Health, Wellness, Libraries, and Literacy

Issues of health and wellness, illness and disease, surround us in our everyday lives. Television advertisements promote drugs for specific diseases, always ending with a long – and quickly spoken – warning about all the possible side effects of the drug being promoted. News reports are filled with stories about drugs being pulled from the market and drug companies being sued. Celebrities stricken with cancer and other diseases discuss their situations publicly, sometimes promoting particular kinds of therapies. Politicians debate the merits of various levels of health care insurance and who should pay for it. In the midst of this flood of information however, finding informative and clearly written materials about health issues specific to you as an individual can be a daunting task. Even those among us who consider ourselves highly literate can have difficulty finding useful information about a specific disease and the various therapies recommended, or how one drug prescribed for us will interact with others we are already taking, or what is or is not covered by our insurance plan – if we are lucky enough to have one. We can well imagine, then, the steepness of the learning curve that confronts our adult literacy students as they try to acquire information vital to their lives and the lives of their loved ones.

Fortunately, the issue of health literacy – and the need to address it – is gaining prominence. The most recent survey of adult literacy conducted by the National Center for Education Statistics included, for the first time, a component specifically devoted to health literacy, which they defined as, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” The report is available through the NCES web site at http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483.

There is also increasing evidence that the health care community is taking note of the many ways in which poor health literacy effects not only their patients but their own success as health care providers. They recognize that poor outcomes are often due to patients’ inability to understand and follow the instructions of their physicians or the directions on the medications they are given. To help improve the understanding and thus the compliance levels of their patients, hospitals and health care facilities are increasingly looking for patient education materials written at accessible reading levels and in several languages. Some hospitals have even established health information libraries specifically designed to serve patients and their families.

What Public Libraries Offer to Support Health Literacy

Simply put the library offers access to Internet resources and a wide range of books and other printed materials that offer health information. Many of these materials will be accessible to ABE or ESL students, especially if they have the assistance of a tutor or librarian to help them discover the materials. Let's look at a few examples.

Resources on the Internet: When looking for any kind of information in this online world, most of us turn first to the Internet. For many of our ESL and ABE students, however, that is simply not an option, as many of them have neither access to computers nor the ability to use them efficiently for information needs. Fortunately, almost all public libraries offer computer access to library card holders as well as staff to help those unfamiliar with the technology.

Gaining access to a computer is the first step, but navigating through the plethora of information available, and deciding what is worthwhile for your particular purpose, is another issue entirely. In the area of medical information, the best place to start, in my opinion, is a service provided by the National Library of Medicine (NLM) and the National Institutes of Health (NIH) called Medlineplus. It’s web site is: http://medlineplus.gov/. Medlineplus offers information about more than 750 diseases, conditions, and wellness topics; extensive information about specific drugs as well as drug policy related to Medicare; directories of physicians and other health care providers by specialty as well as geographic area; discussions of current clinical trials; and news items about important research. It has always offered information in both English and Spanish, but recently it added information in forty (yes, 40!) languages. Equally important, Medlineplus is not a commercial product. It does not allow advertisements and does not promote specific drugs or procedures. It is based on or links to authoritative and reliable materials produced by NIH and many other professional organizations dedicated to the dissemination of accessible and understandable medical information to the lay public.

Medlineplus is a free service, provided by the government. Many other useful and reliable resources are not free, however, but are made freely available to the public through the public library. These include databases such as Health Source: Consumer Edition and Health and Wellness Resource Center, both of which provide information written in lay language and intended for patients and their families and care givers. Check with your local public library to see if they have access to these or similar databases.

Books for ABE and ESL Students: Books presenting facts and discussing issues related to health and wellness constitute a significant part of the nonfiction collection of most public libraries. For ABE and ESL students, the children’s collection will contain many books which address their topics in a straightforward and informative style that will be both helpful and appealing to adult literacy students. These collections offer books covering a range of topics, from general information about health and the human body to detailed discussions of particular diseases and conditions. The books range in style and readability from the picture book format to highly illustrated atlases to textbook-like works on particular topics that offer excellent practice in reading scientific or technical information for students preparing for the GED. Let’s look at a few examples, some of which are appropriate for adult students and others which are suitable for family literacy programs.

Chris Hawkes’ book, The Human Body: Uncovering Science (Firefly, 2006) is one example of a book that can be used by students on several levels of reading ability. Although the text is written primarily at the intermediate-advanced new reader level, much information can be gleaned from the extraordinary diagrams and illustrations that draw the reader in and inspire a host of reactions. With exquisite overlays such as the internal organs over the muscular system over the skeleton, and magnified diagrams of organs at the cellular level, these illustrations provide many opportunities for students to match information from the printed text with the illustrated examples, even if that printed text is read aloud to them. Another book with great read-aloud-for-discussion potential, is Donna Jackson's In Your Face: The Facts About Your Features, (Viking in 2004). Moving from our evolutionary origins in creatures of the sea to the modern technology of face recognition as a means of identification, Jackson examines many aspects of the human face. Rich in fascinating facts, this book also suggests numerous language lessons, especially for ESL students. There is a wealth of vocabulary in the names of all the parts of, for example, the eye: iris, pupil, cornea, eyelash, etc. There are cultural discussions as, for example, when it is proper to make eye contact with another person, or how and why various cultures adorn faces with make-up or tattoos. And there are idioms associated with just about every part of the face: “all ears,” “won by a nose,” “face the music,” and the title itself, “in your face.”

We’ve talked in earlier entries about picture books that can appeal to readers of all ages. Simon Seymour’s The Heart: Our Circulatory System (William Morrow, 1996) is an outstanding example of this category. The “pictures” in this book come from such devises as scanning electron microscopes and computer enhanced imagery. The text precisely details the path of human blood through arteries, capillaries, and veins, and discusses topics such as how white blood cells fight infection and how cholesterol builds up in arteries. This clearly written factual account then ends on a poetic – even reverent – note, describing the “sixty-thousand-mile voyage” of blood through the body as “a journey as strange and wonderful as any journey to the stars.” In a similar vein, Simon has produced several other titles in this series of picture books, including, Eyes and Ears, The Brain, Bones, and Guts.

Several publishers have produced series of books covering health issues that will be of particular interest and appeal to the audience of adult literacy students. Heinemann Publishers of Chicago, for example has published a number of series at different reading levels. The series “Just the Facts,” written at the intermediate new reader level, covers a range of diseases. Their entry titled Aids (2003) is typical. It discusses the symptoms, treatments, complications, and risks associated with the disease. But it also goes beyond the medical facts to examine some of the social, political, and legal ramifications of this epidemic, thus suggesting avenues of discussion that will be of particular interest to adults. It introduces readers to Ryan White, for example, the young hemophiliac boy who contracted aids from a blood transfusion and was ostracized by his school community but eventually became an eloquent spokesperson for the rights of aids patients. Emphasizing the importance of knowledge, this simple book debunks prevalent myths about the disease and treats a difficult subject in a respectful, matter-of-fact manner that respects readers of all ages.

A genre of books popular for the children’s market could loosely be described as picture dictionaries or atlases. DK Publishing has produced a number of such titles that are visually appealing across age ranges and offer information through illustrations as well as text, making them accessible across reading levels as well. One excellent example is Human Body: An Extraordinary Look from the Inside Out (1997) from the series Inside Guides. Written by Frances Williams, it offers a comprehensive yet accessible atlas of the human body in which all the body systems are presented by handcrafted models of extraordinary detail and many shades of color. Microscopic photographs offer a look at the cellular level and clear text explains the function of each body section. Although marketed to children, many libraries will have additional copies in the adult collection.

At the intermediate – advanced new reader levels, some series offer an almost textbook-like format that will be helpful for students preparing for the science reading section of the GED. Lucent Books, for example, offers a series titled Diseases and Disorders in which individual books discuss a range of diseases including Alzheimer’s disease, breast cancer, epilepsy, autism and dyslexia. The chapters in each of the books discuss the nature of the disease or disorder, how it is diagnosed, what the standard treatments are, some possible alternative treatments, and day to day problems. They also offer an overview of potential research developments as well as a list of organizations to contact for additional information.

Books for Family Literacy Programs: For family literacy programs, public libraries offer a wealth of materials for adult literacy students to discuss and learn from along with their children. In Caroline Arnold’s The Skeleton System (Lerner Publications, 2005), for example, part of the Early Bird Body Systems series, each chapter opens with a question, the answer to which can be found within that chapter, offering opportunities for adult and child readers alike to practice finding specific pieces of information within a larger text.

Part of The Cat in the Hat’s Learning Library series, Tish Rabe’s Inside Your Outside: All About the Human Body (Random House, 2002) offers a whimsical, rhyming tour of the human body. Along the way, readers are introduced to lots of vocabulary as well as “fun facts” such as the size of the bones in the inner ear. Children and adults will laugh at the antics of The Cat, and they will learn a lot as well.

On a more serious note, Bee Peta’s Living with Asthma (Steck-Vaughn, 2000) follows the daily routines of three children as they learn how to control their environment so as to minimize the effects of their disease. Books such as this one which feature an instructive and positive view of children coping with difficult medical conditions remind all readers that knowledge and a positive attitude are essential aspects of all therapy.

The Nonfiction Collection

A Treasury of Knowledge

The nonfiction collection in the children’s department of any public library is indeed a treasury of knowledge and a rich source of reading materials for adult literacy students. It will contain books discussing virtually any subject, many written in simple but instructive prose that does not specifically address children as its intended audience. These books are often rich in graphic presentations of information, including photographs, illustrations, maps, charts and graphs, and facsimiles of original documents. They use the true vocabulary of the subject, not a simplified or dumbed-down version, but they also provide clear definitions and pronunciation guides. Works of nonfiction are also found in genres beyond the expected factual texts and biographies. Some books classed as picture books, for example, tell true stories about cultural and historical events and about noteworthy people. Even certain works of poetry are based on actual events, offering the reader an opportunity to examine that event or issue from a different and often deeper perspective. For ABE students who missed much of the content of early schooling because of reading difficulties and for ESOL students who are eager to learn about their new home – its history, geography, and culture, as well as its language – the nonfiction collection of the children’s section offers many opportunities for students to “read to learn” while learning to read and speak the English language.

There are many subjects to choose from to illustrate the point of this entry, but given that it is February, celebrated as “Black History Month,” we’ll look at a range of books depicting the Civil Rights Movement of the twentieth century, and in particular, one pivotal event of that movement, the Montgomery Bus Boycott, begun in response to the arrest of Rosa Parks on the day she refused to give up her seat on a city bus to a white man. The lessons below suggest ways to use a few titles related to this topic. Other books are suggested in the bibliography listed on the left as well as in both Adult Learners Welcome Here and

Choosing and Using Books with Adult New Readers.

A few lesson ideas

Biographies: Rosa Parks is the subject of numerous biographies, written at varying reading levels. On the beginning new reader level, consider, for example, I Am Rosa Parks (Dial Books, 1997), written by Rosa Parks herself with assistance from Jim Haskins, and illustrated by Wil Clay. In this book, Parks recalls important events from her childhood, then tells the story of the fateful day she refused to give up her seat on a bus to a white man, a seemingly simple decision that led to the Montgomery Bus Boycott, a seminal event in the burgeoning Civil Rights movement of the 1950s. On one level, the simple text of this book offers students a good example of writing that describes an important event in the writer’s life in simple, declarative sentences. Such personal story telling is an excellent place for literacy students to begin developing writing skills. But given the enormity of the event described, this easy-to-read book offers adult literacy students something more, an opportunity to discuss and perhaps write about more complex issues. By refusing to relinquish her seat, Rosa Parks was striking out against centuries of injustice; she was also breaking a law, inconveniencing herself and others, and subjecting herself to potentially harsh treatment from the angry bus driver and the police who arrested her. Ask your students:

• Could you imagine yourself in such a situation? What would you do?

• What if you were another black person on the bus. Would you get up and leave as some did or would you stay?

• What if you were a white person on the bus. What would you do?

• Suppose you are one of the policemen. What would you say to Rosa Parks?

• Is it ever acceptable to break a law?
  

Picture Books: Although thought of almost exclusively as children’s books, many picture books appeal to “readers of all ages.” An excellent example is poet Nikki Giovanni’s Rosa (Henry Holt, 2005), written in prose at an intermediate new reader level. The picture book format offers a more personal perspective of that fateful day, as Giovanni first introduces us to Rosa in her kitchen preparing breakfast for her husband and worrying about her mother, who has been ill. The reader then follows Rosa through a busy day working as a seamstress for a Montgomery department store. As she boards the bus to go home, we know she is tired and thinking about what to cook for supper when she is confronted with a situation that forces her to make a momentous decision. Dramatically illustrated by Bryan Collier, Giovanni’s story places Rosa in a context that helps readers relate to her as an ordinary person who, by a simple act of defiance, became a catalyst and a symbol of a major social movement.

Encourage students to examine the details of the illustrations of this book. For example:

• What is in Rosa’s kitchen?
  
• What is she wearing?
  
• What kind of sewing is she doing?
  
• What do the expressions on the faces of the people on bus – or the bus driver and policemen – say to you?

Have students read I Am Rosa Parks first and then read Rosa. Discuss with them how the picture book, with its additional text as well as its illustrations, changed or added to their understanding of Rosa Parks.

Artist Faith Ringgold takes yet another approach in her picture book, If a Bus Could Talk: The Story of Rosa Parks (Simon & Schuster, 1999). In this imaginative story, a young girl steps up to what she thinks is her school bus but which turns out to be a kind of magical talking bus that appears once a year to commemorate Rosa Parks’ famous ride, teaching the young girl – and all the books’ readers – about an important event in American history. This picture book is clearly intended for children and is not what I would call a book for readers of all ages. However, it has a potential use in an adult literacy classroom as an example of what could be an interesting writing exercise for intermediate or advanced students. We all know stories - cultural, historical, and personal stories - that we believe should be passed on to children. Ringgold’s approach to passing on the story of Rosa Parks was to invent a magic bus. Consider asking students to think of a story important to them in some way, then ask them to write about it in a way that children would understand. They may choose to write a purely factual account, they may write a poem, or they may invent a story that would appeal to a child’s imagination but also convey important facts, as Ringgold’s book does.

Poetry: In her collection titled On the Bus with Rosa Parks (W.W. Norton, 1999) former Poet Laureate Rita Dove devotes a section of the book to poems about Rosa Parks and the Civil Rights movement. In the simple poem “Rosa,” Dove describes her almost obliquely (“Her sensible coat,” “That courtesy”) yet she says so much about this ordinary person who became a cultural icon. “Rosa” is a beautiful example of how a poem can capture a certain essence of a person by noting a particular detail such as a gesture or an article of clothing. Read this poem aloud to your students and talk about it with them, pointing out the particular details Dove chose to include. Then ask them to think of person they know well and write a poem about that person, using a few specific details that capture something essential about that person. (The book On the Bus with Rosa Parks will be available at most public libraries. “Rosa” is on page 83. Permission to reprint the poem here is being sought.)

Nonfiction: Finally we come to those books more generally thought of when we think of the nonfiction collection. Numerous titles, at various reading levels, are available in public libraries’ nonfiction collections offering biographies of Rosa Parks or discussions of the Montgomery Bus Boycott ; others describe the larger context of the Civil Rights Movement. A few examples include The Montgomery Bus Boycott: Integrating Public Buses (Rosen, 2004), written by Jake Miller. Part of the Rosen Publishing Group’s series “The Library of the Civil Rights Movement,” this book, written at an intermediate new reader level, introduces us to other people important to the movement, including Jo Ann Robinson, a professor at a black college in Montgomery who had conceived of the idea of a bus boycott to protest segregation in public transportation, but had been waiting for the right moment to promote her idea. It examines the effect the year-long boycott had on the black people who refused to ride the bus and on the economy of the city of Montgomery. An even more detailed account, written at an advanced new reader level, is Russell Freedman’s Freedom Walkers: The Story of the Montgomery Bus Boycott (Holiday House, 2006). Finally, Diane McWhorter’s A Dream of Freedom: The Civil Rights Movement from 1954 to 1968 (Scholastic, 2004), (also written at the advanced new reader level, discusses the bus boycott as one of several significant events that ended the culture and practice of segregation throughout the south, and the country, during two turbulent decades.

These and other books present many opportunities for integrating the exploration and discussion of interesting content into the curriculum of a literacy program. For example, consider asking students to:

• Compare facts in various biographies of Rosa Parks with Giovanni’s picture book Rosa.

• Create a “glossary” of terms related to civil rights issues

• Look through several books on the bus boycott to find some of the same photographs, then discuss any differences in the captions describing those photographs

• Discuss the impact of actual photographs versus drawings and illustrations

• Find information, in books or perhaps through the Internet, on other people mentioned in discussions of the wider movement

• With help from a local librarian, find examples of poems written about the people, events, and consequences of the Civil Rights Movement. (Two possible titles include Langston Hughes’ collection The Panther and the Lash (Knopf, 1967) and Arnold Adoff’s anthology I Am the Darker Brother (Simon & Schuster, 1997).