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 with Kristine Sorensen, who is founding director of the Global Health Literacy Academy. Kristine also is the first president of the International Health Literacy Association, chair of Health Literacy Europe and advisor to the World Health Organization on health literacy.

Kristine lives in Denmark. I live in the US. We don’t think we’ve ever met face to face. While our day-to-day experiences may be quite different, as we’re planning this podcast we’re realizing how much we share in terms of our passion about and commitment to health literacy.

Kristine, I am so glad you are a guest today on Health Literacy Out Loud. Welcome.

Kristine Sorensen:Thank you so much, Helen. I’m so happy we can meet here in the air.

Helen Osborne:In the air, over the waves, yay technology. Kristine, I know that your travels and your work take you to many and continents. You have connections to health literacy efforts in Europe, Asia and Australia. Can you give us an example of some things that are happening around the world?

Kristine Sorensen:Yes. First of all, my challenge coming into the field of health literacy was to manifest health literacy in Europe because it wasn’t a well-known concept. Just trying to translate health literacy into European languages was really the first challenge I met.

Helen Osborne:That’s interesting. When was this? I’ve been doing health literacy work for a little over 20 years now. When did it reach Europe?

Kristine Sorensen:About 10 years ago I got involved. At that time in 2009, there were groups scattered around Europe and they wanted to have a more united approach. We got funding from the European Commission to start looking at health literacy in Europe and to see whether it mattered.

Helen Osborne:Perfect. Great. Then you were saying from Europe you went on to where?

Kristine Sorensen:To Asia, because a colleague of ours, Peter Chang, from Taiwan wanted to look at how he could help facilitate health literacy in Asia. We discussed how we had tried to spread it to European countries and he learned. He now established the Asian Health Literacy Association.

Helen Osborne:That’s really exciting. And Australia. I’ve had connections to Australia. In fact, I’ve been to Australia and I met with people quite a while ago in Australia doing this similar kind of work. Tell me about what’s happening there.

Kristine Sorensen:In Australia, where I have not been yet but I’ve met many people from Australia and working in Australia, they are quite far ahead. We have our colleague Professor Richard Osborne, who’s developed the concept. We have people in Sydney with Don Nutbeam, who’s also played a big role in conceptualizing health literacy.

The English-speaking countries like yourself, the US, Canada, Australia and the UK have really been our role models.

Helen Osborne:I know, from the health literacy work that I’ve been doing, that it started as very much a medical model, what was happening in that doctor-patient interaction. In the US, it has since spread out from there to the public and to communities.

Is that the same way that it’s grown and emerged in your experience around the world?

Kristine Sorensen:It has changed from being, as you say, really clinical and a challenge in the clinical setting to growing out to spread also to other arenas.

Ilona Kickbusch has played a big role in saying it’s an everyday issue. I think that’s what has been picked up, especially in Europe. It’s also happening in everyday life, at the marketplace, in the political arena, at work and so on.

Helen Osborne:Tell us some stories. I’m a clinician and know the clinical the most. Your work is a lot in public health and health policy. I also know that researchers are getting involved, and that’s all around the world.

What are you experiencing and seeing? Tell us some stories about that.

Kristine Sorensen:I think what has really been striking to me, and I think where I also try to be one of the vehicles, is really that it has spread from the clinical world to many more disciplines.

Part of my work is really about professional development and trying to put health literacy on the agenda in different disciplines. That is for nurses, medical doctors, librarians, IT specialists, politicians, you name it.

Helen Osborne:How do you get it on the agenda? I know of a lot of efforts that are trying to do the same. It’s a challenge.

Kristine Sorensen:Part of my work has been to concretely translate health literacy into European languages, and trying to set up networks locally and nationally where people can meet. We realized we can’t do this alone.

A concrete example is in Brussels where the EU, the European Union, is meeting.

We’ve set up a coalition where we meet with the European Federation for European doctors, European nurses and with European pharmaceutical companies, trying to work across sectors, across disciplines, to say that health literacy is really context- and content-specific.

Then hopefully, through those meetings, we can see that health literacy is dripping into curricula, into policies and into practice.

Helen Osborne:Are you the one saying, “Let’s have a meeting. Let’s create a network”? Are you the one doing that? Are you a voice of one or is it a voice of many who’s doing this?

Kristine Sorensen:It will be a voice of many eventually, but sometimes it starts really small. It doesn’t really matter whether we talk about a local community, the EU or the World Health Organization. The mechanisms are the same. Let’s sit around a table and talk and face each other, focusing on where we can make a difference.

Helen Osborne:Our listeners, as myself sometimes, have a small area where we want to make a difference, a local focus perhaps. What would you recommend for those of us who do genuinely want to make a difference but may feel some frustration? How can we start moving toward the model that you’re creating or working with?

Kristine Sorensen:As you are saying, we sometimes face those difficulties ourselves. We are so keen and eager. We want to make a change immediately, but this is really a long journey. I think all of us working in this field have experienced this. We need to help each other keep up that endurance.

Helen Osborne:How do you do that?

Kristine Sorensen:I try to look at five areas, levels or orders of health literacy.

One is really concretely on text products or illustrations. That’s very concrete in terms of design.

Second is interaction. What are our attitudes toward each other?

Then services. Can we change processes and systems and eventually a culture?

It goes to look at the barriers. The people we try to reach out to, what is their struggle? What’s their irritation? What are the barriers that they face, and how can we as professionals change those barriers or tear them down, so to speak?

Helen Osborne:For the people you’re meeting at whatever level, do they somehow share this passion?

Maybe they hadn’t heard about health literacy before and you’re introducing them to the concept. Is there, and this is a term that I like to use, pushback about that? Is there resistance to it, or do they say, “Of course. This matters. Even if it takes some effort, let’s do it”? How do you find the response to what you’re talking about?

Kristine Sorensen:I think we have our frontrunners, our health literacy champions, who really grasp this concept, and they run away with it because they see the need. Then we have others who are more resistant and more conservative in their approach.

Recently, I was teaching at a management school and this student said, “We can’t change the system of patients having 10 minutes. That’s how it is.” Then my question back was, “Do you really think so? If people would need more time to tell the story to the doctors, can’t we change?”

Helen Osborne:What was the answer?

Kristine Sorensen:She was a bit surprised, I think. My answer is, “Yes, of course we can change. We are the system. We are the people. We should change our mindset to be much more people centered and really say that the processes are not for the people, but we are there for the people, and we have to learn to listen.”

Helen Osborne:I agree with you wholeheartedly.

Certainly in the US and our healthcare system that’s very fragmented and often fee-based, the incentives are different. Our structure is in place often that just supports these ridiculously short appointments. Are you finding those same issues around the world where the healthcare systems are set up in different ways?

Kristine Sorensen:Yes, I do hear that resistance to it, but again I think this is how we need to make that change. We as health literacy champions have an obligation to keep questioning whether this is the right way to do it.

You can consider being in a hole and you realize that you’re stuck there. Should we then keep digging the hole deeper, or should we actually move out of it and find a new way?

Helen Osborne:It sounds like, for each of us deep inside ourselves, to remember why we are doing this work.

You talked about how health literacy is dependent on the context and content, and how that can differ around the world. Tell us a story. Is there some example that might be out of our day-to-day thinking about how health literacy is making a difference?

Kristine Sorensen:Yes, I can do that. I just returned from traveling to Taiwan. I was invited to see a pharmacy, a drugstore. It was completely another world to step in to. I thought, “What is this?”

First of all, the interior was completely different. It was like going into a lounge or wellness center. The staff was greeting me. I asked, “What is this?” It was really a fantastic design, but the products were the same on the shelves.

I talked to the owner and he said, “This is not about illness. This is about health.” It was part of his mindset. He wanted to teach his customers, the clients, how to keep themselves healthy and not only focusing on when they were ill. The products were exactly the same. That’s one example.

Another one was a hospital I visited in Taiwan. It was actually owned by a foundation developed by a previous cancer patient. He had not been too happy about his patient journey through the healthcare system, so he decided to make his own hospital.

Helen Osborne:Make his own hospital?

Kristine Sorensen:He was a philanthropist having his own hospital. In the lobby, can you imagine, there was a piano. They were playing a concert for all the people waiting.

Helen Osborne:There is commonality. At one of the cancer centers in Boston where I live there also is a piano. I can just picture that and it makes it so human. That’s why we’re doing the work.

I want to share one of my experiences, and I even did a podcast on this years ago.

I had the good fortune to visit South Africa several times. Several of the times, I met up with village health workers. It was a remote part in South Africa. One of the women I met up with worked with a physician to eradicate a blinding eye disease.

What she did was she would go into people’s homes. One way that this eye disease was spread was by sharing washcloths.

With the permission of the tribal elders in the community, she would then teach the women, who were responsible for the home health, to cut the washcloths and sew a different color fiber in each one so each family member knew which little piece of the washcloth was theirs, for their eyes. That alone made such a difference.

Another example that I saw, and I also have a podcast on this because I was so moved by it, was young women who were village health workers in a neighboring community who wrote songs about HIV and AIDS prevention.

Through song, through sewing a fiber through fabric and now you’re talking about environments, attitudes and reframing what health is about, people really are making a difference.

One thing I’ve been wanting to do, Kristine, and I think you’re starting to do that, is to share those strategies. That’s one thing I try to do with the podcasts. I want to hear from you how people can learn what is effective in other nations in parts of the world.

Kristine Sorensen:I think we have to focus not only on the mind and logics, but also the heart. I think those were the stories you also shared.

How we can learn from each other is, for example, to join the different health literacy events around the world and to follow the lists that are available to invite international speakers to American meetings and conferences, but also just to embrace the local diversity that is in most places. We live in a globalized world, so we don’t even have to travel to get close to other ways of doing.

Helen Osborne: Absolutely. If you look at a community, if you walk down a street, you see people of all backgrounds.

I know sometimes I might be taking a cab ride, and sometimes I might be talking with the driver. The driver might ask me where I’m going and I might say I’m going to a conference and we talk a little bit about it.

If the drive is long enough, I might ask about learning about health in a new country or culture. That driver often will be sharing the experiences that they’ve lived.

You’re right. This can start locally.

I see, I feel and I hope our listeners get that sense that even though you might be bringing the great big global picture, each of us can feel it personally and locally. Together, we really can make a difference.

Kristine, I want to thank you so much for all you do and for sharing this big vision with us. Thank you for being a guest on Health Literacy Out Loud.

Kristine Sorensen:Thank you. You too, Helen, for all the work you’re doing.

Helen Osborne: As we just heard from Kristine Sorensen, when we think about health literacy–dream big, have global visions, act locally. We can all make a difference.

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

New health literacy podcasts come out every few weeks. Subscribe for free to hear them all. You can find us on iTunes, Stitcher Radio, Google Play and the Health Literacy Out Loudwebsite, www.HealthLiteracyOutLoud.org.

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

Until next time, I’m Helen Osborne.

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