Health literacy is the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions. Nearly half of all American adults - 90 million people - have inadequate health literacy to navigate the health care system. Implications of Health Literacy for Public Health is the summary of a workshop convened by the Institute of Medicine Roundtable on Health Literacy in November 2013 that focused on the implications of health literacy for the mission and essential services of public health. The workshop featured the presentation of a commissioned paper on health literacy activities under way in public health organizations. Other presentations examined the implications of health literacy for the mission and essential services of public health, for example, community health and safety, disease prevention, disaster management, or health communication. This report includes the commissioned paper and summaries of the workshop presentations.

Bioterrorism, drug-resistant disease, transmission of disease by global travel . . . there's no shortage of challenges facing America's public health officials. Men and women preparing to enter the field require state-of-the-art training to meet these increasing threats to the public health. But are the programs they rely on provide the high caliber professional training they require? Who Will Keep the Public Healthy? provides an overview of the past, present, and future of public health education, assessing its readiness to provide the training and education needed to prepare men and women to face 21st century challenges. Advocating an ecological approach to public health, the Institute of Medicine examines the role of public health schools and degree-granting programs, medical schools, nursing schools, and government agencies, as well as other institutions that foster public health education and leadership. Specific recommendations address the content of public health education, qualifications for faculty, availability of supervised practice, opportunities for cross-disciplinary research and education, cooperation with government agencies, and government funding for education. Eight areas of critical importance to public health education in the 21st century are examined in depth: informatics, genomics, communication, cultural competence, community-based participatory research, global health, policy and law, and public health ethics. The book also includes a discussion of the policy implications of its ecological framework. Table of Contents Front Matter Abstract Summary 1. Introduction 2. History and Current Status of Public Health Education in the United States 3. The Future of Public Health Education 4. Future Role of Schools of Public Health in Educating Public Health Professionals for the 21st Century 5. The Need for Public Health Education in Other Programs and Schools 6. Public Health Agencies: Their Roles in Educating Public Health Professionals Conclusion References Appendix A: School of Public Health Catalogue Abstraction Appendix B: School of Public Health Survey Instrument Appendix C: Organizational Input Appendix D: Education of Public Health Professionals in the 21st Century Appendix E: Occupational Classifications Appendix F: A Collection of Competency Sets Appendix G: Public Meeting Appendix H: Committee Biographies Index

The roots of health literacy can be traced back to the national literacy movement in India under Gandhi and to aid groups working in Africa to promote education and health. The term health literacy was first used in 1974 and described as "health education meeting minimal standards for all school grade levels". From that first use the definition of health literacy evolved during the next 30 years with official definitions promulgated by government agencies and large programs. Despite differences among these definitions, they all hold in common the idea that health literacy involves the need for people to understand information that helps them maintain good health. Although the United States produces a majority of the research on health literacy, Europe has strong multinational programs as well as research efforts, and health literacy experts in developing countries have created successful programs implemented on a community level. Given these distinct strengths of efforts worldwide, there are many opportunities for collaboration. International collaboration can harness the United States' research power, Europe's multilingual and multinational experience, and developing nations' community-based programs to create robust programs and research that reach people-not based on language or nationality but on need and value. A workshop on international health literacy efforts that feature presentations and discussion about health literacy interventions from various countries as well as other topics related to international health literacy was held as the basis for this report. Health Literacy: Improving Health, Health Systems, and Health Policy Around the World summarizes the findings and discussions at the workshop. Table of Contents Front Matter 1 Introduction 2 Welcome 3 Health Literacy Perspectives 4 Health Literacy Policy and Programs 5 Innovations in Health Literacy 6 Concluding Panel Appendix A: Commissioned Paper: Health Literacy Around the World: Part 1: Health Literacy Efforts Outside of the United States Appendix B: Speaker Biosketches

Health literacy-the ability for individuals to obtain, process, and understand basic health information and services to facilitate appropriate health decisions-is increasingly recognized as an important facet of health care and health outcomes. Although research on health literacy has grown tremendously in the past decade, there is no widely agreed-upon framework for health literacy as a determinant of health outcomes. Most instruments focus on assessing an individual's health literacy, yet the scope of health literacy reaches far beyond an individual's skills and abilities. Health literacy occurs in the context of the health care system, and therefore measures of health literacy must also assess the demands and complexities of the health care systems with which patients interact. For example, measures are needed to determine how well the system has been organized so that it can be navigated by individuals with different levels of health literacy and how well health organizations are doing at making health information understandable and actionable. To examine what is known about measures of health literacy, the Institute of Medicine convened a workshop. The workshop, summarized in this volume, reviews the current status of measures of health literacy, including those used in the health care setting; discusses possible surrogate measures that might be used to assess health literacy; and explores ways in which health literacy measures can be used to assess patient-centered approaches to care. Table of Contents Front Matter 1 Introduction 2 An Overview of Measures of Health Literacy 3 Approaches to Assessing Health Literacy 4 Population-Based Approaches to Assessing Health Literacy 5 Measuring Health System Responses to Health Literacy 6 Measuring Health Literacy: What? So What? Now What? References Appendix A: Workshop Agenda Appendix B: Workshop Speaker Biosketches Appendix C: CAHPS(r) Clinician and Group Survey: Health Literacy Item Set