1. Child Health and School Readiness: The Significance of Health Literacy Laurie Martin, ScD, MPH Human Capital Research Collaborative Conference October 15, 2010

2. Overview Why health literacy? Current strategies to improve outcomes –Health, education, culture and society Major Impacts –National action plan to improve health literacy –National health education standards (NHES) Policy Implications Future Research

3. Health literacy defined Degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions Skills within health context Cultural and conceptual knowledge Influenced by clarity of health information

4. Societal costs of low health literacy Only 12% of population is proficient –Disproportionate number of racial and ethnic minorities, immigrants, low education, elderly Cost to nation’s economy: challenging to estimate –Ballpark of $106-236 billion dollars annually –Does not include costs to child health and school readiness

5. Potential pathways linking parental health literacy, child health, and school readiness Child Health School Readiness & Academic Outcomes Parental SES, health, and health behaviors Parental Health Literacy

6. Parental characteristics are related Child Health School Readiness & Academic Outcomes Parental SES, health, and health behaviors Parental Health Literacy

7. Parental health literacy affects child health Child Health School Readiness & Academic Outcomes Parental SES, health, and health behaviors Parental Health Literacy

8. Example A two-year old is diagnosed with an inner ear infection and prescribed an antibiotic. Her mother understands that her daughter should that the medication twice a day. After carefully studying the label on the bottle and deciding that it doesn’t tell how to take the medicine, she fills a teaspoon and pours it into her daughter’s ear. (Parker et al, 2003)

9. Parental health literacy as a moderator Child Health School Readiness & Academic Outcomes Parental SES, health, and health behaviors Parental Health Literacy

10. A life course perspective of health literacy Parental health Literacy Parental SES, health, and health behaviors Child healthAcademic outcomes Child health literacy Parental health literacy Parental SES, health, and health behaviors Life course Children become parents

11. Education promotes child health literacy Data from NAEP highlight importance of educational system In 2009 –One third of 4 th and 8 th graders proficient or above in reading –39% of 4 th graders and 33% of 8 th graders proficient or above in math –29% of 4 th and 8 th grade and 18% of 12 th graders scored proficient or above in science

12. Overview Why health literacy? Current strategies to improve outcomes –Health, education, culture and society Major Impacts –National action plan to improve health literacy –National health education standards (NHES) Policy Implications Future Research

13. Potential points for intervention Parental health Literacy Parental SES, health, and health behaviors Child healthAcademic outcomes Child health literacy Parental health literacy Parental SES, health, and health behaviors Life course Children become parents Health SystemEducation System Culture and Society

14. Current strategies to improve outcomes Health –Assessing health materials –Improving the transfer/retention of information –Assessing health care environments Education –Adult education –Coordinated school health program Culture and society –Communication –Identification of communities with lower health literacy

15. Overview Why health literacy? Current strategies to improve outcomes –Health, education, culture and society Major Impacts –National action plan to improve health literacy –National health education standards (NHES) Policy Implications Future Research

16. National Action Plan Outlines seven goals that contribute to a society that: –Provides everyone with access to accurate and actionable health information –Delivers person-centered health information and services –Supports lifelong learning and skills to promote good health

17. Seven goals of the National Action Plan 1.Develop and disseminate health and safety information that is accurate, accessible, and actionable. 2.Promote changes in the health care system that improve health information, communication, informed decision making, and access to health services. 3. Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in child care and education through the university level.

18. Seven goals of the National Action Plan 4.Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community. 5.Build partnerships, develop guidance, and change policies. 6.Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy. 7.Increase the dissemination and use of evidence-based health literacy practices and interventions.

19. National Health Education Standards 1.Students will comprehend concepts related to health promotion and disease prevention to enhance health. 2.Students will analyze the influence of family, peers, culture, media, technology, and other factors on health behaviors. 3.Students will demonstrate the ability to access valid information, products, and services to enhance health. 4.Students will demonstrate the ability to use interpersonal communication skills to enhance health and avoid or reduce health risks.

20. National Health Education Standards 5.Students will demonstrate the ability to use decision- making skills to enhance health. 6.Students will demonstrate the ability to use goal- setting skills to enhance health. 7.Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce health risks. 8.Students will demonstrate the ability to advocate for personal, family, and community health.

21. Overview Why health literacy? Current strategies to improve outcomes –Health, education, culture and society Major Impacts –National action plan to improve health literacy –National health education standards (NHES) Policy Implications Future Research

22. Policies to improve parental health literacy Implement performance incentives for the use of universal precautions Deliver accurate, accessible, and actionable health information through early childhood programs

23. Policies to improve child health literacy Implement a unified curriculum across schools Incorporate examples of health skills and knowledge across all academic subjects

24. Overview Why health literacy? Current strategies to improve outcomes –Health, education, culture and society Major Impacts –National action plan to improve health literacy –National health education standards (NHES) Policy Implications Future Research

25. Future Research Directions Quantifying associations Include parental health literacy as potential explanatory factor in relation between parental characteristics and child outcomes Rigorously evaluate and identify evidence- based approaches in health and education system Health literacy measurement

26. Conclusions Health literacy sits at the intersection of health and education Health literacy, both of parent and child has important and lasting implications for child health and school readiness. Cross-system collaborations and strategies may be particularly effective in addressing issues related to limited health literacy, child health and academic success.