January 2018 - Health Literacy Lab

Why am I taking the time to write this blog? Is it…

a) I’m putting off working on an academic article that was rejected by an international health journal this week.

b) I haven’t posted in a while and my students get a kick when I do.

c) Recent women’s discourse has reminded me that abuse is never acceptable.

d) I have chilling feeling that what people have been saying about how the rest of the world sees US, post election 2017, is really true!!!

You guessed it. A little of all of the above.

Let me set the stage – briefly.

A while back I submitted one of my research studies to an international health journal of some repute. In the little bitty corner of the academic world I’ve worked in for 40+ yrs. – health communication work – my reputation is not too shabby.

This week, as has happened many times before, I and my co-author both received an email from the journal’s Editor in Chief notifying us that our article was not going to be accepted. Nice enough as rejections go. After all these years the prick of rejection is dulled. The instantaneous urge to go eat a box of Chips Ahoy cookies remains.

My co-author and I assumed the reviewers’ comments would be sent along shortly.

Neither of us realized that – and this is VERY CRITICAL TO MY STORY – the reviewers’ comments were included at the bottom of the rejection email letter. You had to scroll down. ( No instructions to do so.) But sure enough, there they were, plain as the nose on your face.

But – and again CRITICAL INFO– because I couldn’t find the reviews I sent the following short email to the Editor.

( and this is where my story really begins)

Chris’ email query:

Chris: Thank you for the response. May I ask whether the article ever went out for review?

Editor in Chief’s response to above query:

Editor: Dear Christina,

I am a bit miffed by your query – the comments of two reviewers and our Associate Editor are included in our decision. Would you suggest we invent reviews in our office?

Chris (apologizes for something she’s done though she’s not sure what):

Chris: I’m sorry that my email was misinterpreted. I haven’t seen the reviews and don’t know how to access them.

And a few minutes later, wanting to make sure I make it clear that I really don’t know where the reviewers’ comments can be found:

I did not mean any offense. I don’t know where to go to access the reviews.
Sorry for not being clear and more diplomatic.

About an hour later: – (me gathering a little moxie)

Chris: Actually, I re-read my email to you – it was a rather polite question – I was seeking information. I now realize I failed to scroll down to see the reviews were in your email – (a custom I am not familiar with).
I think your response to my initial query was snide, unprofessional and completely uncalled for.

Editor Responds One Last Time (the cute de grâce)

Editor:

Dear Christina,

We may live by different standards of politeness. In my world a letter, even an email, starts with a kind, even friendly, salutation. Similarly, it ends with a gentle expression of sincerity, e.g., ‘yours truly’.

Maybe the Trumpian era has shifted your bearings?

The insinuation that we would have rejected your paper without properly reviewing it was – in particular considering your stature in the field – sufficient reason for a terse response. If this has offended you, so be it.

Yours,

…

“Yours”!!!! Is she kidding?

So, what can I make of this?

I’ll usually give people a pass – at least once. She goes off on me – well any number of things can be in play:

Bad hair day

Bad day generally

Sore feet from Women’s March

World hunger

Personality disorder

But Trump!!!

Has it really come to this? That even someone on the other side of the globe is now so revolted by Trump’s crassness, arrogance and stupidity that her perceptions and judgments of Americans is so contaminated that she can only read mal-intent into anything I say.

Unlike some who have tired of the incessant political and social critiques, I still read the paper, listen to Rachel Maddow every night and expose myself to Trump’s nonsense in tweet alerts that plague my days.

But being scolded, bullied, because of my imaginary links to Trump – this one got to me.

On Jan 15 Aaron E Carroll (NYT, Section, The Upshot) wrote a good article about why the public should get vaccinated against flu – Still Not Convinced You Need a Flu Shot? First, It’s Not All About You.

While urging the public to do so is a perenniel pursuit, Carroll focuses on the role of herd immunity.

Photo & captions from NYT article

I quote the author here –

“If you fall into one of the lower-risk groups (i.e., adults age 18-50), you might still think that the flu isn’t such a big deal, and that you don’t need to worry much. I could argue that there’s evidence that even if the shot doesn’t prevent you from getting the flu, it could make your illness less severe. But even this misses a huge point. You don’t get immunized just to protect yourself. You also get immunized to protect those who can’t protect themselves.”(my bolding)

Carroll makes his point further by citing statistics of childhood deaths from chickenpox between 2004 – 2007. No children died of chickenpox during these years (US), even though young children are not given the vaccine.

Carroll explains –

“But, their older siblings were – thus protecting them from getting sick…and perhaps dying. “That achieved the herd immunity necessary to slow or prevent the rates of infection significantly.”

For many years I’ve thought about health and science concepts such as herd immunity and tracked if and how they are embedded into health messages for patients and the public. In short, I don’t see this important concept foregrounded enough.

I’d like to introduce the way my co-authors and I talk about the aspect of health literacy related to seeing oneself as part of and a contributor to the larger group’s health and well being ( Christina Zarcadoolas, PhD., Andrew Pleasant PhD., & Dr. David S Greer, ) in Advancing Health Literacy: A Framework for Understanding and Action, Jossey Bass

In that book we defined a component of health literacy we call CIVIC LITERACY.

In part, “Civic literacy includes understanding how to act with the collective good in mind (Gaventa, 1993; Kawachi & Berkman, 1998).”

“When a person has both a sense of individual and collective identity they are better prepared to consider and coordinate personal and collective interests. Civic literacy comprises a range of understandings including:
• Judging the sources of information
• Judging the quality of information
• Knowing where and how to access information
• Knowing how to advocate for yourself and others
• Understanding the relationship between your actions and the larger social group

I continue to believe that health education/outreach, health messages and campaigns can be strengthened by integrating the role that civic literacy plays. Using more positive framing than negative/punitive, health messaging can use dual benefit strategies – (“Take the Stair: Burn Calories + Save Energy ). It’s equally important to not assume that people “get it.”
Real world example – take the stair signs. They’re fairly ubiquitous in NYC building now. When they first started to be displayed about 5 years ago, in my best non-intrusive ethnography fashion, I’d simply ask people about the signs as we stood at the elevator. I can’t tell you how many people grumbled, “I don’t think taking the stairs is gonna save me any energy.”
Advice: You have to make sure you explain the dual benefits effectively.

Messages implicating the consumer’s responsibility to consider and protect the health of others can strengthen campaigns ranging from second-hand smoke, and handwashing in hospitals, to disaster evacuation directives and, of course, flu vaccination. Creating patient/consumer messaging that taps into and advances a person’s civic health literacy would be a very good thing.

Carroll’s phrase – It’s Not All About You – would be a perfect start.

Bleak future for US Academics in Trump Era?

Month: January 2018

Bleak future for US Academics in Trump Era?

Herd Immunity and Other Civics Lessons