HLOL Podcast Transcripts

Health Literacy

Vaccine Literacy (HLOL #189)

Helen Osborne:Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z: Practical Ways to Communicate Your Health Message. I also produce and host this podcast series, Health Literacy Out Loud.

Today, I’m talking with Dr. Scott Ratzan, a physician who has three decades of pioneering accomplishments in the United States and globally in health literacy, health communication and strategic diplomacy.

He is the founding editor-in-chief of theJournal of Health Communication: International Perspectivesand serves on the Board of Global Health for the National Academies of Science, Engineering and Medicine.

Beyond his many publications and ongoing advocacy, Dr. Ratzan is co-author of the definition of health literacy that was adopted by the US government and incorporated in our nation’s Affordable Care Act. He now is taking on the challenge to improve vaccine literacy.

Scott and I have known each other as colleagues for many years. I’m delighted he agreed to be a guest on Health Literacy Out Loud.


Dr. Scott Ratzan:Thank you, Helen. Great to be here today.

Helen Osborne:Vaccine literacy. Until we were doing our little planning on this, I had never quite heard that term. I know you are championing communicating about vaccines, and we will get to that. But what do you mean by this term “vaccine literacy”?

Dr. Scott Ratzan:Helen, as you know, health literacy has been around for some time. While we worked to define this in the last century even, looking at the thousands of articles that were written on this or had used the term, it was clear that it meant different things to different people.

We tried to narrow it in a way that we could also help measure it. That dealt with skills, knowledge and giving people opportunity to actually obtain, process and understand information to make appropriate health decisions.

Helen Osborne:That’s the definition of health literacy that’s been around for quite a while now. I know it’s open to discussion and review again, but that’s our long-standing definition that you co-authored.

Dr. Scott Ratzan:Yes, absolutely. When Ruth Parker and I did that by reviewing the National Library of Medicine’s Current Bibliography of Medicine, we did that with the idea that this would have application in people’s daily lives. This was not meant to be hypothetical. This was not just meant to be a new piece that we measure.

As you said in the introduction, I’ve been editing the Journal of Health Communicationnow for 24 years. That journal also helped set the stage for a field where health literacy also has stood amongst.

We’ve done more than two separate issues now on health literacy not just as an article, but an entire themed edition. Health literacy has grown in a huge way.

Helen Osborne:Your role in this is just instrumental. Tell us now about what you’re focusing on with vaccines.

Dr. Scott Ratzan:Thanks, Helen. The reason it’s been instrumental is what we do in health literacy requires some basic communication, how the system either communicates simpler and how the individual is able to process and understand that, like the cultural linguistics. It’s all these other pieces that your 100-and-some-odd, probably now 200, podcasts have spoken about.

Let’s look at vaccines now. Vaccines have been around since 1792. It’s the fourth century now.

Helen Osborne:Really?

Dr. Scott Ratzan:Yes, when Edward Jenner was working on the vaccine for smallpox. We were able in Boston with Samuel Johnson, Ben Franklin and others to actually overcome some of the challenges of trying a new technology. Over those years, of course, we’ve developed many other pieces.

The word “vaccination” originally goes to “vaccinio” with the smallpox vaccination, even though immunization is a broader term. Yet we know from health literacy, “Did you get your shot? Did you get your jab?” depending on where you are in the world.

Unfortunately, what’s been happening is people are not getting their shots or jabs like they used to. It shows up, unfortunately, in children when they don’t get their measles vaccine, or the measles, mumps, rubella vaccine, MMR when it’s put together.

That’s where we’ve coined, “How do you deal with health literacy with vaccines?” Even more so, how do we create a vaccine literacy, which is a little bit different than just health literacy.

Helen Osborne:I already have some questions, and I’ve already learned some new things. I had no idea vaccines have been around for four centuries. That’s astounding.

You’ve also used a series of words. I know from my health literacy plain language work and hat that it helps to have consistent terminology, but you’ve used “vaccines,” “vaccinations,” “immunization,” “shots” and “jabs.” That’s five different ways to say something that may not be exactly the same, but along the same path.

You’re a pro in communication, too. Is this part of the problem?

Dr. Scott Ratzan:Absolutely, Helen. I’ve been fortunately, or unfortunately, having to describe this in a variety of venues over at least the first half of 2019. I know that, as we look to the future, this issue is not going to go away.

In fact, it goes back to 2003 when I worked with the World Health Organization following my days at USAID to try to deal with MMR vaccine.

Helen Osborne:Wait. You’re a doctor, but you do MMR. Explain it for all our listeners, please.

Dr. Scott Ratzan:That’s what I tried to say earlier. Sorry. It’s measles, mumps, rubella. It’s three vaccines that children get at age 1. Unfortunately, measles used to kill millions of children around the world.

In the year 2000 in the United States, there were zero cases of measles. Still, around the world, there are issues, but let’s speak about the United States now.

Here, when we’re recording this in 2019, we have a resurgence of measles. Twenty-eight states have outbreaks with over 1,000 cases.

In New York City alone, they had 50 hospitalizations at NYU Langone Medical Center from measles, 18 of which in the first half of the year were in ICU. This is not just a simple rash.

The City of New York has said it’s cost $2 million, because when you find somebody who has measles, you want to find everybody that they may have contact with. The virus can stay in the air active for a couple of hours.

Helen Osborne:How scary.

Dr. Scott Ratzan:It’s a very contagious disease. It’s very scary. If kids are not vaccinated, they get measles, they can get complications and they can die.

Helen Osborne:We’re at a very scary time here, Scott. I see this on the news. I know people who have infants or who are immunocompromised who are very afraid of this.

Putting on your communication hat, what in the world can we do about this? It sounds like the science is there to not have measles, but it’s all the other parts that are conspiring against us to bring measles back.

Dr. Scott Ratzan:Absolutely, Helen. What a great question. That’s really where we are with why I think health literacy is important as we apply it to even how we communicate, whether we’re a town commissioner, a parent or a school, and the way we even talk about vaccines.

We ask a lot of people, “What is it?” and even a lot of scientists and probably a lot of physicians say, “We need to get herd immunity. We need to get 95% of people in this community, our herd, vaccinated, and then we have immunity.”

Helen Osborne:That’s a really troublesome word. You don’t mean “heard” like, “I’m listening to you.” It’s a very technical term. Tell all our listeners. Let’s hear it from you, the correct way. What is herd immunity?

Dr. Scott Ratzan:Here’s the correct way that I would like to change it. It’s only been around since 1923. I know, “only.” That’s almost 100 years. It’s taught in schools of public health and grade schools. It’s the word “community protection.”

It’s not just me saying this. Walter Orenstein, who used to lead the CDC’s program on immunization, has written and published about this in the National Academy of Science of proceedings. Professor David Cash at Harvard has been talking about this for years. But they’ve not been bringing the communication or health literacy lens.

Why is it community protection? One, we all know that we need to protect our community with police and fire, and have ambulances that are ready if there’s emergency response. We also know about sanitation, handwashing and some of these other pieces.

When it comes to vaccines, we treat it differently. All of a sudden, we put this scientific term.

Even if the mayors or family think about community protection, they’ll want everybody in that school to be protected from measles. Hence, we would need to have everyone vaccinated.

Helen Osborne:Scott, I want to raise some issue there. Putting on my plain language hat, community protection is a mouthful. They’re both multisyllabic words.

If it’s my kid and I’m going to the doctor and I’d really rather my child not be stuck with a needle today, are those words going to matter to me as the mom?

Dr. Scott Ratzan:These are great points, Helen. I’m really talking about community protection as a policy goal that we know why we’re doing vaccines. How we get these done is a different story.

There were a couple studies that were done, whether they were communication studies or health literacy studies, that just had the question, “Do I need my shot?”

Helen Osborne:Clear, simple, to the point.

Dr. Scott Ratzan:Exactly. “I’m here with my baby today. Do I need shots today?” That’s the question to ask.

Helen Osborne:That’s all about me. That’s a question that’s clear and direct. Under health literacy ways of looking at that, it sounds good to me.

I also right now want to make a plug for an article that you were one of the co-authors of. I know you write prolifically and we will have links to many of your articles and resources on your Health Literacy Out Loudwebsite.

The one that really struck me was published by the American Medical Association in JAMA Network, which is open access. Thank you.

This article I think you authored with other people is “Safe Vaccinations for a Healthy Nation: Increasing US Vaccine Coverage Through Law, Science and Communication.” I really recommend that listeners take a look and read that article. It’s powerful. Thank you for that.

Dr. Scott Ratzan:Thank you. That article is a two-page article, so listeners can read it fairly quickly.

It’s with Larry Gostin, who’s a professor at Georgetown in the World Health Organization Collaborating Center on Global Health Law, and with Barry Bloom at Harvard. He’s a former dean of the School of Public Health there.

It’s now in JAMA Open Network, but it’s actually in the Journal of the American Medical Associationprint version as well.

We called for a communication campaign, like Smokey the Bear is for forest fires, which we know has been around for 75 years.

Smokey says, “Only you can prevent forest fires.” It’s not the forest department or environmental health and safety. You have to do something. It’s the same sort of thing for vaccines.

Helen Osborne:Our listeners could be anybody, and I’m delighted for each and every listener to Health Literacy Out Loud. But for the most part, I think we are people concerned with everyday communication.

As a clinician in public health, as a teacher, as a parent, what are some things we can be doing on this everyday level to communicate more clearly, accurately and actionably about vaccines?

Dr. Scott Ratzan:I say the word “community protection.” We need to know what our role is in society both as individuals, parents, brothers, sisters, mothers, fathers and so forth, as well as our professional role, as you say, teachers or whatever our place might be where we interact with others.

We need to normalize the ability to talk about health, which we frankly don’t do in some areas, like dementia. Thirty years ago, when I was in med school, people didn’t want to talk about AIDS or cancer. You remember you would whisper, “He or she has this disease or this area.”

We’ve gotten to a point where we’re talking about those. Can we do the same on other areas? Dementia is one. Clearly, we have this vaccine area, which should be a no-brainer. It should be a social norm that everybody is vaccinated by the time they go to school or go to college, and then they keep up with it throughout their life.

What are simple things? To be aware of that, to be able to communicate that and also, which is much more difficult, to discern truth from fake news, what I lately have been calling misinformation malpractice.

Helen Osborne:I like that mouthful.

Dr. Scott Ratzan:I know it’s a mouthful. Yet we have these big search engines . . .

Helen Osborne:Right, misinformation malpractice. What I’m thinking is has this message about vaccine gotten muddier because we are in the day of social media and it’s easier to post things online that are not vetted and scientifically rigorous or accurate?

Dr. Scott Ratzan:Absolutely. There’s absolutely no doubt that the search engines and the ability to lead people to information that looks credible, sounds credible, often is even through an intermediary that not be real, an avatar, or even a celebrity may have different levels of evidence. We’ve created vehicles to give people a distorted view of reality.

Helen Osborne:We’re creating that herd, but in the wrong direction.

Dr. Scott Ratzan:Exactly. When it has consequences for health, medicine or our families, we need to do something in a bigger way.

We have an ethical role and responsibility. People who are listening to this and, Helen, certainly with the great work you’ve been doing in health literacy over the years, to hone in on that message day in and day out, the importance of science and evidence-based approaches.

Helen Osborne:I’ve got a question for you. I know you’re a big-picture person and you operate in large policy levels for the large part. What would you advise someone whose neighbor is saying, “I will not get my little baby vaccinated”?

What do you recommend to our listeners who might have a neighbor, friend or relative like that? What words can we use?

Dr. Scott Ratzan:The first thing we need to do is listen. Why do they believe that? Is it because they read one doctor who says something about aluminum, or is it because they say, “Vaccines and the autism link,” which has been debunked a thousand times over, whether it’s from big data studies in Denmark to national academies and so forth. Listen. What are the reasons?

Help understand that, and then basically deconstruct those, whether it’s to talk about other people they may trust. Hopefully, people who are listeners are pro-vaccine and pro-evidence and science.

Be able to listen and bring in other people, whether they are health professionals or others who have this community protection and individual protection understanding.

Then there’s a whole other field of risk communication and how we communicate risk. But that’s another area that we can discuss.

Helen Osborne:What I’m getting from you is that it’s so multi-leveled. You’ve got the big picture policy. You’ve got social media plans of what they are including and not. This is well written in your article and easy for me to grasp the roles of industry, perhaps, and the roles of government, policies, not being immunized and the reasons you might not do that.

I guess I’m much more concerned on the day-to-day level of what we can do as caring, knowledgeable people and advocates. You’ve addressed all that.

Scott, I know there is so much more to say about this. I hear your passion, and I thank you so much for it. For now, I think we should put a pause on this conversation.

Hopefully, listeners will go to all those great resources that we’ll have on your Health Literacy Out Loudweb page.

I personally want to thank you so much for everything you do and then sharing it, inoculating us with this passion, on Health Literacy Out Loud.

Dr. Scott Ratzan:Thank you so much, Helen. It’s really been a pleasure to see all the great work, read about it and listen to your podcast and the lectures that you’ve done over the years.

I think this is one of the most important areas that we can make a difference long-standing, not only for us as mothers, fathers, brothers and sisters, but for our kids, grandkids and future generations.

The work for health literacy is so important, and I want to thank you and listeners for trying to do this the best they can. Realize it’s an iterative process as we continue to try to make the world a better place and communicate in a positive way for better health for everyone globally.

Helen Osborne:Thank you, Scott.

As we just heard from Dr. Scott Ratzan, communicating clearly about vaccines is a part of health literacy, too. But clearly communicating messages like this and all others is not always easy. For help clearly communicating your health message, take a look at my book, Health Literacy from A to Z.

Especially in relevance to this podcast are Chapters 1 and 13 that have much more information about the origins of healthy literacy and also ways to talk with the public about what they learn from the media.

You can also contact me directly at helen@healthliteracy.com.

Health Literacy Out Loudpodcasts come out every few weeks. You can get all the episodes automatically by subscribing for free at www.HealthLiteracyOutLoud.com, or find us on iTunes, Google Play, Stitcher Radio or wherever you get podcasts.

Please help spread the word about health literacy and Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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