Helen: 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 my conversations with some truly remarkable people. You will hear what health literacy is, why it matters, and ways we all can help improve health understanding.

Today I’m talking with Elspeth Murray, a Scottish poet whose background is in cultural anthropology, health promotion, public health policy and patient involvement in cancer care.

Elspeth also works with the Puppet State Theater Company on their award-winning puppetry and storytelling production, “The Man Who Planted Trees,” that has toured internationally for many years.

A health literacy colleague told me about Elspeth and suggested I watch a video of her reading the poem she wrote, “This is Bad Enough.” I was so touched by that poem that I invited Elspeth to be a guest on Health Literacy Out Loud. Welcome.

Elspeth: Hi, Helen. Thanks for having me.

Helen: We’re talking by Skype overseas or, as they say, across the puddle. I really am delighted and honored to introduce our listeners of Health Literacy Out Loud to you. Let’s take it from the top with how I met you. Could you share your poem, “This is Bad Enough”?

Elspeth: Sure.

“This is bad enough / So please… / Don’t give me / gobbledygook. Don’t give me / pages and dense pages / and / ‘this leaflet aims to explain…’ / Don’t give me / really dodgy photocopying / and ‘DO NOT REMOVE / FOR REFERENCE ONLY.’

Don’t give me / ‘drafted in collaboration with / a multi-disciplinary stakeholder / partnership consultation / short-life project working group.’ / I mean is this about / you guys / or me?

This is hard enough / So please: / Don’t leave me / oddly none the wiser or / listening till my eyes are / glazing over. / Don’t leave me wondering what on earth that was about, / feeling like it’s rude to ask / or consenting to goodness knows what.

Don’t leave me / lost in another language / adrift in bad translation. / Don’t leave me / chucking it in the bin / Don’t leave me / leaving in the state I’m in. / Don’t leave me / feeling even more clueless / than I did before any of this / happened. / This is tough enough / So please:

Make it relevant, / understandable – / or reasonably / readable / at least. / Why not put in / pictures / or sketches, / or something to / guide me through? / I mean how hard can it be / for the people / are steeped in this stuff / to keep it up-to-date?

And you know what I’d appreciate? / A little time to take it in / a little time to show them at home / little time to ask “What’s that?” / A little time to talk on the phone.

So give us / the clarity, right from the start / the contacts, there at the end. / Give us the info / you know we need to know. / Show us the facts, / some figures / And don’t forget our feelings.

Because this is bad / and hard / and tough enough. / Please speak / like a human / make it better / not worse.”

Helen: I’ve watched the video. I actually show it at the start of some of my health literacy presentations because you kindly gave me permission to do so. But I am so moved by hearing you say this right now. Your peom is the essence of health literacy. Tell us about it.

Elspeth: A few years ago in 2006, I was working with the Southeast Scotland Cancer Network. They work with patients to bring on board patient viewpoints about how the services need to change and improve.

The number-one thing that people were saying among that group of patients and caregivers, and also in the literature around wider research that has been done, is that people are more concerned about being treated with respect than they are about the length of the wait, the size of the machines or how modern the building is. It’s a simple thing.

This was my attempt to condense the viewpoints of a lot of people and present it in as straightforward a way as I could. It matched what people were saying. It’s been amazing to see how many people have recognized something in that, whether they’re in cancer care or other kinds of healthcare, or they’re actually people who are dealing with information that’s not even in healthcare.

Helen: What resonates with me is your use of images and words. You talk about gobbledygook, dodgy photocopying and giving us time. You talk about thinking about our feelings. Those are all deep and profound concepts that are part of health literacy.

You’re not a health literacy person, per se, even though you have a health background. To hear you put all of that together, it’s like every word needs to be in your message.

Elspeth: Thank you. I’m really pleased that it resonates. The strange paradox is that on one hand it is something that’s quite simple. There’s the bit that says, “How hard can it be / for the people / who are steeped this stuff / to keep it up-to-date?”

On the other hand, it’s so broad and affects every aspect of how the health system interacts with patients from face-to-face things, surgery, posters or leaflets. It’s so broad that it requires a great deal of work.

Helen: It is. I often say it’s hard to be simple. You know that too as you’re using the arts.

I’m interested in this process. Many of our listeners are real advocates for health literacy. We want to go out and spread the word about why clarity in communication matters. We also want to find better ways to communicate our message.

Maybe we can take this step by step. How could somebody use something like this to raise awareness, whether they use your poetry or create a message of their own? How can they do that in an engaging way?

Elspeth: Because poetry condenses a lot of things, you can just introduce a topic very concisely.

In a lot of situations where you might be giving a lecture, talk, or PowerPoint presentation to people who may or may not feel ready to take on board what you’re telling them, poetry is a really interesting option to think about. It brings things concisely and from a different angle. You can swerve ball a little bit.

Helen: What was that term?

Elspeth: Swerve ball.

Helen: I’m trying to get a visual image. Is that kind of like throwing them a curve ball?

Elspeth: Yes, exactly. It’s arresting, it’s condensed and it engages emotions.

Helen: It certainly does that. Listeners might be interested in knowing that. I contacted you and asked if it was okay to use the video clip of you saying this poem.

As an artist and the creator, what’s the permission process? If we find something that we find engaging, what are we as advocates, speakers and healthcare people supposed to be doing? Are we supposed to contact the artist?

Elspeth: I think that’s good practice. The answer that I always give about that poem is yes. I’m glad for it to be used in a wide setting, so that’s the message to your listeners today.

Helen: They don’t each need to contact you?

Elspeth: No, but I like to hear about the different ways that it’s being used. For example, it has been taken on board in Tasmania by their health and human services, the US Centers for Disease Control, councils around England and Scotland and all sorts of places.

I don’t have to know, but it’s nice to know. I’m just speaking for myself here. I’m aware that there are many other poets, writers or artists in different settings with other views around publication, copyright and so on.

Because I wrote that poem while I was with a work team that was a publicly-funded estate for NHS, it was part of my job.

Helen: Thank you for letting us share this poem. We will have the link on the Health Literacy Out Loud website so people can watch the video and decide if this is something they want to do.

If the whole world is going to be sharing your poem, that’s wonderful to a point, but how can we go beyond that? We don’t want to keep using the same thing over and over. We want to engage and entertain our audiences. Entertaining is part of it because we need to get to their emotion.

What are other ways that we can help communicate our health message?

Elspeth: I’m interested in seeing what’s happening around online videos. It’s an area that’s changing so fast at the moment. It seems that more and more of our lives are taking place on either side of a screen, a bit like we’re talking to each other now.

There’s a form of animation that’s called whiteboard animation. I don’t know whether you’ve seen any. There are some amazing talks that have been done through the Royal Society of the Arts, or RSA, in London.

Helen: Is that where you can watch someone drawing while they’re speaking?

Elspeth: Yes. It’s basically a way of illustrating a talk, but it’s speeded up. It’s really fun to watch. The RSA website has some tremendous examples of that.

Helen: We’ll have that link too.

Elspeth: It’s a trend. Other organizations are using that technique as a way of explaining what they do.

Helen: Is that hard? I’ve seen it. I took a webinar on how to illustrate while you’re giving a talk. It was terrific. It was one of the best webinars I’ve been to, but it’s hard. We work so hard trying to get our words right. To have to do something else is hard.

Elspeth: Sure. It’s not a straightforward thing to do. Research wise, it sounds like people remember things better that way and enjoy the information more. It’s a challenge to all sorts of people who want people to get the message.

Helen: In the health literacy world, I feel like I have a personal allergy to the tradition of reading bulleted words to people. I can’t sit through that anymore.

Now I’m noticing that people are starting to add more video clips or creating their own. Sometimes it’s just one camera looking at one person talking. After a few moments, that gets a little hard to watch if it’s not done very professionally. What are your thoughts about that?

Elspeth: Your viewers might not like to look at me on that video for more than two minutes. It is only two minutes.

Helen: I like watching you.

Elspeth: I can’t bear to watch myself. Beyond the talking head, this was the challenge that the arts have been grappling with for centuries. Earlier storytelling was face-to-face talking heads, or maybe it was animations in shadows on the wall of a cave.

There are all kinds of media. I work with puppetry and storytelling.

Helen: I wanted to hear about that and how we might use it.

Elspeth: Storytelling is a real buzz word around at the moment. I think there’s honesty and vulnerability when you have a desire to connect with an audience. The desire to do it is a real key.

Helen: When you’re talking about storytelling, are you talking about creating a new story, evoking somebody’s story at the moment or giving an old fable? What are you talking about?

Elspeth: It could be many things. It might be you telling me about a time in your life when you faced a particular challenge. By doing that, I may feel more connected with you. I get some important information and some broad principles that are contained within that story. It could be a myth or fable which encapsulates the essence of what you want to put across.

The play that we tour with, “The Man who Planted Trees,” is told as if it’s a true story, but it’s not a true story. It’s a fable of one man who achieved a massive amount by singlehandedly planting acorns for 40 years. He restores a barren region by doing that.

Just because it’s not literally true doesn’t mean that it doesn’t inspire people to plant trees.

Helen: It has the essence of the truth.

Elspeth: Yes, exactly.

Helen: I’m intrigued with storytelling too. It sounds to me that when you did your poem, “This is Bad Enough,” you interviewed a lot of people and captured their stories. Then maybe you took just a word or concept from each.

Elspeth: Yes. It’s hard to think back to exactly what I did when I sat down to write it. I wrote it the night before the launch of this Patient Information Reference Group.

Helen: You did it right away?

Elspeth: I volunteered to write something for this event. I probably had 10 days to get my act together. I knew roughly what I wanted to say. Sometimes it just comes together. I was very lucky in that instance because I had a clear purpose and I was aware of what people wanted me to say.

Helen: The message to others is to take a risk and try something new. I don’t know how you use puppetry about trees. You’re using all of these artful ways. Is it scary to do this?

Elspeth: I guess it is. I work in the arts, so there is a little bit every day about writing a poem or performing. That’s not necessarily the case for everybody. I do believe that we are all creative beings and that we all have good ideas.

Plus, we have a great deal of resources at hand. You were talking about people using video clips, photographs, imagery or objects. There are loads of them out there. The world is your oyster.

Maybe it’s not you that has to do it. Maybe there are people nearby who you can enlist. Maybe there are colleagues or people who you can work with to create something special. Maybe there are artists, students or teachers in your community. There is so much that could be done.

Helen: I just love hearing that from you. I try to live by that in my presentations so it’s not just like everybody else’s. The essence is the same. The essence is the truth that I want to share about health literacy, but to do it in ways that really resonate with people.

Maybe not every part will resonate with everyone. It’s a little bit bold and scary, but the feedback I get is that overall it works. The same is true with podcasts. You are actually my 99^th podcast. I’ve just been sharing information in ways that nobody else had. I’m so glad that you are doing what you’re doing and teaching us about it. You really are an inspiration, Elspeth.

We’ve been talking about poetry, stories and all of these other ways. Is there anything you’ve seen that we could learn from or that has inspired you? Are there any other ways of communicating health messages?

Elspeth: Something that I’ve seen just in the last couple of days really challenged me and has made me think about things in a fresh way. It was on the website of Michael Leunig, who is an Australian cartoonist. He has on his website some beautiful cartoons and some poems.

This one actually comes under the category of a prayer. It’s about love and fear. It struck me because a lot of the time with health literacy, we’re trying to do some surgery on language to take the fear out.

Helen: I love that metaphor.

Elspeth: With poetry, the approach is more like, “Let’s add some love in.” Let me just read this very short piece.

“There are only two feelings, / Love and fear. / There are only two languages, / Love and fear. / There are only two activities, / Love and fear. / There are only two motives, two procedures, two frameworks, two results, / Love and fear. / Love and fear.”

Helen: That’s so beautiful.

Elspeth: Isn’t that great? Looking through those lenses at life in general about all kinds of acts of generosity and interactions is really useful.

Helen: I agree with you totally. We’ll have that URL of that website too.

Elspeth, I want to thank you for doing all you do. You started and ended with a poem. This is beautiful. Thank you so much for being a guest on Health Literacy Out Loud.

Elspeth: Thank you, Helen. It has been a real pleasure.

Helen: I learned so much and was so inspired by Elspeth Murray, and I hope that you were too. But health literacy isn’t always easy. For help clearly communicating your health message, please visit my health literacy consulting website at www.HealthLiteracy.com.

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Did you like this podcast? Did you learn something new? If so, tell your colleagues and friends. Together, let’s let the whole world know why health literacy matters.

Until next time, I’m Helen Osborne.