Literacies

Hey you, WHO, CDC, OECD: go stuff your endless texts!

There are many kinds of literacy. One that we all recognize is the ability to read and write in a native language. The average adult literacy, of that kind, in the United States, is utterly abysmal.

So bad, in fact, that health information should be written at no higher than an eighth-grade reading level (13-14 years old). That’s according to the American Medical Association, the National Institutes of Health, and the Centers for Disease Control and Prevention, as reported by Wylie Communications.

You might say: it is what it is, we do the best we can. But publishing health information, at the level of younger adolescents, is bound to reinforce health inequities. The reason for that? Even when information is dumbed-down thus, about half of all adults still won’t understand it. Not because they’re morons, of course, but because they lack reading skills.

This is a problem for anybody who produces health information, health education, or health promotion. Those are three pillars of self-determination, for controlling and improving health. They are meant to empower people. Problem is, most of what gets published under those headings is text. It must be read rather than watched, heard or experienced.

Ergo: no read, no learn; no learn, no improve.

There’s an additional problem for those who have proficient reading skills. Shown text that is written for juvenile eyes, they are more than likely to be bored. People tend to check out when boredom occurs. They don’t pay attention. They don’t engage. They don’t learn.

If we add the 50% of the adult population, who can’t understand the basic text of health information, with the 15% of the adult population that gets bored reading Golden Books, that leaves only 35% in the crosshairs of epitomic health information, health education and health promotion. No wonder the pillars are wobbly!

(Literate persons reading this may have noticed that health care is not listed as a pillar — for obvious reasons, to anybody who has received health care on a regular basis. It doesn’t empower through self-determination. Just the opposite, with rare exceptions. For better or worse, usually for worse, health care is a system of command and control.

However, I digress.)

The ability to read and write is a foundational literacy. It must be present in order for other literacies to flourish. Two others that are particularly important to Humaginarium are health literacy and scientific literacy.

According to the World Health Organization (WHO), health literacy is the ability of individuals to access, understand and use information in ways which promote and maintain good health.

According to the Organisation for Economic Co-operation and Development (OECD), scientific literacy is the ability of individuals to engage with science-related issues (including medicine), and with the ideas of science.

Each of these definitions, in their contexts, requires proficient foundational literacy to understand. The language is tortured. But for me they refer, somewhat allusively but inevitably, to reading skills: in one case, reading the rhetoric of medicine, in the other, reading the rhetoric of science.

Professionals spend decades in school and training, acquiring health or scientific literacy. And the 85% of adults in the United States, who have less than proficient reading skills? They don’t have a clue or a chance. They are sitting quietly, in the last row, waiting for the bell to ring.

That’s a problem that feels like an opportunity, at least to me.

Humaginarium has an opportunity to solve that problem. After noticing that the literatures of health information, health education and health promotion are banal and ridiculous for adults who are not morons (i.e. almost everybody), we cut a new path to empowerment. We obviously can’t develop the reading skills of folks with chronic illness, so instead we made reading optional. In fact, we made reading unnecessary. To be clear, people who come to our brand read nothing.

Instead of reading, they do what comes more naturally, no matter what level or kind of literacy they have attained. They get to:

  • Look at beautiful pictures
  • Play with amusing things
  • Crush thorny brain-teasers

In other words, they play video games. Our novel video games are health promotion in disguise.

Nobody will recognize the health promotion, because there’s no command-and-control text on the screen telling them what to think or do. Instead there are persuasive voices asking them to explore and act according to their own self-interest, their intimate wants and desires.

And for what? To win the game. To control the illness. To increase their share of well-being.

So hey, you, WHO, CDC, OECD: go stuff your scrolling pages of text already! Read my lips. The work needs to be about much more than information. It needs to be about empowerment!

Nurse Nancy, a Little Golden Book, now available from Amazon, and others since the 1950s

Scientific

What one observes and what one imagines are mutually reinforcing.

Last week I poured a dollop of health literacy and a gobbet of health acumen into a shaker, and shook. Shaken thus (not stirred), they yield a heady cocktail known as self-determination. Why does that matter? Because the self is the most instrumental determinant of health outcomes. Literacy and acumen each by itself informs and weighs; together they empower.

I always call this cocktail “scientific entertainment,” an oxymoron that evokes what Humaginarium is about. We know what entertainment is: it is art; it is artifice that tells the truth and gives pleasure; it is amusement, enjoyment, fun that replaces what actually is with what might or should be in a world of our own making. Everybody knows what entertainment is because everybody needs it, wants it, pays for and uses it; goes out of their way to get it and feels anxious or frustrated when they don’t get enough. But what about scientific? Most of us use that word without knowing (or maybe even caring) what it means.

Science is knowledge; or more precisely systematized knowledge; or more precisely still, systematized knowledge that results from observation and investigation, and that is consistent with evidence. That last bit is the main difference between science and art. Both generate knowledge, but science is empirical while art is philosophical. No big deal. Many people believe that one is more valuable, practical, truthful, influential than the other, but they are wrong. Not only are science and art equal in importance, but each is incomplete and hobbled without the other. Art and science together are another heady cocktail whose parts may also be enjoyed separately, but why on earth would you?

The usual answer is, because science is hard whereas art is easy. Science is technical whereas art is creative. Science is boring whereas art is exciting. Scientific insight resists and eludes discovery and application, whereas artistic insight just lies there waiting to be apprehended, and is useless. All of these contradistinctions are drivel: they just aren’t true. Yet we organize many civilized endeavors, including health promotion, according to our beliefs in them.

I say “scientific entertainment” to prevent the two concepts from coming apart at Humaginarium. My oxymoron is a frank declaration that empiricism and philosophy are not, or should not be, distinguishable. I push this to the farthest extreme by dovetailing the most erudite of all sciences (biomedicine) with the silliest of all arts (fantasy). For Humaginarium, when it comes to health and well-being, what one observes and what one imagines are mutually reinforcing. Always! I am, therefore I think; I think, therefore I am. (Descartes got it half right.)

You will not find health acumen mentioned by the World Health Organization or the Centers for Disease Control and Prevention in their campaigns of health promotion. Only health literacy. The reason for that is probably because literacy is scientific; acumen is fluff. Consequently, because of this scientific bias, their institutional essays on health literacy are generally unsatisfactory, futile, trivial, beside the point. Humaginarium hopes to improve the balance.

Nor will you find WHO and CDC tipping their hats to the arts as they bow to science, except on very rare occasions. Artists have no seats at the table of health promotion; all of the permanent seats are occupied by scientists and clinicians. Is that right and proper? No, it isn’t; it is disastrous. At Humaginarium we hope to do something about that as well.

Our hopes are not effusions of a company that has a dissociative identity disorder. Humaginarium is not trying to meld things that don’t belong together. We are not trying to be clever by getting funky with subject matter that is essentially technical. We are merely doing what needs to be done to break the cognitive chains that hold down the 98% whom I mentioned last week. Science can’t do it alone.

Or to put it a different way, we are making a heady new cocktail that is greater — far greater — than the sum of its parts. Shaken thus (not stirred).