Helen Osborne:Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on some amazing conversations with truly remarkable people. You will hear what health literacy is, why it matters and ways we all can help improve health understanding.

Today, I have the privilege of talking with Dr. Richard Carmona. He is the 17th Surgeon General of the United States, distinguished professor at the University of Arizona, and vice chairman of Canyon Ranch.

Dr. Carmona understands the importance of health literacy from a lifetime of personal and professional experiences.

Welcome, Dr. Carmona.

Dr. Carmona:Thank you. I’m happy to be with you.

Helen Osborne:I’m delighted. You’re our country’s foremost health literacy champion. How did all this get started?

Dr. Carmona:I don’t know that I want to accept that title. I think I’m one of many that we see here today with Wisconsin Literacy and others around the country who are very passionate about this. I’m happy to be part of the team.

This started years ago as a child with the barriers of growing up with an immigrant family and fast-forwarding into a lot of different jobs I’ve had. I learned I had to become a good communicator, especially as Surgeon General of the United States.

Helen Osborne:I think you’re modest, being the Surgeon General of the United States and touting health literacy. When I heard you speak about it, it was almost an out-of-body experience for me.

I remember way back when we didn’t have the words “health literacy.” I’d ask people, “What are we going to do about health literacy?” They would say, “Health what? Isn’t that teaching people to read?”

Somehow you’ve gotten on board with this and are championing the cause loud and clear. Why does health literacy matter so much to you?

Dr. Carmona:In my lifetime, over about 40 years and lots of different jobs around healthcare and public service, I recognize that part of our responsibility is to be able to communicate with those we serve. If we don’t effectively communicate, then sometimes we’re wasting our time.

Health literacy is simply taking what we know and translating it in such a way that the average person who has a different life, language or culture can use that information to affect behavioral change to improve their health. It’s a really simple equation, but it eludes us because we spend a lot of time on high-tech things.

This is about communication. I’m so happy to see that this health literacy advocacy has grown and swelled in the United States. There are so many organizations, like here in Wisconsin, that are positive advocates because we cannot undergo healthcare transformation effectively without being good health communicators. That’s what health literacy is all about.

Helen Osborne:I know your background is in emergency medicine and crisis communication. It’s also taken a path down public health communication. Do you see health literacy as a factor in both of these spheres? They’re at very different ends of the continuum.

Dr. Carmona:Health literacy is a factor in everything I’ve done in my whole life. Even as a police officer, paramedic, registered nurse, physician assistant or physician, you have to be an effective communicator.

When a police officer shows up in an emergency and there’s somebody unconscious or down, they become the doctor of the moment. They become the savior. Communicating with the people around and giving instructions in an emergency is very important.

With every job I’ve had I see more and more, especially retrospectively, how important communication has been and continues to be for our nation.

Helen Osborne:I think that nobody else listening to this podcast will ever be Surgeon General of the United States. Maybe we will, but probably we won’t. There are people who are advocating within their organizations and communities. They are championing their cause for whatever their realm is. What would you like those people to know and do about health literacy?

Dr. Carmona:As citizens of the United States, every one of us should listen, learn and have a greater understanding of how we interact with our environment, and most importantly, what we can do to stay healthy and prevent disease. That’s health literacy.

As we look at our United States, it is so diverse. Paradoxically, the strength in this nation is its diversity, yet it’s sometimes what creates barriers for us in culture and language.

Every citizen has to understand what we know so that they can incorporate it into their life and make appropriate changes to reduce morbidity and mortality, improve the quality of life and decrease the cost of care. There are a whole lot of endpoints that are desirable.

As we go through this debate about healthcare in our nation, we’re never going to be successful unless every citizen is touched by these messages and then is able to contribute and be part of their pursuit of optimal health. That’s the bottom line.

We who have the privilege to understand health literacy have the obligation to educate our fellow citizens so they get the best benefit of all this great science that’s out there.

Helen Osborne:When you talk about education, what would that look like? In a real way, how can we help educate people to take better care of their own health?

Dr. Carmona:I look at this in a hierarchy. First of all, there are professionals who know the science, but do they really understand how to teach that science and transfer that information? Then there’s the citizen who may be health illiterate. It may be someone with a college degree, but they don’t understand how their daily behaviors ultimately contribute to their health status.

There are all types of gradations. When we move into a community and have people who are trained in health literacy, they understand the culture and environment they’re in and how to deliver resident messages that will hopefully change behavior. One size doesn’t fit all.

What needs to happen is that the concept of health literacy is embedded in everything we do in grammar school, high school and college old-fashioned home economics courses, which we don’t see too much, and all of our professional education. Health literacy needs to be part of that.

Helen Osborne:That’s inspirational hearing that there’s really room for all of us. I’ve often thought, being a health professional myself, that I’m part of the problem. For years, I communicated in ways that I think a lot of the people I worked with couldn’t understand.

I feel that in many ways we are part of the problem, but I also feel that we are part of the solution. You’re helping find ways that we can be putting that into our day-to-day work. That’s just commendable.

What do you see in about five years? What would a health literate United States or world look like?

Dr. Carmona:If I just look at the last decade from when I became Surgeon General, throughout my time as Surgeon General, and then my time working in the last few years with the Canyon Ranch Institute, which is about health literacy as well, that gives us a nice timeline.

When I first started as Surgeon General, as you alluded to earlier, when we’d say “health literacy,” people would say, “What’s that?” Even our professionals would say, “What do you mean?” People would think, “You mean we need an interpreter.” It’s not about an interpreter. This is really about truly translating not only language but culture and understanding.

What I’d like to see in the future is that this concept is embedded in everything we do. Whether you’re talking to the paramedic on the street, a nurse in a public health clinic or a teacher in a school, they all understand the concept that they have to carefully figure out how they’re going to translate what they know to an end user who needs that information so they can pursue optimal health and wellness.

That’s what I’d like to see in the future.

Helen Osborne:That’s a wonderful vision. What do you see as some of the stumbling blocks to get there?

Dr. Carmona:One stumbling block is our own culture. The fact is that those of us who have been educated in the Western world see allopathic medicine in a certain way and don’t take into account the many people who really look at what we call complementary and alternative medicine. There are people who don’t have understanding and people who are displaced because of disparities of health, wealth and so on.

We have to figure out a way to breach those barriers that we call “social determinants of health” today. It’s the message we deliver in an inner-city, underserved population in the South Bronx, like we’re working with in Canyon Ranch Institute, versus where we would deliver a message in Beverly Hills, California.

It’s the same science, but you’re delivering a different message to the population because different populations will resonate based on how you deliver that message. It’s being sensitive to their culture.

Sometimes it works best if you work in an underserved community through the opinion leaders in that community. It might be a priest, rabbi or mullah.

Helen Osborne:It could be a hairdresser.

Dr. Carmona:Barbershops and hairdressers are great for information. It’s a great public health model. In a Hispanic community, they use promotoras, young men and women who are not health professionals but are trained in a particular area. It might be for asthma prevention or mitigation. It may be for maternal/child health.

All of those are extraordinarily important, but we have to use every aspect of society, get them involved, and be better public health practitioners. Every citizen needs to become a health literate public health practitioner.

Helen Osborne:Thank you. That’s wonderful to be able to hear. I also know from your work that is very much based in evidence-based medicine. This is not just the person at the drugstore or barbershop deciding on a health message. We’re giving science-based, accurate health information. Is that correct?

Dr. Carmona:Absolutely. As you see in our meeting with Wisconsin Literacy and others, some of the thought leaders in our world are right here who have studied this for years.  My colleague, Dr. Andrew Pleasant at the Canyon Ranch Institute, is a prolific researcher and writer of textbooks.

So there is a very strong science behind health literacy but incorporating that and being able to translate it is what’s important.

Anybody can do this. It’s not that difficult. It’s not rocket science, as they say. It’s paying attention, being culturally sensitive and learning how to deliver these resonate messages to communities that need this information.

Helen Osborne:Thank you. You’re a wonderful advocate. What would surprise most of us about the work you’ve discovered in health literacy? What about your work would really make someone think, “I didn’t think of that”?

Dr. Carmona:I’ll give you a perfect example that may be concrete. At our Canyon Ranch Institute, we’ve embedded ourselves in the South Bronx in a federally qualified health center where there are 40,000 of the poorest Hispanic immigrants in the country. There are many barriers, like language and culture. We have the highest rates of obesity, type 2 diabetes, hyperlipidemia and depression.

We have measureable indices that we look at. In the two years we’ve been there, we’ve gradually been able to change all of those indices in a health literate model. It’s figuring out how to communicate with this population in a resonant fashion where they see us now as friends, not foreigners. We’ve become part of their family. They trust us.

The proof is in the pudding. All of those metrics I measured are changing. Diabetes is going away. Weight loss is happening. People are becoming more socially and physically active. They’re developing new social networks. The interesting thing is that it’s very simple principles of health literacy that have done it.

Health Osborne: Thank you for that. That’s at the local, individual level. It’s really making a difference to people, communities and health literacy advocates everywhere. I thank you so much for sharing that with listeners of Health Literacy Out Loud.

Dr. Carmona:It’s my privilege. Thank you for the opportunity to be with you today.

Health Osborne: I learned so much from talking to Dr. Carmona, and I hope that you did too.

Health literacy isn’t always easy. For help clearly communicating your health message, please visit my health literacy consulting website at www.HealthLiteracy.com. While you are there, sign up for the free e-newsletter, What’s New in Health Literacy Consulting.

New Health Literacy Out Loud podcasts come out every few weeks. Subscribe for free to hear them all. You can find us on iTunes as well as the Health Literacy Out Loud website,www.HealthLiteracyOutLoud.com.

Did you like this podcast?

Dr. Carmona:I loved it. It was fun.

Helen Osborne:Did you learn something new?

Dr. Carmona:I did.

Helen Osborne:Tell your colleagues. Tell your friends. Together, let’s tell the whole world why health literacy matters. Until next time, I’m Helen Osborne.

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