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July 2013

Last modified 2013-07-22 08:27

Colleague Spotlight: The Work and Wisdom of Dr. Billie Lindsey – A Reflection on Her Career and Three Final Lessons as She Ventures into Retirement
By Katie Meehan

dr. billie lindsey

I am a new health educator in the Health Promotion Practice and Policy Section at the Washington State Department of Health, and I feel honored to write July’s colleague spotlight on one of my first mentors, Dr. Billie Lindsey. Dr. Lindsey is Associate Professor Emerita for the Community Health Program at Western Washington University (WWU). Interviewing Dr. Lindsey gave me the opportunity to learn a lot that I don’t remember learning in the classroom. For example, she raised cattle on a 3200 acre ranch in northern New Mexico after graduating from college and she lived in nine different states throughout her life.

Dr. Lindsey spent her early career as a public school teacher. It was after graduate school that her career in health promotion and wellness really took off. Following graduation from the University of Northern Colorado, she went on to develop wellness programs for four major universities: the University of Iowa, Arizona State University, the University of New Mexico, and Columbia University. In 1993, with her team at Columbia University, she created the Go Ask Alice! health question and answer Internet site. Go Ask Alice! is the first program of its kind on the Internet. It continues to reach people around the world today.

After 14 years in student affairs, Dr. Lindsey transitioned back to teaching—first at Lynchburg College in Virginia, and then at WWU. She met Dr. Evelyn Ames, who developed WWU’s Community Health Program, at a Society for Public Health Education (SOPHE) conference in Atlanta. Dr. Ames told her about an opening with the program and encouraged her to apply. Dr. Lindsey was hired and started working at WWU in the summer of 2002. After one year at WWU, Dr. Lindsey took over Dr. Ames’ role as the Community Health Program coordinator.

The Community Health Program has evolved quite substantially under Dr. Lindsey’s tenure. She expanded the curriculum to include courses in social marketing, public health, epidemiology and biostatistics, program evaluation and research design, and the organization and administration of health programs. She hired two new professors, maintained selective admissions to keep class sizes small, and spearheaded the effort to get the Community Health Program accredited. In 2011, WWU’s Community Health Program became one of 20 undergraduate programs nationwide to receive SOPHE-American Association for Health Education (AAHE) Baccalaureate Program Approval.

At the end of the summer, Dr. Lindsey will wrap up an amazing career and retire. She plans to return to New Mexico—the place she calls home. There is much that awaits her in the Southwest: sunshine, tennis, golf, old friends, and a lot of green chile. As we send her off with best wishes for her next adventures in life, I leave you with three final Dr. Lindsey lessons.

In her words:

  1. Remember that “Everything is related. Employ a holistic, ecological approach to health and social problems and respect the wisdom of the community.”
  2. “Always ask why before how.  There are multiple determinants of health and social problems and we need to understand the importance and the probability we have of changing each factor as we plan our strategies and interventions. We can’t always directly affect the causes of the causes.  Be humble. Make mistakes. Remember that you are part of the process of change and don’t get discouraged if you don’t see immediate results.”
  3. “Know what brings happiness to your life. Make your list of 20 things you love to do and make sure you engage in those activities regularly.  Don’t be afraid to change your life situation.  Spend time with nature. Take good care of yourself, each other, the animals, and our beautiful planet.”


The State of America’s Health

The Robert Wood Johnson Foundation released a new report that profiles the state of America’s health and the inequities within it. The report:

  • Compares and graphs health outcomes of different groups based on factors like:
          -Race and ethnicity
  • Explains how the following social factors affect health:
          -Race and ethnicity
          -Childhood experiences
  • Discusses promising areas for America’s health. It most notably recommends policies to promote:
          -Child and youth development and education from infancy through college.
          -Economic development, reduce poverty, and reduce segregation.
          -Healthier homes, neighborhoods, schools, and workplaces.

Read the full report or report summary of Overcoming Obstacles to Health in 2013 and Beyond.

For similar information, visit the H.E.R.E. Health Equity, Cultural Competency, and Social Determinants of Health page.


Lessons Learned from My Trip to the 12th Annual Health Literacy Conference
By Brandon Prall

Two months ago I was fortunate to attend the 12th Annual Health Literacy Conference, hosted by the Institute for Healthcare Advancement. It was one of the most insightful and practical trainings I have been to. Plenary and breakout sessions offered a wide variety of applicable information for people in healthcare and public health. Sessions I went to described low literate readers and the problem of low health literacy, how to write for low literate audiences, typical problems with messaging, conveying risk meaningfully, designing health information, and gave the perspective and advice of people with low health literacy skills.

While some of what was covered was a pleasant and welcome review, certain parts stood out to me.

  • Health literacy is the strongest predictor of a person’s health status. More so than education level, race, income, age, etc.
  • The prevalence of the problem – 88 percent of adults have a hard time using health information commonly available in healthcare facilities, media, and communities.
  • When audience testing messages or talking to a patient, use the teach back method to asses understanding. Ask what they would tell their friend about the topic you’re communicating. See if they are able to repeat the main message(s) you want them to take away.
  • We should aim to write at a 4th to 5th grade reading level when communicating to the public.
  • Avoid conveying risk as a percentage, fraction, bar graph, or pie chart. Using a pictograph or icon array is a visual way for low literacy readers to understand easier. Or simply convey it by saying low risk, medium risk, and high risk.
  • Use the inverted pyramid to structure messaging in a document. The main message(s) should be in the first few sentences at the top, supporting information in the middle, and background information should come last. This is because low literate readers tend to read the top of a document and trail off more and more as they proceed.
  • Conveying messages through health information design is crucial for people with low health literacy because they prefer not to read. Use white space, sans serif fonts, bold headings, bulleted lists, icons to call out important text, images that convey the main message(s), and use conceptual cues like the colors of a stoplight to indicate what is safe and what is not.

For highlights on each session for all days of the conference, visit a recap of day 1, day 2, and day 3.

For more information or sources for these statistics, please contact Brandon Prall at 360-236-3796 or


2012 National Healthcare Disparities Report

The Agency for Healthcare Research and Quality (AHRQ) released the 2012 National Healthcare Disparities Report in May. This annual report looks deeply into our progress, prevailing disparities, and areas of urgent focus. The report found we most urgently need to focus on:

  • Diabetes care.
  • Maternal and child health-care.
  • Adverse events.
  • Cancer care.
  • Quality of care in Southern states.

For more information, see the full report at:


National Action Plan to Improve Health Literacy

Health literacy is the ability for someone to access, understand, evaluate, and use health information. Studies show that 88 percent of adults have difficulty using everyday health information that is commonly available in healthcare facilities, retail outlets, media, and communities. In other words—we have not communicated very clearly. Low health literacy is connected with:

  • Poor health outcomes.
  • Poor ability to manage chronic disease.
  • Less screening/preventive care.
  • More hospital visits and return visits.
  • 106-238 billion dollars in unnecessary health-care costs.

The Department of Health and Human Services created a National Action Plan to Improve Health Literacy in 2010 to help address this public health problem.  The report talks about the problem of low health literacy, lists seven goals that will improve health literacy, and offers partner-specific strategies to achieve the goals. Organizations can use the action plan as a framework, adapt goals and strategies to their situation, and decide on specific actions to take.

This plan is meant for policymakers and health professionals working in public health and health care. It is based on the 2006 Surgeon General’s Workshop on Improving Health Literacy, a series of town hall meetings in 2007 and 2008, and feedback from stakeholders in 2009.

Visit H.E.R.E.’s Health Literacy section for more resources on this topic.


Improving Patient-Centered Care Through Health Literacy

An Institute of Medicine Roundtable on Health Literacy published a paper that explains 10 health literacy attributes healthcare organizations can embrace to improve patient-centered care. Tailoring these concepts to each organization can make it easier for patients to navigate, understand, and use the health information and services we provide.

The report explains the rationale behind each attribute and lists actions you can take for each. This guidance is meant mainly for professionals and leadership in organizations that directly provide healthcare—hospitals, community health centers, clinics, pharmacies, and others. 

The paper 10 Attributes of a Health Literate Health Care Origination is available as a full report and a report summary. Review how some of the recommendations may apply to your organization. Email the report to your colleagues working in healthcare in case they are not aware of it. 

Visit the Material Development and Social Marking parts of H.E.R.E. for information on the patient-centered processes of tailoring messages.


What You Need to Know About Culturally and Linguistically Appropriate Services (CLAS)

Q: What are the CLAS standards?
The CLAS standards are a blueprint to ensure that all people, regardless of where them come from and the language they speak, can participate in and receive our services. The CLAS standards act as a guide to help health organizations become more culturally competent.

Q: Who published the CLAS standards?
A: The Office of Minority Health (OMH) first published the National Standards in 2000. After reflecting on a decade of work, they published the enhanced standards in April of this year.

Q: Where did the idea of CLAS come from?
A: The Civil Rights Act (CRA) of 1964 first introduced the legal basis for such an approach. The CRA is backed up by a Presidential Order which requires all organizations that receive federal funding to make sure their programs are accessible to people with limited English proficiency.

Q: Why is it important to consider culture and language in public health work?
A: In doing so, we help ensure civil rights, advance health equity, improve the quality of programs, and eliminate health disparities.

Q: What resources are available to my organization?
A: OMH has resources to help organizations become more culturally competent. Visit their website for more information and implementation strategies at:


How to Write for Your Audience

Public health professionals may sometimes worry that if they use Plain Talk or Plain Language, they won’t be able to convey the message they intend. The Federal Plain Language Guidelines can help you find that balance between meeting Plain Talk Standards and conveying your message in an accurate and appealing way.

The first rule is to write for your audience. Using language that your audience is comfortable with will help ensure that your message is well received and understood. The Federal Language Guidelines recommend you answer these questions to help you:

  • Who is your audience?
  • What do they already know about the subject?
  • What do they need to know?
  • What questions will they have?
  • What is the best outcome for your agency? What do you need to say to get this outcome?
  • What is the best outcome for your audience? What do you need to say to get this outcome?

Once you have a clear grasp on your audience, the guidelines can help you organize and write your document so it is clear and concise. Start with the most important information first and follow some of these pointers.




Singular language and pronouns like “you” and “we.”

Plural language.

Headings to organize and structure the document.

Headings that are longer than the content.

Lists and tables to present information.

Long sections or paragraphs.

Bold and italics to get the reader’s attention.

Underlining or capitalizing to emphasize a point.

Active voice.

Passive voice.

“Must” to indicate requirements.

Using “shall.”

Nicknames (Example: The Oral Health Committee = the committee).


 For more in depth information including how to write for the Web and test usability, see the full report at:


Material Spotlight: Feeding Babies Under 1 Year Old

The Department of Health has revised and updated one of the most downloaded materials on H.E.R.E. Don’t Feed These Foods to Babies Under 1 Year Old is now titled Feeding Babies Under 1 Year Old. This revised poster focuses on:

  • Feeding breast milk, or formula with iron if breast milk isn't available.
  • How to bottle feed.
  • Hunger and fullness cues.
  • What solid food to introduce and when.
  • Foods and other things to avoid.

The new poster is primarily meant for people working in childcare, foster and group care, and other places where small children are cared for. The poster was audience tested with childcare workers at various centers.

It is available to download and print in English and Spanish. The poster is available in two sizes. There is an 8.5x11 and an 11x17 version. Share the poster with childcare centers in your community.

This poster also has a newly updated companion poster titled Prevent Choking in Toddlers.

For more information about these posters, contact: Lowest Jefferson at


Top 10 Downloaded Materials on the Health Education Resource Exchange (H.E.R.E.)

 1. Living with MRSA 5,038
 2. Feeding Your 3 to 5 Year Old2,775
 3. Nutrition Interventions for Children with Special Health Care Needs 2,240
 4. Tooth Tutor 1,867
 5. Feeding Your Baby 6 to 12 Months 1,167
 6. Autism Guidebook for Washington State892
 7. Feeding Your 1 to 2 Year Old 800
 8. Washington State School-based Sealant and Fluoride Varnish Program Guidelines 646
 9. Prescribing Pain Medication in the Urgent Care Clinic 501
 10. Bug Bombs: Overkill Can Be Dangerous 469


New Upcoming Trainings

Below are upcoming events that have been added to the H.E.R.E. website since the last newsletter was released. Visit the Training & Events page to view more trainings by month, as well as free online trainings that are available. To promote your own health education or health promotion related training, visit the new Submit a Training page.

Nominate a Colleague to Spotlight in the Newsletter

Do you know someone who has made an impact in public health? Nominate them for the Colleague Spotlight article.