of publicissues, to participate in criticalissues, to participate in critical dialoguedialogueabout them, and to become involved inabout them, and to become involved in decision-making processesdecision-making processes..

zz media literacy skills,media literacy skills, knowledge of civic and governmentalknowledge of civic and governmentalsystems and processes,systems and processes, knowledge of power, inequity andknowledge of power, inequity andother hierarchical relationships, andother hierarchical relationships, and knowledge that personal behaviorsknowledge that personal behaviorsand choices affect others in a largerand choices affect others in a largercommunity and societycommunity and society

zz

zz

zz


·-· - ..


[photo caption reads] Two residents wade through chest-deep water after finding bread and soda from a local grocery store after Hurricane Katrina came through the area in New Orleans, Louisiana.(AFP)


[photo caption reads] A young man walks through chest deep flood water after looting a grocery store in New Orleans on Tuesday, Aug. 30, 2005. Flood waters continue to rise in New Orleans after Hurricane Katrina did extensive damage when it made landfall on Monday. (AP )


Cultural LiteracyCultural Literacy

��Ability to recognize, understand and useAbility to recognize, understand and use thethe collective beliefs, customs, world-collective beliefs, customs, world-view, and social identityview, and social identity of diverseof diverse individuals to interpret and act onindividuals to interpret and act on information. Bilateralinformation. Bilateral - eexperts shouldxperts should understand aspects of the culture of theunderstand aspects of the culture of the recipient and visa versa.recipient and visa versa.

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Percent Distribution of Foreign Born by World Region of Birth: 2000

Latin America 51.0%

Asia 25.5%

Europe 15.3%

Other Regions

8.1%

Source: Current Population Survey, March 2000, PGP-3 Zarcadoolas MSSM 2006




There is little capacity for health andThere is little capacity for health and environmental equity without good,environmental equity without good, effective communication. There iseffective communication. There is no civil society without it.no civil society without it.


GuidelinesGuidelines

��Understand people’s current conceptionsUnderstand people’s current conceptions and cultural models for understandingand cultural models for understanding and acting on environment/ healthand acting on environment/ health informationinformation

��Collaborate to tailor communications toCollaborate to tailor communications to their environmental health literacytheir environmental health literacy

��Evaluate the impact of communicationsEvaluate the impact of communications on an ongoing basis.on an ongoing basis.

��Advance the public’s envAdvance the public’s env hhealth literacy.ealth literacy.


Forgive me for writing such a long letter.Forgive me for writing such a long letter. I did not have the time to write a shorterI did not have the time to write a shorter one.one.

(Pascal)(Pascal)


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