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 my conversations with some really remarkable people.

Today, I’m talking by phone with two physicians who not only share a commitment to health literacy, but also, along with the marathon runner and coach, Jeff Galloway, are co-authors of the new book, The Women’s Guide to Health: Run Walk Run, Eat Right, and Feel Better.

Dr. Ruth Parker is Professor of Medicine, Pediatrics and Public Health at Emory University in Atlanta, Georgia.

For over two decades, her work has focused on research, education and policy to advance our nation’s health literacy.

Her accomplishments are many, including being an author of The Test of Functional Health Literacy in Adults, or TOFHLA, and the widely used definition of health literacy included in numerous scholarly articles and national health policies.

Ruth is also a lifelong athlete and has completed more than 25 marathons.

Dr. Carmen Patrick Mohan is an internal medicine physician, an urban homesteader and a marathon runner, who prescribes food and exercise as medicine.

She works to foster change in healthcare delivery through internet technology, improved patient communication and information access.

She specializes in cardiometabolic risk factor reduction, with a focus on women. Carmen is also a competitive runner, and on a quest to complete marathons in 50 states and on seven continents.

Congratulations to you both. As an author myself, I know it is an enormous accomplishment to write a book. Maybe, but I wouldn’t know, it’s like running a marathon.

I’m intrigued to hear about how your experiences as physicians and as marathon runners and commitment to health literacy all come together. What’s the nugget of this book you wrote, The Women’s Guide to Health?

Ruth Parker: Helen, I love that. You’re right. It absolutely was a marathon to write this book, another type of marathon. Like you, I have decades now, more than 26 years, I would say, working in health literacy.

Helen Osborne: Right. I know you’ve been doing it a long time.

Ruth Parker: What a pleasure to be able to chat with you about this book that really is sort of a culmination of multiple interests.

I don’t think there’s hardly anything I can do that relates to health where I don’t use my lens of health literacy now. I think that’s the result of having done it for so many years and having thought about it so much–as you know, initially as a researcher and as a clinician and primary care physician.

This book really was taking a lifelong lens of something I love, which is engaging in physical activity and engaging the public in something that I think is so incredibly important for health.

Helen Osborne: Ruth, obviously, you and I know each other. We’ve been seeing each other at meetings and all this work we’ve been doing for so long in health literacy. I’m really intrigued in how you put together your personal interests, your experience as a physician and health literacy.

You’ve been doing it a while and somehow married all these different parts together. Carmen, you and I never met in person. How did you put all these different pieces of the puzzle together?

Carmen Patrick Mohan: Helen, thank you so much for having us both on today. It’s really a pleasure to speak with you.

I’m just blessed to have Ruth in my life and to have been in clinic with her and in conversation discovering what we all know, which is the connection between women. This lead to wonderful projects, such as this book. We get to share our love of moving our bodies with other women.

Fortunately, our co-author Jeff Galloway has been doing it for so long. Putting all these pieces together sounds complicated, but once we were in conversation with each other, it came together really nicely.

It really put together the components of fundamental health and what’s valuable about health literacy into patients understanding. This includes getting really clear on what fundamental health is and then getting clear on the steps that are needed to reach fundamental health, and in what order.

Helen Osborne: That’s neat. I like that applied health literacy. I want to hear about those connections there.

I’ve been looking at the book. Thank you for writing it. It looks like you’re, of course, very focused on activity, specifically walking and running. But you also bring in the value of sleep and proper nutrition in there.

Those are underlying principles that affect all of health, right? It’s being more active, getting enough sleep and eating right. Is this something you see in your practice? You’re both practicing physicians. Is that usual recommendations you make to your patients?

Ruth Parker: Helen, I think you would probably agree that the vast majority of people in our country and beyond can remember going and seeing their primary care physician, their primary care doc, and being told sometime during the visit, “It’s really important to exercise more. It’s really important to eat right. It’s really important to make sure you’re taking good care of your body.”

As physicians, Carmen and I both as primary care physicians, we say it a lot, but how often do we really take those incredibly important messages and break it down into the baby steps?

Helen Osborne: And difficult, if I might add.

Ruth Parker: Exactly.

Helen Osborne: It might be easy for both you as lifelong athletes. You’re going to run marathons. For myself, I’m a lifelong walker but certainly not a runner. How do we up what we’re doing? For someone who’s not even that active, how does she or he add that to a life?

Carmen Patrick Mohan: That’s one of the key messages of this book. So much in our culture we are exposing people to either the bumper sticker of 0.0 or the bumper sticker of 70.1, meaning “I have run a triathlon and you’re not fit or healthy unless you’ve done that.”

I actually try to de-emphasize my marathon running to my patients who don’t need to do that to be fundamentally healthy. We’re talking about what you need to do to have one less cold per year. What do you need to do to have the energy it takes to chase your children around?

It’s having the right set of expectations of yourself to achieve what most women have the time to do.

The book gets down to what’s important to most women in getting the right amount of exercise, aerobic exercise, getting the right foods and in sleeping well enough, good enough for fundamental health.

Helen Osborne: I see in your book that you do a variety of different techniques. I always have my health literacy hat on about how to communicate these messages. You give facts, you have research, you have references, but you also encourage people to keep diaries. You have charts and photos, and you have that conversational tone. Is that where you’re bringing in your health literacy techniques?

Ruth Parker: Absolutely. Helen, you said it early on. The content of “Hey, you need to make sure you’re doing all you can to maintain or improve your health by exercising and eating well,” how do I do it? The devil is in the details there.

What we did in the book was we combined with Jeff Galloway, who I will tell you is a household name in our country. He’s an Olympian and he has used his RunWalkRun® method now with over a million different people around the world. It’s amazing. He’s got programs in 40 or 50 different countries and a couple hundred cities in the United States.

It’s living proof that engaging, taking it as a program over 30 weeks and advancing slowly, but steadily can get you up. What we’re looking for is the baseline of 150 minutes a week over 30 weeks.

Helen Osborne: That’s for your patients, right?

Ruth Parker: Yes. That’s an evidence base that comes out of the CDC. As physicians, it was very important to us to take the most common, chronic conditions that we see in women across the life cycle and just say, “How will doing this impact my health? How will this impact my high blood pressure, my high cholesterol, my anxiety, my depression, my breathing or my cardiovascular function? How does doing this impact those important chronic conditions?”

It’s really the marriage of our lens as physicians, the practice of the Galloway Method that’s been used by over a million people and then a lot of tips that come from this appreciation that, with health-literate approaches of making content in segments, steps and an engaging term, we’re more likely to be able to have people understand it, navigate it and use it. That’s really where we are.

Helen Osborne: That’s what I want to focus on now, the greater message there, your commitment to this and your belief in this. Your knowledge and experience to the importance of being healthy in this way comes through.

Our podcast listeners come from all over the world. We may be clinicians, but may be people in public health, librarians, academics or the general public.

What can we take from this either as we encourage others to be more healthy or we put it in our lives? How can we use what you’ve learned and put that into practice?

Carmen Patrick Mohan: I think it’s important that all of us understand that the reasons that women do what’s right for themselves are pretty different from why men do.

This is actually in the commercial literature, that women are less likely to trust their doctors. They’re less likely to trust the healthcare system than other people traveling within it.

Helen Osborne: Really? Women are less likely?

Carmen Patrick Mohan: Yes. Less likely.

Helen Osborne: I can relate to that personally, but that’s a new factoid.

Carmen Patrick Mohan: We need to just recognize that up front. The tone in which we speak really matters. Not only that, but the reason they’re going to exercise has got more to do with the way they connect to each other and the friendships they form than anything else.

I would say with my running group, for example, I love those women. I’ve developed deep bonds with those women, and on days when I just don’t feel like running, I go just for them. The same would be true in the converse.

I think that’s why Jeff’s programs work. They emphasize relationships between people. The more health professionals are able to connect to their patients and connect patients to each other, the better off everyone is going to be.

Helen Osborne: That’s really interesting. You raised a couple of interpersonal issues there, the fact that women may not be as absolutely trusting of whatever a provider might say to her, but also the fact that we might do this as a group and that might help.

I’m actually a walker every single day. I don’t do it with other women, but I listen to podcasts. Not necessarily my own, but if “This American Life” is on or something else.

Carmen Patrick Mohan: You’re a “dream patient.”

Helen Osborne: I also learned formyself that if I don’t walk first thing in the morning, I will find ways to talk myself out of doing it for the rest of the day. It will be too cold or too hot, or I am too busy. But if I do it before I have time to think of it, that’s when I go for my walk.

I had to find ways to make it possible in my life. I appreciate that you appreciate the tone and putting it in that personal sense.

What other tips would you have for our listeners? Ruth, what practical strategies have you learned that people can put into place?

Ruth Parker: I totally understand what you’re saying there, Helen. You’re speaking truth, and I think anyone who tries to regularly engage knows how incredibly important it is to just do it.

I will tell you, for the book, we really approached these as prescriptions. We have as our mentality that we’re a couple of primary care docs and, through our lens as physicians, we would encourage people to think of their approach to physical activity, what they eat and how they sleep as prescriptions for health.

We’ve created tools that you can use in conversation with your doctor. They’ve been used by literally hundreds of thousands of others successfully.

We link it to evidence to try to make it very clear that it improves your health and how we know it improves your health. If your knees hurt, you can still go. There’s journaling and interacting with others. There are tips along the way that can make it, if you will, more doable.

The reason we targeted the book for women is because we really share a belief that women, if you will, are brokers of health. They make decisions for themselves. They make decisions that influence their families, their children, in their home, in their neighborhoods, at school.

They make a lot of decisions for families about health insurance and about where families seek and obtain healthcare, so they’re incredibly important brokers.

There’s another big piece of this. You say you walk alone, but I’ll tell you something. People are watching you. You’re a broker of health because you’re being seen.

Helen Osborne: Actually, I am. My neighbor said to me, “Wasn’t that you walking across the bridge the other day?” I said, “Yes.” I see all these other people who are out at dawn, just like me.

Ruth Parker: That’s what we’re trying to really encourage, for people to realize how much that improves health.

Helen Osborne: I just want to put this together. I encourage people to read your book, The Women’s Guide to Health: Run Walk Run, Eat Right, and Feel Better. We will have a link to the book on your Health Literacy Out Loud web page for sure. Thank you so much for writing it and talking about it.

I want to ask you, “What’s your vision?” If everything worked the way you wanted, what would it look like?

I’ll tell you my vision. My vision is what I see when I watch the Boston Marathon every April. Hundreds of thousands of people running through my town. Everyone’s cheering on everyone. For some runners, it looks like it’s hard for them. Some look like this is a breeze.

Do you share that vision, that maybe we can all participate in our own ways?

Carmen Patrick Mohan: Helen, I just want to tell you that there is nothing like the crowds at the Boston Marathon. It was so much fun to run it this last April. The spirit with which that community approaches that marathon is unreal. That crowd is second only to the crowd at the Olympics.

Helen Osborne: That’s what I get from both of you. You both are the leaders, the teachers, the coaches and the crowd, cheering on everybody as they get that much healthier.

Thank you both so much for all you do and for being guests on Health Literacy Out Loud.

Ruth Parker: Thank you, Helen, for having us. And thank you for the work that you do for the health literacy community to realize that the work that is done in that field really is foundational to improving health.

I think what I’ve learned, thinking about health literacy, looking at it, working to practice it and working to try to make it a part of what we do to make health better, is absolutely foundational. It won’t solve all the problems, but if we don’t do it, we leave a lot of people out. Thanks so much for all you do.

Helen Osborne: Thank you, Ruth. You have been a mainstay in moving us forward. Carmen, I look forward to cheering you on when you run through Boston in the Boston Marathon next year.

Carmen Patrick Mohan: Thank you so much, Helen.

Helen Osborne: Take care.

Wow. I learned so much about women, health and exercise, and communicating all that in ways that resonate and have meaning to all of us. I learned that from Dr. Ruth Parker and Dr. Carmen Patrick Mohan, and I hope that you did, too.

Health literacy and communicating this way 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, feel free to sign up for the free monthly 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, Stitcher Radio and the Health Literacy Out Loud website, www.HealthLiteracyOutLoud.com.

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

Until next time, I’m Helen Osborne.

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