More on the US

I want to write about Baltimore though I was there more than two weeks ago now. And there lies the problem with such a whirlwind adventure, it can move way too quickly and the complex pieces fall into place a little too slowly. Now I find myself in London still deeply reflecting on my time in the US and next week I'll be in Amsterdam probably thinking about London and so it goes. The US left me gasping for breath. There, health literacy can be a calling more than a concept. Dean Schillnger at the IHA conference said something to the effect that the health literacy movement are the people who are driven to change the inverse care law - where healthcare is inversely proportional to healthcare need. He then quoted Jerry Garcia (remember, The Grateful Dead?) who said "somebody has to do something and it's just incredibly pathetic that it has to be us". Because who are we in the US? We are a handful of renegade doctors and researchers, some fabulous health and education academics and a whole lot of driven and passionate nurses, librarians, adult education practitioners - people who have "community" running in their veins. And yet health literacy doesn't have a development framework in the US, well not in practice at least. Academics like Christina Zarcadoolis are definitely about engagement and Rima Rudd's work is about understanding the consumer experience but generally the notion of engagement is still relatively foreign amongst the people working in the field. The passion is focused on what we can do to help you rather than on how can we work collaboratively to decrease this communication chasm.

Having said that, in the US there is lots being done. No pussy footing in this country, there is clearly a problem and the chosen are building their networks and spreading the word of ask-me3 and teachback (two very decent tools to improve communication in practice). The academics seem to be doing a fine job of infiltrating practice, of communicating the research and the science in edible bites that can be replicated throughout the country.

Finally, if the healthcare system in the US is underpinned by an inverse care law (not likely to change any time soon) there are policy gestures like the National action plan for health literacy which the chosen few will adopt, implement and create a rumbling change from the ground up.

I really will write about Baltimore and then I shall move my reflective space to London which is where my head needs to be now.