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. I also produce and host this podcast series, Health Literacy Out Loud.

Wellness is a term I hear a lot these days. But like a lot of commonly used terms, I sometimes wonder if everyone understands wellness the same way.

Dr. Teresa Wagner has experience in both wellness and health literacy. I’m delighted she agreed to be a podcast guest and discuss these important topics.

Teresa is a registered and licensed dietician with a doctorate in public health. She is Assistant Professor in the School of Health Professions and in the School of Public Health at the University of North Texas Health Science Center.

Teresa’s research focuses on alleviating health disparities in underserved communities through health and nutrition literacy. That includes working closely with community health workers to meet unmet community health needs.

Welcome, Teresa.

Dr. Teresa Wagner: Hello. How are you today?

Helen Osborne: Very well, which maybe is appropriate when we discuss wellness. Wellness and health literacy are really very much your focus. Can you put this all in context? When you use the term wellness, what do you mean?

Dr. Teresa Wagner: Interestingly, Helen, wellness can mean a lot of different things. I took the liberty of looking it up. Merriam-Webster defines wellness as the quality or state of being in good health, especially as an actively sought goal.

Then I put that in plain language and said the state of being in good health through active pursuit of health as a goal.

We know there are a lot of models of wellness, and I think that’s really where we should start in terms of talking about what all makes up wellness. If we know that health is a goal, how do we get and stay healthy so that we achieve wellness?

Helen Osborne: That’s our goal. Inherently, everybody worldwide just wants to be healthy. What are different ways to get there? How do you frame that when you say there are different models for that?

Dr. Teresa Wagner: What we know is that the World Health Organization considers health to be a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity.

When we look at the different models, what makes those up? The first one I want to talk about is lifestyle medicine, which is actually what we teach in the program Lifestyle Health Sciences at the University of North Texas Health Science Center.

Helen Osborne: Lifestyle medicine, that’s actually not a term I’m all that familiar with.

Dr. Teresa Wagner: Lifestyle medicine is actually a pursuit that you can get certified in. It has six domains of wellness, which include nutrition and physical activity, the two that most people think of. But it also includes substance avoidance, sleep, stress management and social connectedness.

It’s kind of looking at that global perspective of all of the different things that we need to be thinking about and actively pursuing to achieve wellness.

Helen Osborne: When you say we should be actively pursuing, everybody should be going toward that? Is that a universal quality and goal?

Dr. Teresa Wagner: Correct.

Helen Osborne: Or is that just within this framework, that’s how you do it?

Dr. Teresa Wagner: As we know, our healthcare payment model is going to be changing over the next several years where our providers actually get paid to keep people healthy and well versus seeing people when they’re sick.

Helen Osborne: I didn’t know for sure. I know we’re heading in that direction. This is in the US, right? Or is that worldwide?

Dr. Teresa Wagner: I don’t know if it’s worldwide or not. I know it’s in the US. I think it certainly should be worldwide, because we really want to achieve wellness as an entity of public, of public health. Staying healthy and well, let’s say we have another pandemic, can help you to be better able to handle a pandemic.

If we look at COVID-19, people who had those chronic diseases underlying were the people who were most affected by COVID-19.

Helen Osborne: Of course.

Dr. Teresa Wagner: I really think that wellness should be what we actively pursue.

Helen Osborne: Then you’re also talking about an economic model. Our healthcare system indeed pays providers and healthcare organizations to treat people when they’re sick. It probably costs a whole lot less money to help them stay well.

Dr. Teresa Wagner: To keep people well. Exactly. That’s why we want to be pursuing health and wellness as a goal publicly.

Helen Osborne: You talked about different models here, and you talked about lifestyle medicine. Are there other ways of viewing this, or is that the primary one?

Dr. Teresa Wagner: There are others as well. Whole Health is a model that was designed by the VA that looks at the whole person and really helps to support that person in where they are.

Helen Osborne: The VA is the Veterans Administration.

Dr. Teresa Wagner: Thank you for helping me with my health literacy.

Helen Osborne: Our listeners can be worldwide, so we just always have to be sensitive to our acronyms and abbreviations. Whole Health is by the Veterans Administration in the United States for anyone in the military.

Dr. Teresa Wagner: Right. With this Whole Health concept, we look at the whole person and we really want that person to play a role in their own healthcare.

Again, they’re actively pursuing and thinking about not only nutrition and physical activity, but also preventing chronic disease. What about mental health? Really looking at all aspects of a person’s health, such as self-care, professional care and community.

Helen Osborne: Do these conflict, or are these complementary, these different ways? There probably are a lot of other models, too.

Dr. Teresa Wagner: Yes, there are other models. In fact, there are the six domains of lifestyle medicine. There are eight domains of Whole Health. Then there are seven domains in the Princeton UMatter. Yes, they are complementary. All three of them are complementary, but they all look at these other aspects.

We always focus on nutrition and physical activity when we think about health and wellness, but they focus on these other aspects that are complementary and really evidence-based.

We know that having good sleep and stress management and being socially connected does help people be healthier and stay well.

Helen Osborne: When I’m listening to these, I’m thinking of the role of the individual. You’re talking about healthcare systems or domains in research, and that’s fabulous. Everything you talked about, I can say, “Yes, that’s important.” But it also sounds like it’s up to the individual to make daily choices.

That’s how I’ve often thought of wellness in that way. It’s those little micro-decisions we make every day. You’re looking at that menu in the restaurant saying, “What should I have? Should I have the dressing on the side of the salad or not, or have that tempting dessert?” Is that part of it, too?

Dr. Teresa Wagner: It is. It’s interesting you would mention that now, because the Princeton UMatter definition says wellness is not merely the absence of illness or distress, but it is a lifelong process of making decisions to live a more balanced and meaningful life every day.

You hit the nail right on the head. It is those decisions. Should I lay here on the couch and be a couch potato? Should I get out and walk my dog?

Rest does a play a role, so it doesn’t mean that we constantly have to be moving. But we do need a certain amount of movement every day.

Interestingly, Whole Health also brings in spirit and soul. That can be a big part of people’s sphere of living as well.

Helen Osborne: Can you explain spirit and soul? Those are terms I can only guess at what you mean.

Dr. Teresa Wagner: It’s more that spiritual or religious. Not everyone has the same religion. Not everyone feels the same amount of spirituality. But it’s embracing what it means to you.

Really, all of these models are based on what your resources are, what you believe, what is meaningful in your family or culture. They really can apply across cultures and across the globe, because everyone has their own setting or environment.

If you think about trying to achieve wellness given the variables that you have available, then that really makes it an achievable goal.

Helen Osborne: It’s achievable, but I wonder also in context of a person’s life and what other priorities they have.

I think at this point, maybe we can talk about the other concept that you also have the expertise in, which is health literacy, and how health literacy and wellness work together in that.

I know you feel very strongly about both of these. Can you just explain to all of us how you put together this model?

Dr. Teresa Wagner: I’ve done a lot of work, as you mentioned, in health disparities. We know that people who are more vulnerable to have low health literacy often don’t have educational or socioeconomic opportunities, etc.

When we start looking at how health literacy would be helpful in trying to break some of these barriers that would empower people to achieve wellness, then that’s really where the two bridge together.

In my mind, health literacy is actually a bridge to health equity. If we could help not only socioeconomically and education and all of that, but health literacy is foundational to all of these things.

People often ask me to talk about health literacy as a social determinant of health, and I say, “Health literacy is not a social determinant of health. It is the social determinant of health.”

Helen Osborne: I can hear where your soul is when it comes to putting this together. Can you tell us a story or give an example of how this can all work together? Not just the words of disparities, equality and equity. Those are important values, but how does this really work on a real person basis?

Dr. Teresa Wagner: A few of my projects that I’ve worked on really bridge the two together. Probably the most successful story I’ll tell you about is we, during COVID-19, of course saw health disparities in our rural communities in Texas.

We got a call from a healthcare system in a rural community that had the highest rate of COVID-19 in Texas. I met with their CEO, which, as we know, leadership has to be engaged to make health literacy work.

Got a call from their CEO who wanted me to help investigate why they were having trouble communicating these preventative measures to their community.

I hired a community health worker out there. We did focus groups. What we found was that they were putting all of their information on the internet, and it wasn’t in Spanish. People couldn’t get access to the information. Much less if they had internet access, they couldn’t understand the information.

What we did was we worked to bridge that gap. They ended up hiring bilingual physicians, opened a bilingual clinic and connected that community all together to help make sure that people had access to gain health literacy, to be able to understand that information.

Helen Osborne: Right. And to realize the relevance to them, and that it is possible.

Dr. Teresa Wagner: Correct.

Helen Osborne: Thank you for putting that together.

Our listeners to Health Literacy Out Loud, we all want to know how to communicate a little bit better today than we did yesterday. I would assume the vast majority of us, or all of us, are committed to the concepts of wellness, and we want to help others achieve that goal.

What would you want to share with listeners about what they might be able to do to help?

Dr. Teresa Wagner: I would definitely want people to focus on their own wellness in terms of thinking about each of these different domains, whichever model you use.

Think about where is my nutrition? Do I need to learn more about that? Where is my physical activity? Am I avoiding substances, like excess alcohol use, cigarette smoking and those types of things?

Am I getting adequate sleep? Am I dealing with my stress? Am I socially connected? Do I get out with friends? Do I have people I talk to, people I can confide in?

It’s all of these things to where I am maintaining the health and wellness that I know I would like to achieve for myself.

Helen Osborne: We start with ourselves.

Dr. Teresa Wagner: Exactly.

Helen Osborne: Let’s say we’re moving along on that one. How do we go about helping others?

Dr. Teresa Wagner: In your social network or your family, you can teach these concepts. I have two daughters. I’ve taught them the concepts of good nutrition and physical activity, cooking meals as a family, socializing, having a lot of friends.

A lot of it comes from your community, and many communities do have all of these factors. It’s just a matter of are we optimizing them in a way that promotes total health and wellness?

Reach out to your communities or become certified in some type of way. I teach community health workers. The girl that I hired in Mount Pleasant went on to become a Certified Community Health Worker, and now she’s enrolled in medical school because she wants to go back to her community.

Helen Osborne: What a nice story.

Dr. Teresa Wagner: Really try to make it a part of everything you live and do, and be that champion in your family, your community and your workplace that promotes health and wellness.

Helen Osborne: Maybe just a little bit on the other side of it, I certainly try to live as well and healthy as I can and make those decisions. Not that I’m always successful.

But sometimes I get pushback from people I know, like, “Boy, you’re really watching what you eat,” or, “Come on. Have a piece of cake,” or, “Have a second piece of cake,” or whatever it is. Or people might say, “I’m too busy. I’ve got too many kids to deal with. I’ve got jobs and other priorities. I can’t keep focusing on that.”

How do you recommend people deal with pushback on these obviously worthy goals?

Dr. Teresa Wagner: Exactly. We all have things. We all are busy. Yes, it is very difficult to focus on your wellness. But there are easy ways to combat that. Also, remembering that you don’t have to be perfect all the time is also huge.

When I used to teach Basic Nutrition, I would tell my students, “If you learn nothing else in my class besides balance, variety and moderation, then I have done my job.”

But I think that applies in all areas of our life. If we’re eating healthy 80% of the time, if we’re getting our exercise 80% of the time and 20% of the time we’re not, then that’s okay. Over time, we’re making those good decisions on an ongoing basis enough to impact our health and wellness.

Helen Osborne: I can really hear from you, Teresa, your commitment to this and the relevance of this to health literacy, and how they all work together to keep ourselves, our communities and everyone everywhere more well.

Are there ways to learn more?

Dr. Teresa Wagner: Yes. Again, lifestyle medicine is a great resource that you can find online. Just look that up on your internet.

We, of course, have our program, which not only emphasizes lifestyle medicine, but also health and wellness coaching, another way you can help others in your community.

Helen Osborne: When you say we, it’s your university. We’ll have those links on your Health Literacy Out Loud web page.

Dr. Teresa Wagner: Perfect.

Helen Osborne: Teresa, thank you. Thank you for making this concept clearer, that there are a lot of models, what the goals are and that it’s a universal goal that we have to want to be well and stay well.

Thank you for all you’re doing. Obviously, you are passionate about this and you have a lot of resources. Thanks for sharing your stories and putting this all together as a commitment closely tied in with health literacy. Also, thank you for being a guest on Health Literacy Out Loud.

Dr. Teresa Wagner: Thank you, Helen.

Helen Osborne: As we just heard from Dr. Teresa Wagner, it’s important to consider ways to be well, not just sick. Health literacy is certainly a part of that key message and tool to achieve it. But doing so is not always easy.

For help clearly communicating your health message, please take a look at my book, Health Literacy from A to Z. Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud interviews come out the first of every month. Get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

Please help spread the word about 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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