summer vacation 3rd grade workbook

>> from the library ofcongress in washington, dc. >> john cole: well,good morning everyone. good morning and welcometo the library of congress for the first timefor several of you. and welcome back to those of youwho are able to join us last night. i'm john cole. i'm the director of the centerfor the book in the library of congress an organization wascreated by dr. daniel boorstin back in 1977 to reach out on behalfof the library of congress

to promote books and readingand to promote the study and encourage the studyof books and reading. to that menu since 1977,we've added literacy which was not discussedmuch in 1977. another major topic thatwhere there's difference but similarity was thethreat in 1977 of technology. everyone was worried but thetechnology we were worried about was television and dr.boorstin created the center, in part, i learned afteraccepting his offer

to become the founding director. he had an idea and that was tostart using commercial television to promote books and reading. and we were able todo that through-- for 10 years through a project with cbs televisioncalled read more about it. and we put those fromreading messages at the ends of major cbs programs andstart with the programs. and if you enjoyed the program,

the library of congress suggeststhese books and we have books that came across the screen that themessage was go to your local library or bookstore, not thelibrary of congress. go to your library orbookstore, they will be happy to help you read more about it. and from that grew one of ourreading promotion networks with not only televisionand technology involved. but booksellers and librariansand gradually we are center for the book will have its 40thanniversary next year in 2017.

but the project that brings ustogether is a special project that came to the center for thebook through david rubenstein, a philanthropist who's doingsome many wonderful things for our country but in washington, dc in terms of helpingsupport government institutions that have a relationship to americanhistory, largely and that appeal to mr. rubenstein interms of his interest. and we did not know when mr.rubenstein first started giving help to the national book festivalwhich is another major center

for the book endeavor,now in its 16th year that mr. rubenstein hadthis interest in literacy. and that came a littlelater and he is the one who initiated this projectand he's funding it. and i'm so pleased to haveyou here and to be able to explain a little bit about theframework that's brought us here. we have aboard, theliteracy of advisory board to help us during the 5-yearpilot grant from mr. rubenstein. and he has encouraged us to thinkabout the future in the hopes

that this will be extended andmaybe developed in a permanent way that might be endowed, but thatthe first 5 years would be almost a period of experimentation in tryingto embrace awareness of the problem of literacy and by doing awardwork but also by symposium and by other means that are kind ofgeneric to this center for the book. we also have affiliatesin every state. so everyone of your states has apartner with us to promote books, reading, literacy, andlibraries in the state. so, this is the secondsymposium held by the literacy--

advisory of our literacyprogram and we're so proud to have nemours asa partner in this. the first symposium was literacy andpoetry and we learned about a number of organizations in poetry thathave common interest with us and have been able to bring severalof them into our network of reading and literacy promotion partnersand laura bailet from nemours is on our board and she was someone who when we had our firstboard meeting was talking about what we're talkingabout today.

how important literacy is to healthand in many ways, and this was news to other members of the board,and we immediately put this on the agenda for a future symposiumand we're here today and i thank you for your participationand i will, i'm afraid, tell you a little bit more about theoverall endeavor as we move ahead. but now, i am going to moveahead and follow our program. we-- i would like tointroduce, however, a special guest dr. louissullivan who has joined us today. he was unable to join us yesterday.

i met dr. sullivan for thefirst time just a few weeks ago when we had him as aspeaker about his new book at the library of congress,his memoir. and he pointed out and istand up straight when he said so that the georgiacenter for the book has-- was featuring his book on hiswebsite as part of their program of putting up on the websitebooks every georgian should read. and this is a rotatinglist of course. but nonetheless, it still isheadlined by dr. sullivan's memoir.

he was the secretary of health and human services during theadministration of george h. w. bush and is the chairman of the boar of the national healthmuseum in atlanta and what? he talked about a lot wasbeing the first president of the more house schoolof medicine. he also is the head ofthe deep washington, dc based sullivan alliance to transform america'shealth professionals

and he's going to bewith us all day. i'd like him just to standand be acknowledged please. [ applause ] last night, we had a wonderfulkeynote address by dr. david bailey and i know that a number ofyou were not able to join us. but we're very fortunatethat he is today going to be the introducerof the keynote today. but i just wanted to thank himpublicly for getting us off to such a good start becausehis talk, no surprise,

really was a wonderfulkeynote that focused on how and why reading proficiencyand literacy are such strong indicators of-- actuallyof overall health through adulthood and that is what we're tryingto bring together as we do in these symposia are fieldsand learn about other fields from the perspective of literacy to see how we not onlyconform new alliances. but perhaps look ahead togetherfor new ways of solving some of the problems thatwe were faced with.

and last night, dr. baileynicely lined up the alignments of various worlds that we occupyand literacy and in education and in health and pointed to thisis an opportunity for us to think about coming together in ways thatwould affect policy and to try to keep the broadest possibleperspective on this on behalf of our society rather than what weall tend to do and we're all guilty of this is spending so much timeon our specialties and trying to prove ourselves andprove our organizations that we often forgetthe broader picture.

so this is an attempt to talk aboutand learn about and do something about the broader picture. dr. bailey is the presidentof nemours foundation, which he became president in 2006. he is leading light and we-- the whole world of health with manyhonors and for those i know a few of my friends are heretoday who don't know about nemours is an integratedchildren's health system with two hospitals in thedelaware valley in florida

and it serves children fromacross the united states and internationally. nemours also operates 45 primary,specialty and urgent care clinics in 4 states and is responsiblefor the website kids health, which we have all learnedabout through laura in our work on the literacy advisory board. and i am very pleased topresent dr. david bailey who is the distinguishedintroducer of a-- our distinguished keynoterfor the morning.

david bailey. >> david bailey: well, good morning. i am dave bailey. and i would just like to add mywelcome to dr. cole's to this summit on literacy, health,and new perspectives. you know, the library ofcongress staff, dr. cole, have been extraordinarilykind and accommodating. they arranged the great weather. the only thing they forgot wasto get cherry blossoms blooming.

>> and the trains. >> the train-- yeah, thetrains are another thing. yeah, we're delightedthat you've all joined us for this i think very importantsymposium and the connections between literacy and health. in this morning, i really have thedistinct honor and personal pleasure to introduce our first speaker,keynote speaker, dr. sandra hassink. dr. hassink is a pediatrician'spediatrician. she is consummate physician

and she's what we knowas a triple threat. a superb clinician, a esteemedresearcher, and admired educator. and it's been my great fortune tobe able to associated with sandy over several years atthe nemours alfred i. dupont hospital for children. dr. hassink is theimmediate past president of the american academyof pediatrics. an organization composed of 64,000pediatricians and an organization that has an aggressive child healthpolicy agenda both nationally

sandy has testified for congress onchildhood obesity, food security, and hunger focusing on supportingthe foundations of child health. she has dedicated her entireprofessional career to caring and advocating for childrenwith obesity and is the director of the american academyof pediatrics institutes for healthy childhood weight. under her direction, the instituteis focused on translating research into practice for pediatrichealth care providers, families and children.

dr. hassink founded theweight management clinic at nemours alfred i. dupont hospital forchildren in 1988. she has lectured widely on thistopic and has published many books. among them, "a parent'sguide to childhood obesity", "pediatric obesity,prevention, intervention and treatment strategies for primarycare", and "the clinical guide to pediatric weight management". and if all of this weren'tenough, dr. hassink has served

on the institute of medicinescommittee on accelerating progress on obesity preventionand was an author on the expert recommendationsfor obesity. and probably a reason she's beenable to get through all of this and maintain such a calm exteriorand that she holds a master's of science in pastoralcare and counseling. please help me welcome dr. hassink. >> sandra hassink:so david, thank you. i wasn't sure exactlywho you were speaking

about for a moment, butthank you very much. so as dr. bailey said, i spent thisseveral years as president elect, president, now past presentof the academy speaking wildly around the countryand internationally, and speaking about thefoundations of child's health. and i love this quote by louispasteur that i think typifies how we as pediatricians and how we reallyfeel all of us about children. "when i approach a child heinspires in me two sentiments; tenderness for what he is, andrespect for what he may become."

and i think that holdsthe hopes of all of us that in the moment we canrespond to the needs of the child in that very moment that weall are encountering the child and their family. but we hold the hopes forthe future of that child. and we know without adoubt that what we do in this moment is significantfor that moment but significant for the child's futureand i hope to illustrate that as we move through this talk.

so i always start my talks byasking how are the children? how are the children doing? and you can look at thisthrough many lenses and i picked out a few things to look atjust nationally how we're doing. and you know this varieswidely state to state, but our diet quality only 50% of children are now meeting federalstandards, diet quality standards, 18% of our children have obesity,30% nationally have overweight and obesity, and 9% of ourchildren have activity limitations

from some other chronic condition. when we look at emotionaland behavioral health, we see the parents are reportingsignificant serious emotional and behavioral problemsin 5% of their children. and our adolescence, 8% of them, 12 to 17 have had a majordepressive episode in the last year. i think we need to justpause a moment on that one. 10% of our children have asthma and52% of our children, ages 3 to 4, are not enrolled inquality or any preschool.

and i think you'll see today howliteracy interweaves itself among all these childhood problems. and almost half of our children,0 to 6, lived 200% are below of the poverty level with11% of our children living under 50% for the poverty level. so, when we think about thefoundations of child health, i've been using a frameworkfrom the harvard center for the developing childbecause i want to be able to have a conversation aboutevery child in this country

and what every childin this country needs. because i think, as dr.bailey, so rightly pointed out that we often livein our silos and live-- and look at the world throughthe-- our own particular lenses. and i think we need to broadenthis conversation and now think about what every child needs. every child needs soundand appropriate nutrition. that means that if we combine foodand security, hunger, obesity, and overweight, 50% ofour children are suffering

from a nutritional hardship. every child needs stable responseof nurturing relationships at home, early childcare and education atschool and in their community. and every child needs safesupported physical, chemical, and built environments and you'llsee how literacy weaves itself through these foundationelements of child health. and so at this conversationin this country right now, should be about whatevery child needs and how we all together canbuild those foundations.

so the academy of pediatricshas it's strategic plan and about 10 years ago we renamedour strategic plan the agenda for children. and you'll see in this circlesome of our guiding principles, medical home, health equity, ourown profession of pediatrics. you'll see pillars, access,quality, and finance, which really mean theability of children to access health and health care. but those elements in the middlereally are a pivot for us.

so 10 years ago, you might have seenoral health, immunizations, tobacco, very important childhealth topics on this list. but what you see now areepigenetics, early brain and child development,poverty and child health. and we just released ourpoverty statement this month. we are now looking carefullyat the foundational elements that build health for children. and i think it's a very importantpivot for us to have taken. and it's out of our anxiety

that children are not receivingthese foundational elements that build good health. so our agenda now speaks to thesocioecologic framework of children because you build healtheverywhere for children. you build it in thehome with your families. you build it in the community. you build it with infrastructure. you build it with literacy. you build it all togetherfor children.

and so you can see thesocioecological model, just some elements that areimportant to child health and they really run thegamut from school nutrition which i've been speakingabout extensively this year to injury prevention, takingcare of the mother infant dyad, taking care of theintrauterine environment. you can see them there andhow it calls us to work in a cross-sectoral fashion. so, why are we speaking todayabout health and literacy?

well, we know as physicianslow health literacy-- low literacy is associatedwith low health literacy. and so, more than 90million us adults at least in 2003 lack the literacy needed to effectively negotiatethe health care system. so those of you who have highliteracy, know how difficult it is to negotiate the health care system. it can be sort of a laboringthing process of paper work and phone calls and appointments.

and if you have basic or only basicliteracy, you are significantly at risk for not being able toget the healthcare you need. and you can see that if you lookat below basic and basic literacy, basic literacy is searching a shortsimple text to find out what you as a patient might be allowedto drink before a medical test, signing a form, adding theamounts on the bank deposit slip, finding a pamphlet for jurors,using a tv guide to find out what's on the program, comparingticket prices. so if you don't have theseskills above basic skills,

you simply can't negotiatethe health care system with any efficacy. and then we write a lot of things in the health careprofession for patients. we write a lot of patient education. but you can see here the percentageof the population of each state that has below a 5th grade level ofliteracy, the darkest red is the 30% or greater, the orange is 20%to 30, 15 to 20 in the green, and 10 to 15 in the blue.

and you know that many patientscan't literally read the information that we're putting out. so i was in one of our clinics innorth wilmington and we were handing out an obesity paper that'ssaid 520, fruits and vegetables, exercise, juice, and tvhad very simple information and what was happening is wewere finding those pamphlets in the trash can inthe waiting room. people simply couldn't process that. and we had tried to be verycareful about the language we used.

so we decided then we have tomodel the behavior we wanted, but this is a huge handicapfor our adults and our adults or the parents of ouryoung children. so low literacy and relatedlow health literacy and parents of young children increasesdevelopmental risk because they can't access whatthey need to support their children and something very mundanein the health care system but incredibly important. they can't negotiate medicationdosing or adhering to routines

or goals or-- are preoppreparation or goal setting around the chronic illness. they can't adhere to that because they don't havethe health literacy skills. and then the perpetuation of thisreally perpetuates the cycles of poverty, poor health anddependency across the life course. so it's really important for us. adults with limited health literacy,and you'll hear this probably over and over today, havediminished diseased knowledge.

they don't use preventiveservices at the same rates. they have increasedhospitalizations, poor health status, poorcontrol of chronic illness, and you know we have an epidemicof chronic illness in this country. globally, we would call thisnoncommunicable disease, lifestyle-related diseases,and the ability to control chronic illnessis crucial to your ability to prevent early deathand severe morbidity and, of course, and mortality.

so reading a routine for aperson with type 2 diabetes and managing insulin dosing isactually quite a complex set of interactions that have tooccur and can occur in adults with limited health literacy. so in 2014, we put out a statementat the academy on literacy promotion and just highlight some ofthe things that you all know that greater than 1 and 3 uschildren start kindergarten without the language skillsneeded to learn to read. reading proficiency by third gradeis the most important predictor

of high school and career success. and 2/3 of children each year,80% of whom live in poverty fail to develop reading proficiencyby the end of third grade. saw a father in myoffice and he was-- actually was a grandfatherraising his grandson and his grandson wasn'tlearning to read in school and he had begged the school to holdhim back so he could learn to read. but the school had-- your ownpromotion criteria and were set on promoting the young man.

so i have the situation of agrandfather pleading with the school and pleading essentiallywith me for some help in helping his grandsonlearn to read because he knew if he got farther into schoolwithout learning to read that was a sentence for him and itwas a sentence about not being able to complete high school, notbeing able to get a good job, not being able to execute on thedreams the grandfather had for him. so, we talked about earlychildcare and education. this is the early learningunmet need in our country.

and you see the maps, the light pinkhere is a 0 to 25%, the dark is 76 to 100% and it's a map that looksa little different than some maps. so, when we look at thesemaps of the united states, the health disparities and thedisparities in accessing solutions to health problemsoften look the same. this looks a little differentbut we had a lot of 4-year-olds that don't have aboutpreschool education. and this is sort ofan interesting map about the change inpreschool enrollment.

so some preschool enrollmentshave gone down in the orange, some have gone up in the dark blue. we don't have a uniformapproach to this. so merely by being born inyour county, in your town, in your state really sets yourhealth trajectory for the rest of your life because thesedisparities are reproduced on every health measurethat we can find. so no one state is doingperfectly on everything but i think that that leads to oursaying that the zip code it--

maybe your most important healthindicator as a young child. so, where does literacy start? well, we look at young children. this is a slide courtesy of pamhigh from presentation to us at our national meeting thatlanguage environment of children at home is highly variableand really tracks with socioeconomic status often. so the vocabulary at age 3and the parent words per hour, you can see how that track.

so the ability to be ina high word environment or not will set your wordgap by kindergarten entry. so, there have been studiesthat show the kind of talk that happens in families. so some families talk alot to their children, some families talk very little. business talk gets things done. brush your teeth. sit at the table.

finish your vegetables. don't say i said that. but nonbusiness talk is sortof that chitchat, the mother or father leaning over the childand just having a conversation, talking about what'sin their environment, talking about a book for instance. business talk was constantacross families but it was this nonbusiness talk,this sort of relational talk that really made thedifference and you'll see here.

so the talk of the families hadmore praise than prohibitions. the more silent familiesmore prohibitions than praise because if you're doing a lot of task-oriented talk,that's what happens. at 3 years, the iq correlatedwith nonbusiness talk. and at third grade,the receptive language. so even very, very early on andthis is what makes early reading and early relational attentionto those early relationship is so important for our young children

because long before they canread your laying the groundwork for literacy and reading. so talkativeness predictediq and vocabulary. i want to talk a little bitabout literacy and poverty because as i told you,half of our child-- almost half of our children live200% or below the poverty level. children from low incomefamily have fewer words in early childhood knowfewer word by 3 years, have fewer literacyresources which--

within their home and you'll heara lot more about that less likely to be read regularly and more likely to experience early childhoodadversity and toxic stress and we'll talk about that. and these are our povertyrates in these countries. so this is the dark red arethe 20 to 30 percent of poverty and you can see courtesy of the2008 recession what has happened to child poverty in this country. and so children are sort ofthe first affected and the last

to be lifted out of poverty. so i want to talk alittle bit now about some of the science that's emerging aboutwhat happens in early childhood and the impact for laterhealth trajectories. and many of you are familiarwith vince felitti study on adverse childhood experiences. and dr. felitti was a physicianat kaiser permanente and study over 17,000 adults and many of whom had chronicillnesses including obesity

and he merely asked them whathappened to you as a child? so he asked them about abuse,emotional, physical and sexual, household dysfunction,mother treated violently, household mental illness, divorce,incarcerated household member, and later about emotionaland physical neglect. and in this study, these werethe percentages of adults who reported having experienced one of these adverse eventsin their childhood. and i would say ifyou'd look at this,

you would say this is pretty high. physical abuse, 29%. mother treated violently, 27%. this is pretty and isdisturbing in and of itself. but what happened when he lookedat their current health status, he realized that thecurrent health status of these adults hada graded relationship to the adverse experiencesthey experienced in childhood. so if you experience more of theseadverse events, you're more likely

to have chronic heart disease,cancer, chronic lung disease, skeletal fractures,and liver disease. if you experience moreadverse childhood events, you would have more risk factorsfor chronic disease, smoking, alcoholism, promiscuity,obesity, substance abuse. these aces, this adverse childhoodexperiences were associated with general health and socialfunctioning, poor general health and social functioning, poormental health, depression, sleep disturbance, anxiety,

poor anger control, andmemory disturbances. so this takes us rightback to where we started which was what's happening to thechild as a child immediately is so important and needsto be attended to. but what happens to that childimbeds itself in our biology and has lifelong health effects. so this was a study of amaternal report of aces at a 5-year followup study andthese were fragile families at risk. it was a fragile familyand child well-being study.

and these were mothers of childrenage 5 reporting maltreatment in their families. physical, sexual, psychologicalabuse and neglect and i think that you can look at this numbersand say that's really disturbing. how many of these childrenhad experienced this aces household dysfunction? and then, the childrenthat had no aces were 45%. but over half the childrenin this study had one or more adverse childhoodexperiences, 27%, 1; 2,

adverse childhood experiences16%; 3, 8%; 4, 3%; and 5 aces 1%. and so they connected theseadverse childhood experiences to their experiences with literacy. so children who had not yetor not began to understand and interpret a story or othertext that was read to them, if you had one adverse experience,you had a slightly higher odds ratio of not being able tounderstand and interpret a story. if you had 3 or more, youhad an odds ratio or 2.2. not yet or beginning to easily

and quickly name all upperand lower case letters. you can see that the trajectory, the trend for more acesless ability to do that. not yet or beginning to read simplebooks, you can see the trend. not yet or beginning todemonstrate understanding of some of the conventions of print. so, we know that literacy isinterwoven here with the experiences of childhood that caneither promote literacy, prevent literacy, interferewith literacy.

and we know that this is alsoaffecting children's brains. so the first years of lifehold the most critical periods for brain development. this is the classic slide thatshows the synapses you have at birth and then you develop a lot of themat 6 and then they're pruned by 14. and the pruning isreally the refinement of the circuitry of the brain. so-- and that refinementis experience-based. it doesn't happen thesame for every person.

based on your experiences, your brain is alteringyour synaptic connection and literally its anomaly. so, the regions of thebrain that are most affected by these toxic stress and adversechildhood experiences are the hippocampus, learning, memory,discrimination of danger and safety. the prefrontal cortex,impulse control. the amygdala, increasein impulsive behavior and that mediates fear and anxiety.

so these toxic experiences areshaping the children's brain development, shaping their exposureto protect the factors like literacy and the context from which thechild comes is so important. so part of what we're askingpediatricians now and all of us is to not just deal with thatimmediacy of what the situation is when the child walksinto your clinic, but ask what's happeningto that child? what's the context of the child? what's the state of family?

what's the state oftheir experiences? and we're trying tobuild resilience. and so the flip-side of thisis how do we build resilience in our children andyou'll hear later on this conference howliteracy is a promotion in children is a powerfulskill, tool, and pathway to buildresilience in children. it's powerful. it's something every parent can do.

and it involves buildingrelational support for the children. it actually i think and maybebob-- we don't know this, bob. but it forces-- i think itreduces stress in the adult to have these quietmoments with children. so i used to literallyprescribe time to my parents. so i was in clinic. we were trying to do a hard thing. we were trying to reallyshift lifestyles to promote a healthy weight.

and any of you who've trieddo that that is very hard. so i literally would prescribe 15to 20 minutes a day for the parent and they were not allowedto do tasks like you couldn't be 15 minuteson the homework or 15 minutes on, you know, what you'regoing to wear tomorrow, it had to be this engagement time. you could read. you can paint eachother's fingernails. you could hair and thechildren were delighted

and the parents wereoften astounded. first that i would askthat they spend this time and they started ask, well,how can i get that 15 minutes? and we figured that out andthen when they would come back, they were astounded becausewhat happened with that time was that they remembered thejoy of being a parent. they remembered how funit was to engage to child. the children of coursewere delighted because it was never a childi never met that didn't want

to spend more timewith their parent. and then-- so, i think thatthis building resilience is not rocket science. but it often feels likerocket science to families when they're trying to carveout this time, time to read, time to be with their children fromvery busy, highly stressful life and you add on those aces thatnot only are occurring now but the parents experience,you can see that this is-- that we need to be absolutelysupportive of our families here.

increase sensitivity to the child'sneeds and that relational time that time with the childincreases that sensitivity. and then when we spend the time toaddress the problem in its immediacy that the parents are having so we can become solutionoriented for the parents. so this is a handout thati would often give parents. and again, not rocket sciencebut often hard to imagine doing when you're in a highlystressful situation. share your feelings, play,set consistent expectations,

protect the child from adultconcerns, encourage small goals, try something new, keephealthy, try something relaxing, things we would allsort of endorse and sort of basic foundational elementsare often hard for parents to do unless they're supported. so our literacy promotionrecommendation for pediatricians wereto promote literacy at health supervision visits. really inform parents,advice parents

that reading it loud canenrich the relationships. counseling about what aredevelopmentally appropriate literacy activities and provide books andyou'll hear more about that as well. we also said make youroffice literacy friendly. use posters and inform parentsabout the importance of literacy. partner with advocates like we'redoing today to promote literacy. incorporate literacy inour training programs. sports-- support funding forchildren's books and research. so we call out our profession

to really do a 360-degreesupport of literacy. and we have some tools. so we have bright futures thathas literacy and woven into it. and also the abilitynow the new addition to detect these adverse childhoodexperiences and build resiliency. promote reach out and read,which you'll hear about. and many, many pediatriciansare doing this in their offices and address these toxic experiencesthat prevent the building of resiliency, the buildingof literacy in our families.

and this is just an interesting map of the book desertsin the united states. and so you'll see that theorange is percent of homes with more than 100 books. and 100 books is a lot. for some of us, i don't think100 books is a lot in my house but it is a lot andyou'll see that they're-- very map reproduces itself, overlaysmany of our maps of chronic illness and health disparitiesin this country.

so we have on our websiteliteracy building tools, books building connection toolkit. this is for professionals andfamilies and just to highlight that. and then we talk about andhelp pediatricians understand and parents why books, whata child can do with a book, how parents can enjoy thebook, and when to share, and how to weave literacyinto your house. and so supporting evidence forprofessionals because our docs like to know why they'redoing it and then what--

ask about and what to do. and then promoting the fivers; reading, rhyming, routines, rewards, and relationships. and you can see how integralliteracy and literacy promotion is into building these reallyfoundational elements of family relationships. so, all families need to understandand hear the important message that literacy is important. so-- and we said that in our policy.

but i was taking the red-eye tochicago and i jumped into a cab and the driver and i werechatting and he learned that i was a pediatricianand many of you who are pediatriciansknow this happens, people find out you'repediatrician and they really want to tell you about their children. and so he began telling meabout a 6-month old daughter and he's working two jobs and he'snot at home with her very often and he wanted to give herthe best possible life.

but he said, "i am workingto give her a better life but i don't have a lot of time,"and he was really lamenting that. and he asked me, "what i should do?" and i said, "well, read to her." and he looked puzzled. and he said, "but she'sonly 6 months old like what are you crazy,read to her?" and i told him howreading builds brains, vocabularies changes behaviors,sets up children for success.

and we wound up discussing earlychild development, literacy and learning, and thecab ride from o'hare to our headquartersat elk grove village. and he was amazed. and he was grateful. and he was grateful that hecould do something for her even in the little time he had. and we arrived at the hotel. he couldn't stop thankingme and shaking my hand.

he said, "i will read to her." and he said, "there'ssomething i can do to help her and help her have a betterfuture and i will do it." so, i think we can underestimate theimportance of this for our children, the importance of this for ourparents, the importance of this for our families, and the importanceof this for building the foundations of child health in our country. so, thank you very much. and i'm pleased to be here.

>> john cole: well, thank you verymuch for that wonderful beginning, followup to what we'vestarted last night. i'm pleased that we can approachthis subject from so many points of view and there are manypoints of view to come. i want to say just a word abouttoday's schedule and logistics. we-- last night, those of you whoare not able to join us, i'm sorry, did not have a chanceto see the library of congress' historic building, the jefferson buildingwhich opened in 1897.

instead we're-- inour newest building, which opened in 1980,the madison building. we're proud that all three ofour buildings across the street, the second building,we're not visiting at all is called the adams building. but we were created in 1800. it was the first federal cultureinstitution and our three buildings on this campus are namedfor book loving presidents. and jefferson had a special rolein founding the library of congress

by selling at his-- atcost really his library, his comprehensive library to thefledgling library of congress in the capitol after thebritish had burned it in 1814. and from the comprehensiveness of his collection came thecomprehensiveness of the approach of the library of congress whichmeant we collect in all subjects and we try to share resources. we are in effect thenational library even though because we're legislativebranch and have congress

as our most important client, we don't have the officialname national library. but that gives us feelingthat we can reach out through educationaloutreach and other activities that cover many differentsubjects and are national place to bring together groups thatnormally would not come together and it's in that spirit in whichthe center for the book was formed and also in which weare needing today. now down to the nitty-greedy.

the restrooms are just outside. there is a lunch for the speakersand their guests next door. but members of thepublic who will be coming and going all day ourcafeteria is just a step away. so it's close by. all of our talks are in this room. is that-- that's right. we are featuring paneldiscussions that have been organized with experts on the variousaspects and approaches to our topic.

we also will have a couple ofspecialized sessions of one with our robie harriswho will speak about-- an author who will speak about herperspective, is a wonderful author of books on our subjects. the second one is somethingwe talked about and are going to have a short presentation and thegeneral idea was the role of health in a crisis in kind of a policycrisis or a different kind of national crisis and we are going to have a short presentation1:10 today by a specialist

from the world bank about ebola,literacy in the ebola crisis to try to bring us up to dateon another way of looking at what we're talking about. and in our keynote this morning,it's interesting, you know, that we really are talking notonly about research for specialist but in fact real life for cabdrivers and for providing advice. and that was another pointthat came out last night is that first confrontation with anadult about a very young child and what time are youspending together.

and dr. bailey made the point atleast to me in another conversation that sometimes he knows immediatelyor maybe with someone else last that if there's no reaction at all,you know there's work to be done. and when someone thinksabout their youngest child and that's an opening,i think, for all of us. our second-- let me see if i-- nowwhen we-- we'll have a chance with-- we'll have a chance forconversation depending on-- and i'm not going toquiet anyone now. we have the time to speak.

but at the very end of theday, we'll see how it works and we have some free time forconversation and questions. but i will encourage the chairsto use that time now to the best of their judgment whether youwant to take questions or not. and we also will not spendmuch time on biographies because biographies arein your handout along with some general informationabout our program about the center for the book, but also aboutthe literacy awards program. and you'll see those handsome--

we've now had three years ofliteracy awards and i urge you to take a look at the handoutsbecause we have developed a plan that goes beyond the cashawards which reach out and read, i should note was the firstwinner of the rubenstein award. so maybe this is propheticthat we are all coming together with this particular focus. it shows how we really are,i believe, beginning to learn from what we're doing and usingthe literacy awards connections with organizations as a wayfor us and you if you're here

to see what how bigthis world really is. but we developed somethingcalled best practices obviously. and we-- it goes beyondthe three large cash awards and these are recognitionsfrom the library of congress. so far, it's just withthe certificate. but we're hoping that as our programevolves we can do more in helping out some of the smallerorganizations that are getting bestpractices awards. and beginning with our second year,we really expanded, figured out what

to do with best practices. and each time we've givenbetween 12 and 15 organizations from around the world best practicesacknowledgments and been able to bring them here to the libraryto talk about their programs and we are filming ourprogramming in the process, developing our website whichone of this days when we crash-- not crash, went-- wrong verb-- when we penetrate the library ofcongress' web services to the point that we can move ourresults up a little faster.

we'll be showing you some of our--the website films from some winners. and for us, it's a greatstimulation to have people from other countries come andjust have their 10 or 15 minutes of recognition and we film it andwe also have a page for each of them in our last two annual books whichthey can use to promote themselves. so, this is an ongoing processand you are now part of it and we will move to our first panel. the panel is child and adolescenthealth and literacy issues. and the panel consist of libbydogget who will be the chair.

laura who is part of it. lindsay carter and dr. needleman. and i would like them to come up and i will introduce libbya little bit but not much. come on up. everybody come up. libby will have the panelmembers say a little bit about their own backgrounds. but libby herself is withthe department of education.

she's an assistant-- deputyassistant secretary for policy and early learning in the office ofelementary and secondary education. and we are all meeting-- some of us are meeting eachother for the first time. >> libby dogget: that'sright, we are. >> trying to figureout who's sitting-- >> libby dogget: we actually met onthe phone because we are prepared. so i think what we'lldo is i'm going to introduce the panel alittle bit or the frame

of the panel althoughsandy did an incredible job of really introducingthe whole topic and it was just a beautifulpresentation. so, thank you for your presentation. but more importantly, thank youfor what the american academy of pediatrics is doingin this country. they are making a difference. >> laura is going to helpwith timekeeping for you. >> libby dogget: ok.

so, one of our panelistscouldn't come but we promised that we would makesure that her message on diversity in bookswould be heard. so, ellen oh was notable to join us today. i regret that because she wouldhave been incredible person. she is an author as well as the ceo of a group called weneed diverse books. and we do need more diverse book. so, we will try to work hermessage into what we're saying.

i'm delighted to be here. it's such an honor. i think the library of congressis the most beautiful place in the entire world andthe idea that we have so many books available hereand electronically now and then in libraries all across thiscountry is just pretty incredible. we have a program at thedepartment of education called "race to the top: early learningchallenge." and we have spent a billiondollars funding 20 states.

and one of the states, maryland,has worked really diligently to get families engaged intheir children's education and to just establishstronger partnerships. and one of the thingsthey've done is to actually introducefamilies to the library. and i think we all takelibraries for granted. when i was a littlegirl, my family-- my mother took us tolibrary every week and beside her bed was alwaysa stock of books this high

and i don't know how she gotthrough them with four kids. but she somehow at leastgot through a lot of them because she was always reading andreading to us and so we all got used to bringing home a stack of books. but in maryland, someof the newer families, the new immigrant families didn'tknow that the library was free. they hadn't used the librarybecause that they thought that that incredibleresource was something for others, people who could pay.

and so they had eventat the library, made sure the families got a librarycard and taught them how to use it and i thought thatwas such a great way to make a differencein families' lives. i remember very well when thefirst time i learn to read, i grew up in a family that ihad no excuse for not reading. family that did very well. i was raised to marywell,which a little-- fortunately, i did but i didmore than that hopefully.

but i didn't know how to read wheni get to first grade and i've gone to kindergarten, i'vegone to preschool at the church, norton's preschool. but i had no idea how toread and i remember sitting in the reading group, have thisvision so clearly in my mind and the teacher put a book, a littlebook in front about eight of us and asked if anybodyknew what tip meant. and there was of course abeautiful cute picture of a dog and my friend mark blumenthal whois still a friend said, "tip."

and i just looked at him likehe was the smartest person in the world because i had no idea. no one had ever takenthe time to teach me to decode the letter and the sounds. and i was in first grade and,of course, once i've learned, it was very easy butit was so interesting because learning toread is not easy. and some kids justautomatically get it. but most children do notand it is very difficult.

so we're going to have a change withlaura to go into depth about that. and then we've already heard abouthow important it is to have books and that that reading and therelationship that develops between the parents and the childsitting close, talking about things, slowing down is sovery, very important. we know to do that. we still aren't doing it. it's just amazing to have--we have reach out and read. we have rif still.

we have all kinds of waysto get children books. but we're not doing a very good job of getting those booksinto the home yet. but we have one great way to do itand i'm glad to see it's expanding. so robert will tell us about that. and then, i think it's interesting that other countries areusing our great research and are doing all kindsof wonderful thing. and so we're very fortunate tohave lindsay from the department

of agriculture to helpus frame this not just in the united states but globally. and so she'll talk a little bit about what we're doinghere and abroad. before i turn it overto my incredible panel, i want to just give you a little bitof background about what's happened in the last seven years inearly childhood education, because that's what i do. we have been fortunateto have a president

who really did focus on this. i can remember sittingaround the table in austin, texas where i actually livewith some of my friends thinking "who can we get to championearly childhood education?" we didn't-- you know, therewas no city council person, certainly not the mayor. there was no member ofhouse or senate in texas. there was certainly no onein congress, no senator. we wouldn't have thought of thepresident championing in this.

we did find a businessleader or the wife of business leader ronyakozmetsky whose husband was present at the business schoolof university of texas. she was incredible advocate for us. and we wouldn't have dreamedof where we would be now. i was sitting just across the way at the capitol a few years agowatching the state of the union. and i had been told that there wasgoing to be a special announcement about early childhood education.

little did i dream thatthe president would set such an incredible goal. but we have the goalof providing pre-k for every 4-year-oldin this country. we're not there yet. but we keep-- the president keepscoming back with it year after year. we know that's not a silver bullet. but we know that's doablebecause oklahoma is doing it, because west virginia is doing it.

georgia, vermont now is offeringpre-k for every 3 and 4-year-old. so we know how to do this. states are getting in line. it's not a silver bullet. we need to do pre-kfor 3 and 4-year olds. we need to improve the wholechildcare system and make it into an early learningsystem where every setting for children is a learning setting and that's going totake a lot of money.

but there is a proposal on thetable also to improve the quality of childcare across our country. and then, there's a wonderfulpiece of the president's agenda which talks to parents becausewe know that every parent wants to do the best possiblejob for their children. you never talk to aparent who hasn't said, "i want to do a better job." i thought your story about thetaxi cab driver was so wonderful because we all hear thatand every parent wants that.

they just don't know how. and even our middle-income families and upper-income familiesare stressed now because mothers are workingand fathers are working and their lives areso very complicated. i have two young daughtersand i just marveled at how they carve outtime for everything. so, with the president's agenda,we have money set or asked-- we're asking for a great increasein the home visiting money.

it is come down through thispresident where it's exciting because we have home visiting now which is really parentcoaching in every single state. but we know it's onlyreaching a small portion of the families that need it. it's all voluntary. but you know what, every family'sasked, "would you like some help? would you like coach or a mentor?" they all-- nearly always say yes.

so there is an agenda on the table. we have people at the highestlevels now talking about it. we had more recently in thenew york, really a competition between the governor and the mayorof new york city about who is going to pay for the pre-k program. we need more argumentslike that to raise this up. i do think the american academyof pediatric is really made-- been a great advocate for this. because it's not peoplelike me who are advocate

but it's really the businessleaders, the doctors, the-- actually, the flag officers,generals, and the naval officers who have come in andhave really made the case that we need this not just forthe kids and for the parents. we need this for our country andfor the future of our workforce. so, it's been a great ride. i hope we can continue themomentum because there's-- we've just barely started. the growth is way too small.

it's way too late. these first five yearsdisappear like that. for us, five years is nothing. but five years, children arealready in kindergarten and then in first grade and we've missedan incredible opportunity. so now, we're going to go in depth. and we're going tostart off with laura. i mean with-- i'm sorry--with robert. and he's going to tell us abouta great reach out and read

which sandy mentioned andhe'll tell us more about it. and they're limited to three orfour minutes and they're going to introduce the topic andthen we're going to just kind of have a conversation among us butwe are reserving 20 minutes for you to have a conversation with us. so, write down your questions,be thinking about this because we really do wantto engage the audience. and we have incredible experts here. so, robert.

>> robert needleman:thank you very much. it's wonderful to be here seeingold friends making new friends, realizing that our vision isshared and it's very powerful. now, i-- my heart is thinkingthough, sandy while you were talking because i'm thinking she's sayingeverything i was going to say. and my only consolationis as a pediatrician, i know that learning is closelyconnected with repetition. so, this will give you anopportunity to master some of this material a little bit more.

and i have written my comments downbecause i didn't want to go over. i could easily talkfor the hour myself. but this is to keep me in line. so, reach out and read is anapproach to pediatric primary care that puts the connectionbetween health and literacy, front and center. we do this in several ways. first, we create literacy-richwaiting rooms. in the best situation,we have volunteers

who are reading with the children. and more importantly, demonstratingto the parents two things, one that it's easy and twothat their children love it. in the situation in whichreach out and read developed which was a large clinic serving alow-income urban population boston city hospital now bostonmedical center. parents regrettably would oftenwait for an hour for their visits. so instead of that hour being filledwith the kind of control speech that you talked about,it was an hour now filled

with observing their childrenresponding to books and somebody who could present themin a happy way. and we discovered a form ofwaiting room contagion which was that as parents were watching oneperson interacting with children about books, otherkids would come along and then the parents would hangin the back would start picking up the books and looking atthem with their children. so pretty soon we created a milieu in which literacy fusedthe waiting room.

and we also noticedthat things got quieter because the kids weren'trunning around and the parents weren'tyelling at them. they were engaged. we have a new developmentally andculturally appropriate picture book at every visit to the pediatrician, every well-child visitsstarting at six months of age. that's important fora lot of reasons; one, is because the books cost moneyand so we have to raise money.

two, the more importantly, it'snot about giving books to families. it's not about gettingbooks into the home. there are many more efficientways to get books into home than having a pediatricianhand them about. it's about having the bookin the clinic to use together with the parent and the child. and i'll say a littlebit more about that. and specifically the mostimportant thing i think that we do is we provideindividualized one-on-one guidance

to a parent with a childabout how that child and parent are together usingliteracy to creat connections, to enrich their language, and to establish an optimisticoutlook for the child. so a great pediatrician told mesomething at the very begging of reach out and read he said,"you know, when i bring the book into the room, we haveconversations with the parents that we never had before. and the conversation is about mychild growing up to be a learner."

and that was sort of aworld-changing perspective for us is that we were tapping into a very,very powerful strong current within the parents of optimismand hope and also fear. parents would not had goodexperiences themselves in the educational world,those were our patients, could see as your cab driver couldsee there is something i can do tremendously powerful. reach out and read reaches 4.4million mainly low-income children. it's about 25% of the low-incomechildren in the country.

that's awful. i mean, it's wonderful, right, 25%. it's awful. what about the other75% who receive care at some 5500 clinicsaround the country? and we have affiliated programs nowin many other parts of the world. italy and germany areon board and some places where books are beingused specifically to help the most stressedkids like the philippines

where we've been involvedwith kids who are affected by the storms there and haiti. we embrace a wholistic view ofhealth which includes physical, social, and emotional well-being. and i won't go into more of thatbecause it's been talked about. and importantly physicians,pediatricians, family doctors have a specialopportunity because of our contact with parent at 10 regularlyscheduled well-child visits because they're in theroom with us one-on-one

and because parents we know come tous not only for advice about health but also for advice abouttheir children's development and what they can do. reach out and read rests ona strong base of evidence. we have 14 and now maybe15 studies published in the peer-reviewed literature that demonstrates somevery important outcomes. most importantly parentalattitudes towards reading aloud, including the judgment whenyou asked parents in a sly way

that doesn't sort ofprejudice their answers. the judgment that reading aloudis one of the favorite things that parents do with their child,so a source of joy together. and correspondinglyincreases in the frequency with which parents read aloud andin the number of books in the home. and then most importantly,we've been able to document through several studies,five at last count, improvements in children'slanguage development, specifically vocabulary.

and that's because vocabularyis both a direct result of reading aloud that we know that as parents read aloudchildren's vocabulary increases the number of words thatthey're exposed to increases. and it's also a very robustpredictor of later school success. so that when we can showexperimentally that institution of a reach out and read programincreases children's vocabulary, which has been shown, then we know that we're setting thosechildren up for later success.

a new evidence, including amarvelous report published in pediatrics awhileago increasingly shows that literacy acquisition,listening to stories, engaging with literature changesthe structure of the human brain, specifically the parts of the brain that are engaged inlistening to stories. so when we talk about literacyin health, we're really talking about the health of a veryimportant organ, the brain. and now increasinglywe're able to see

through technology howliteracy changes the brain. no mystery there. but it's quite clear that a healthybrain is important if you're going to become a literate andsuccessful member of society. so, our intervention is specificallyhealth-related in the sense that we have a target organ,the brain, that we're changing. and also, as you mention, sandy,very importantly, shared enjoyment of stories strengthensattachment and emotional health. and i believe builds resilience.

so, recognizing this into aconnection between literacy and health, reach outand read is an answer to one very specific question. what can doctors do? what can doctors do concretelyeveryday in their offices? there are many things we can do. we can advocate. we can educate. but what can we do everydayin our office day in and day

out to move children towards greaterliteracy and thereby greater health? i just want to end-- iprobably talked long-- saying one thing about the namereach out and read, all right. i would say it in this context. it's a little in-joke for me. the name was thought off by mywife, who is a surgical pathologist. and is she sees childrenin her professional life, that's little, tinypieces of children. and she thought off the namebecause we wanted a cool acronym

so it was r-o-a-r,reach out and read. that only lasted until themayor of boston informed us that r-o-a-r also stood forrestore our alienated rights, which is anti-boston group in south. so we became the first maybe onlyliteracy organization that's spells its name wrong. but it also turned out tobe prophetic in the sense that we're learning thatreaching out is not only reaching out to parents and connectingwith their aspirations

for their children, butthat this enterprise for pediatricians requires us toreach out to other professionals who have other expertiseto business people, to educators, to policy people. the program really only workswhen we cross boundaries. pediatricians cannotand do not do it alone. and giving pediatricians,family doctors a tool that they can use everydayalso encourages them to look beyond the walls oftheir clinic, because they need

to make common cause withothers in the community. so in that sense, we're reachingout as well and that's the reason that i'm especiallydelighted to be here to have this discussion with you. >> libby dogget: thank you so much. you know, we wouldn't have reach outand read if it weren't for robert, because he's one of the cofounder. so, the fact that your wifegot the name, obviously, tells us how imminently you wereinvolved in the beginning of that.

i think he's given us a challenge. only 75% of the kids don't havethis and we know how to do this. this is doable. i think the other challengethat we all have is getting time for pediatricians to do this. because i know i have ason-in-law who's a pediatrician and he is challenged andmy daughter did family-- it has family practice and,you know, that challenge of having the time to do it.

they both do it butit's very difficult, so. thank you. so, laura is next and she's goingto take a little bit different tack and talk a little bitmore about literacy but you'll see how itall comes together. >> laura bailet: good morning. i'm laura bailet and i directthe nemours brightstart program. nemours is an integratedchildren's health system and nemours is recognizedreading failure

as a major child healthissue several years ago. given a really significanthealth educational and truly life consequences of poorreading ability, nemours identified that it couldn't just sit onthe sidelines of this issue. and this has been soreinforced to me just in the last 12 hours listening to dr. bailey's wonderfultalk last night and then dr. hassink this morning. and these are two of ourphysician leaders at nemours.

dr. bailey is our president and ceo. and their pediatricians and to hearthem talk about literacy issues with such in-depth knowledgeand emphasizing all the ways and how much that's important for pediatric health care isjust stunning to me still. and it just reminds me what anhonor and privilege it is to work at an organization like nemours thatreally does value the whole child and helping every childmaximize their potential. so i just had to give thatcommercial for nemours.

it's stunning. so, for the past 11 years,nemours brightstart has developed and researched new toolsfor educators, parents, and health care providers becauseas we know all of those folks in our community havea big role to play. and we want to help each of thesefolks understand what it takes for every child tobecome a strong reader. and sandy did a greatjob of reminding us. we need to talk more aboutwhat all children need.

and there's still is alot of misunderstanding about what every childneeds to thrive. we also focus a lot on how toidentify those children who maybe at risk and what to do to catch them up before they havea chance to fail. so we've developed educational tools that through our research have beenproven highly successful in reducing that reading readiness gap in thesevulnerable children before they even get to kindergarten.

i wan to talk a little bitabout one of our current project which is a website forparents of children from birth through 5 calledreadingbrightstart.org. on that website we've really takeneverything that we've learned from our work withthousands of children. we've worked with childrenour selves. parents and teachers directwork with all of these people. and put all of thatcontent into a website with the goal empowering parents,really putting them squarely

in the driver seat in preparingtheir own child for reading success. one of the best features of our website is ourpreschool reading screener for 3 to 5-year-olds. this is a simple check listthat helps the parent find out if their child is on trackin their reading readiness or maybe needs more help. after the parent completesthe screener, they receive a customizedaction plan for there child.

all aspects of thewebsite are currently free and we've optimized the site forsmartphone to make it as accessible as possible to peopleacross the income spectrum. so today, in this setting we'rereleasing our very first national reading readiness snapshot. so through the website thousandsof parents from all 50 states and washington, dc havecompleted that screener. and thousands of them havegiven us there permission to use their child's datafor research purposes.

so we're sharing with you our veryfirst set of result as a springboard to our goal ultimately of universalreading readiness screening for every 4-year-old in the country. we have copies of our readingreadiness snapshot document out on the table. so, please grab one. we're happy to discuss the result and answer any questionsyou have about that. and we think this screeneras well as the website

as a whole can work really, reallywell with programs like reach out and read and othercommunity initiatives to strengthen early childhoodprograms and resources. >> libby dogget: great. we want to hear more about that because i do want tohear the results. >> laura bailet: ok. >> libby dogget: so where-- as i mentioned in my intro lindsaycarter is here from the usda,

university-- us departmentof agriculture. so we have education and we talked about health and wehave agriculture. and they're doing amazing stuff. we were really excitedwhen we were talking and just hearing allwhat's going on abroad. so lindsay, give us a little taste. >> lindsay carter:thank you very much. yes, i'm here today from theus department of agriculture.

and many of you maybe aware ofthe national school meals program and school breakfast programsthat we implement here in the us. but over what-- that's withthe food and nutrition service. but coming over toanother part of usda, we have the foreign agriculturalservice which has a mission to improve agricultural tradeand reduce world hunger. and one of the programs underour agency is the mcgovern-dole, full title, internationalfood for education and child nutrition program.

which i think even in thetitle alone really ties in the health and then nutrition. our program began bin 2003 after being authorizedunder the farm bill. and our mission is to help promoteeducation, child development, and food and security in some ofthe world's poorest countries. this is done through the use of usagricultural commodities as well as technical and financialassistance to initiate, start, and continue with schoolmeals programs.

and it's through this provisionof school meals that we look for an initial increasein school enrollment and school attendance rates, whichis very visible visiting programs in malawi you suddenly see a lotmore children being sent to school when their parents realize "hey, ourkids are going to get a free meal." and sometimes that is the onlymeal that they receive in a day. and we-- through programs aswell, we're improving enrollment, increasing attendance rates, and then also reducingschool dropout rates.

our program is implemented by ourprivate voluntary organizations and also international organizationslike the un world food program. our program is runningfrom three to five years, sometimes potentialfor continuations. and at present, we have 33active agreements in 25 countries across latin americaand the caribbean, all parts of africaand southeast asia. and what we find throughour programs is, well, we saw initial increasesenrollments,

our program is doing a great jobabout getting children into school. it's when you got theirbutts in the seats, how do you start teachingthem to learn? so in 2012, we developedtwo results frameworks, which include increaseliteracy and increase the use of health and dietary practices. and this is through howsort of school feeding leads to at more children beingwell fed, being at active and attentive, ready to learn.

a hungry child is going-- is not going to have thesame learning capacity as a child that is well fed. improve nutrition that comes fromproviding a daily nutritious meal. but we found that in order toreach these goals we needed to have complementary activities. so, what we have a lot underour program is an addition to the providing a school meal. we're bringing the parent-teacherorganizations together usually

to prepare the meal, toserve the meal as well as to support the school. we'll introduce schoolgardens which include a-- the fao has developed theschool gardens curriculum. this isn't for the children to be,you know, out of the classroom, but it's the opportunity for thechildren to use the garden to be out learning aboutwhat's being grown. i've seen school gardens wherethey create the planting beds in different shapes, so thechildren can learn shapes.

there's a whole way of developinga constructive curriculum. we then talked about in order forthe children to get the nutrition and the meal, buildingroutines, teaching handwashing, making sure there'saccess to safe water, so that the school mealscan be safely prepared and the overall health ofchild is going to be supported. we're also doing teachertraining and we're making sure that there are booksin the classrooms. for example, room tolearn is working in laos

to make sure thereare school classrooms. and a lot of these communitiesthere's usually a generation of parents where a largeproportion of them are illiterate. so, how do you bring them in? our program in mali hasdeveloped report cards, which is landmark reportcards for illiterate parents. that connects the parentswith the goal of the child because we believe a parent doesn'tnecessarily need to be literate to understand the value of educationand want their child to be literate.

so, we have broughtall of those together. we encourage our organizations tobuild capacity at the national, regional, and local level, which usually involves developinga national school feeding policy and understanding whatis the benefits. so we try a lot of-- there's a lackdata connecting really what is the value of providing a school mealto improve literacy and health and nutrition of theschool age child and how those two objectivessupport one another.

so, we have-- we havebaseline, midterm, and final evaluationsbuilding a base of data as well as taking our own initiativeswithin our office to develop systematic reviewsof what's already been studied out there across the world. and then build upon that, bybuilding our own learning agenda. what do we need to know and whatpathways of attribution do we need to learn so we can providethis data to foreign government to further support theirschool meals programs

and there improve literacy. and i think this is important. the final note thati want touch upon is, here in the us our schoolmeals program is housed within the departmentof agriculture. this isn't the case in manyof the countries that we work. the school feedingunit is usually housed within the ministry of education. so working on curriculumdevelopment,

when we need to advocate for why that should be a national schoolfeeding policy we're talking to the education ministry. so coordination with them andrecognizing the connection of how school feeding can lead toimprovements in literacy and health. but that touched upon todayespecially the pediatricians between the connection of literacyand health and health and literacy. and then my final thing is that--my final point is the connections that we need to making as far asfought for coordination in order

to supplement these impacts. providing a school meal alone isnot going to improve literacy. there need to be complementaryactivities and our office has benefitted fromthe memorandum of understanding with us aids office ofeducation who have a goal one to have improve theliteracy, early grade reading of 100 million children worldwide. working with them, theliteracy experts will able to improve the qualityof our program

and further providinga school meal helps to bring those children to school. so thank you very much. >> libby dogget: thank youlindsey that was amazing. yes clap. [applause] ithink it's incredible for us to be reminded againhow important food is. it is the very basic medicine. i mean it's so basic and wedon't worry as much about that because of the great school mealprograms although i think we worry

over the summer and over vacationsbecause some children even in our country aren't gettingthe nutrition they need. that was incredible. so we're going to go a littlebit more in-depth to be thinking of your question becauseyou all are next. but i want to go back toyou and talk a little bit about intergenerational poverty. i mean, you're working--you're working with the parents and the children and rightnow there is a resurgence

on what we call two-gen programs. programs that don't just focuson the children don't just focus on the adults but focus on bothbecause we know they are important. so, how does reach outand read fit into that? >> robert needleman: many yearsago i had a study underway through maternal andchild health bureau in which we enrolled severalhundred mothers of children coming for their five monthwell-child visit. and part of what we did in the studywas we gave the mother very simple

reading test, the wide rangeachievement test, which is nothing but a list of words that youhave to read you get a score. 50% of our mothers in thatstudy were untestable. their scores were belowthe bottom of the test. so, the problem withliteracy is extreme. many of the graduates fromour public schools graduate without the ability to read well. my own take on it is thathaving low literacy skills as a parent contributes to a senseof despair in terms of your ability

to help your child see a better way. and at the same time, every timeyou pick up a book you're reminded of your own history of frustration and discouragementgrowing up in school. so, one of the things that we try todo in reach out and read is be aware of that and understandthat telling a parent in that situation you should read to your child is nota benign thing to do. it's actually very bad thing to do.

and that the message needs to be,you can help your child love books by having fun with yourchild with the book. don't focus on words. make it fun and talk about thepictures and enjoy it together. so that-- we have aproblem in terminology. we call it reading aloud. but what we're really talkingabout is not reading at all. what we're talking aboutis a joyful interaction between parents andchildren and books.

and to convey that to parents, what we find is mosthelpful is not really to say very much atall but to do it. so, our methodology at leastwhat i think is most effective is to watch the parentlooking at the book of child for a very short period of time. one can get a good sense of itin a very quick interaction. to notice when it looksbeautiful and be a witness to that this is beautiful.

or when it doesn't lookbeautiful to be able to right there demonstratehow to do it. and it is as simple as stepping andsaying, "why don't we try this?" and then you do something. and it may be justlooking at a picture and saying, "hey, where is the boy? what's he doing? where is the dog? can you show me the," right.

and you play that game for a minute. and then when the child isengaged and happy we say, "this is what we mean when we talkabout reading, now you do it." and then giving another parent achance to mimic what we've done. so, that's a very concreteapproach to this question of interrupting a transgenerationaltransmission of not only literacy is aninability to read but literacy as an unhappy relationshipwith books. and i think we can do that becauseof the power of the relationship

between the doctor and the parentwhere the relationship is one of appreciation withoutjudgment and of collaboration. we are in this togetherto help your child to be the most wonderfulperson that can be. so your quote from dr.pasteur was exactly right. that's exactly what we're about. >> libby dogget: so laura,talk us more about the reading. i mean it's difficultto learn to read. we know from bob a lot offamilies can't read and we have

to teach them how to read thepictures and tell the stories and use their words in other ways. but how hard is it to learnto read and what is that-- what's going on in the brain andwhat does the research tell us? >> laura bailet: well, learning to read is really a verychallenging task for the brain. and i think we're reminded of thatwith the statistic that sandy showed in one of her slides that bythe end of third grade 2/3 of american children-- we'rea very affluent country

on an international scale. two-thirds of them arenot proficient in reading. that does that mean 2/3 of allof our children are disabled or that there's somethingwrong with them. what's wrong is thatthey're not getting the kind of instruction startingearly and you have to help them becomeproficient readers. and one of things that thebasics that we have sort of forgotten is how challenginga task this is for the brain.

you know, reading occurs very latein the course of human development and you know i think a lot wheni'm at the library of congress about gothenburg and i onceheard a brilliant neuroscientist, dr. gordon sherman say, "you knowwhat really cause dyslexia was gothenburg because when heinvented the printing press all of a sudden the masses are sortof expected to be able to read, whereas before it was onlythe elite few that could read. but now that everybody hasthe opportunity to read, the expectation goes up, well,then everybody should read

and it's not a naturaleasy thing for the brain." and so i think there'sa lot to that. but we still have this prevailingmyth that children do learn to read naturally if they justsort of have books around them and a reasonably supportiveenvironment. now children do learnto talk in this way but most children don'tlearn to read in this way. for most children learning toread in english takes about three to four years of intentionalsystematic high quality instruction.

if you're italian itonly takes about one to two years to learn to read. if you're chinese ittakes about 10 years. so it definitely variesdepending on the complexity of the written language system. and even many educatorsdon't fully understand this. learning to read requires severalparts of the brain which are built to do something else to learn anew skill and then synchronize with these other brain areas.

they're also learningsomething new at the same time. so it's pretty darn complicated andwe really shouldn't be surprised that so many childrenstruggle with it. now i do want to emphasizethat success with reading instruction isreally predicated on a lot of high quality talking, reading,singing and playing that parents and other caregivers will do withyoung children starting from birth. so that is absolutelynecessary and lays down that solid brain foundationso that the child is ready and able

to benefit from thathigh quality instruction. so it takes both sides of that andthe earlier that we start providing that evidence-based developmentallyappropriate reading instruction the stronger the reading outcomes. i do want to go back to a pointthat libby actually mentioned. i can't believe she said it. but another really important-- because we didn't talkabout it in advance and i already had thistyped, you can look.

another really important pointabout reading is that it tends to be viewed as a proxyfor intelligence. so it works like this, if you're agood reader you must be very smart. and that's exactly whatlibby said that kid who know the word tip shesaid he must be very smart! >> libby dogget: hewas and he still is. >> laura bailet: that's--and he still is. but you're no slack and youweren't reading that word, so. but if you're not agood reader maybe it's

because you're just not very smart. and this is the message thatstruggling readers receive over and over and begintelling themselves. and those of you who work withadults with low literacy skills, you know what i'm talking about. i can't tell you how often i haveheard from children, teenagers, and adults that they think theyare not smart no matter what other evidence there is that they areincredibly bright and talented. and once they start to thinkthat they're not smart,

it's like it become sort ofseared into their psyche. and they just can'tstop believing that. and it has so profound animpact on their confidence, on their willingnessto ask questions in institutional situations or withauthority figures like a doctor. they are terrified toread with their children because they think theycan't do it well enough. and that if they don't know a word or make a mistake that's theworst thing that can happen.

we spend a lot of timeand effort on our website and in our direct interaction with parents talking exactlyabout what robert said. it's not about readingevery word on the page. it's about engaging aroundthat book, having fun, having a loving supportiveconversation. that's what's important with thebabies not reading every word on the page. that's what really motivates us

at nemours brightstartwell stuff there. >> libby dogget: so lindsay, we'vetalked to all about the intersection of health and literacy andyou added really nutrition because we know that's importanttoo and hassink talked about it. what if you learned from abroadthat we should know or heed? >> lindsay carter: it's-- acrossall programs depending on the other, there's a lot of differences. but sometimes i'm struckby when i'm in the field when i hear very similarities,

a lot of sort of qualitativediscussions i have with a parents or a community member reallydrives home and be like, i'm pretty sure i could behaving this conversation with the parent in the us. a lot of it having to do with-- we taught a lot about earlychildhood development. hearing teachers burkinafaso where childcare and early childhood developmentis certainly not common feature. but we do part of that.

our activities there is we dosupport early childcare centers and provide training to caregivers. and hearing the parents thereand the teachers talking about these children they arrivedand they already know their letters and they're ready to read. in the community where many ofthe households have notebooks, whatsoever, but a well-suppliedearly childcare center has the same impact, very similar impact towhat it can have in burkina faso to what it has in oklahoma.

so there are lot of similaritiesas well as some differences. but what really strikes meis the conversations today as far what i've seen is literacyis not restricted to the classroom. it's what happens in apediatricians' offices, what happens in a childcare,what happens a lot in the home. and when we talk-- working invery remote and isolated locations around the world, a school isimportant because a school is where a community cancome together in a place where they may notbe a health clinic

but there is usuallya primary school. so i think it's importantto remember that a school and education system is aresource of the community where it can be a locationbut it's not those-- the boundaries of the schoolgo beyond the school gate. so that's really how [inaudible]of providing a school meal and addressing nutritionheath and literacy that sort of our entry point. but we really try anddevelop programs

that go beyond the schoolgate and that engages with-- engaging with parents and doingnutrition trainings and working-- if there's a preschoolworking with a preschool. and developing that sort ofsustainability and really trying to save a community which ithink is probably true in the us. and i'll just use thisas another places. we found that the schoolis incredibly useful on these very remote and isolatedlocations as also an entry point for providing certain aspects

of health educationand health services. and i didn't get a chance tomention during my introduction. but another part of theability of a child to take in the nutritionalquality is something like providing de-worming campaigns. so that's actually a way that aministry of education may coordinate with a ministry of health as far as if there's a national de-wormingcampaign having that entry point into a community not be through thehealth center that doesn't exist

but being through to school. and by providing nutrition andeducation and health education to a child is kind of a twofoldeffect because you both-- you reach the parents and alsoyou're reaching the future parents through the children. laura? >> laura bailet: can i share withthe audience a little bit of-- a conversation thatthe three of us had as we all met first thingthis morning and lindsay

that was the point that you madethat sometimes inadvertently, a literacy program or afeeding program because of time and resource constraints endup one supplants the other. and it may be inadvertent or you--you know, organizations may know that this is going to happen butfeel like, "well, we can't do both, so we're going to have topick one over the other." and i think in some ways thathappens a lot in this country, too, where we sort to havethe "tyranny of the or." we think we can dothis or we can do this.

but there's no way wecan do both together. and i think that's where, you know,some creative thinking and thinking across traditional boundaries andsilos could really help us do both in a very resource-efficientand time-efficient. well, i don't know if you--either of you we all talked about. >> robert needleman: well, i think that the key insight is youcan't be healthy if you can't read. and you probably can'tread if you're not healthy. so the or proposition isa nonstarter and we need

to just be really clear about that. >> libby dogget: i thinkit brings us back around, actually what dr. hassink was sayingwhich is zip code and community and how important all theservices are in that community and how we need to reallywork to bring it all together and make sure that it's efficient. that there's not duplication but that we're reachingall the families. so i have one more question thenwe're going to throw out open

to the audience andthis for any of you. given that, that we needto breakdown these silos and that we need todo and instead of or. what advice do you have? >> lindsay carter: research. it's understandingthe school feeding. it's the hardest thing as far aswe can collect to all the data but especially even though therehave been few random control trials when we work in schools, when you'reproviding a school meal to a child,

having-- developing random controltrials that already helps us draw that f attribution is difficultat best and we need more data and research in orderto tell our story of seeing not only theintended impacts but some of the unintended impacts and makingsure we're designing the best set of-- the best package ofinterventions to reach our goal. >> robert needleman: so,if your answer is research. my answer is bookkeeping. in particular because ourfocus is on very children,

very young children tend to beserved through the health system and older children tend to beserved through the education system. and it makes very difficultto do a cost-benefit analysis if the cost are beingborn in one system and the benefits arebeing realized in another. so we need to do some creativebookkeeping where we recognized that investments that may flow through a doctor'soffice might have payoffs that show up later in school.

>> libby dogget: i love it. laura you want to come in? >> laura bailet: sure. i think both of theseare so important and i think also how we talk aboutissues of literacy and health, just how we frame the issues and theterms that we used have such impact on the structures that we setup, so it's really struck again by what lindsay said, youknow, in the united states, the school nutrition program ishoused in department of agriculture.

whereas in many countries oversees, it's housed in thedepartment of education. and the very fact thatit's an agriculture ports-- and i'm not saying that'sbad or that's wrong. but there's historicalprecedence and decision making that have implications down the roadthat we may not have recognized. and so by put-- byhaving it in agriculture, in some people's mind we think ofthat as strictly a food program and a farming issue andnot an educational issue.

and so to be aware of how thestructural barriers prevent us thinking differently, which thenprevents us from acting differently. and i think blended funding streamswhere, you know, or recognition that dollar spent in one system mayhave their greatest dollar savings long term in a verydifferent system but that-- that that is good,that that's not bad. and how do we have that sort ofjoint accounting monetarily and also in terms of the broader goals ofwhat we're trying to accomplish. and i keep coming backto what sandy said.

we've sort of taken oureyes off the fundamentals and what does everychild fundamentally need. and they need food and nutritionand they need to learn to read. i mean those shouldbe fundamental things that no matter what elseis happening nationwide, we don't take our eye off that ball. and i think that's happened a lot. >> libby dogget: so you couldsee we have an excellent panel. it's your turn now andwhat questions you have?

what's raised and willgo to the very back. >> laura bailet: yehey. i love the hands going up. >> libby dogget: and tellus your name and where you from just so we have a contact. >> sandra charles: sure. good morning. i'm dr. sandra charles. i'm actually the physician here

at the library running theoccupational health program. >> laura: bailet: oh great. >> sandra charles: andyou're coming at it from the child literacypoint of view. we try to come out fromthe health and literacy for the adults whoare our employees. but i'm really fascinated by thisbecause i couldn't agree more with the whole the premise ofgetting not only to the nutrition but the literacy combined.

and to that end, the responses tothat last question where we talked about we need moreresearch and data. i would say you have enough of thatto try, start the collaboration between the usda programs and theeduction programs and try to get that out there where peopleare making the connection. so put what you alreadyhave out into the community. i guess that sort of likethe practical application of the research that you've done. so make it more out in thecommunity and i think that we will--

i'm sitting here thinking of allkinds of possibilities in terms of programs that people could start. and i actually have achild, a daughter who's-- she aspires to be where you're interms of pediatrics and dealing with the childhood problems ofliteracy and health and nutrition. and so i'm been hearing this forsometime from her and i just think that you have enough to startmaking the collaborations and implementing someof the programs. and one of the things we've start

to do here is starting afamily health and wellness day. we encourage employees to bringtheir families in and introduce them to different healthand wellness things and i think this is a real keycomponent that we could incorporate. and commend dr. cole becauseever since i've been here, you know, start with the reading. it's fundamental and it's comea long way and it is fundamental to both health and wellness. >> libby dogget: thank you.

anyone want to comment? >> laura bailet: i'lljust say stick around. we have an adult panelright after lunch, so. [ inaudible remark ] ok. >> libby dogget: robie,the floor is yours. >> robie harris. hi. can i ask one question-- >> libby dogget: stand upand tell them who you are.

>> robie harris: all right. i'm robie harris [inaudible]. oh. [ multiple speakers ] -- show the people out there. i'm just sorry that ellenoh can't be here today. the founder and a marvelouschildren's book author run around and just wondered, started withother, mostly librarians but people with children's book field, weneed diverse books for children.

and i just wondered if the panelcould maybe comment on the issue of diversity and how you see itfitting in what you have to say. >> robert needleman: i'll start. >> libby dogget: thankyou very much. >> robert needleman: so in thecourse of the work in the clinic, especially for older children. my clinic because of fundingissues relays on donated books. and so the books that wehave for children 6, 7, 8, 9 are whatever we can get.

and very few of those books areafrocentric books and very many of our patients areafrican-american. and so i'll ask parents whentheir child is, you know, holding that book and beingvery excited about it, "do you know aboutafrocentric books, do have any?" and for most of theparent they don't. and it really is a problem becausethe message to a young child who has a beautiful book that haspeople in it who are not identified with that kid is that these booksare written for somebody else

about a world thatis not your world. and the shame of it is isthat there are many, many, many wonderful afrocentricstories and books that our parents don'tknow about them a lot. and so, you know, if i can wavemy magic wand and get a budget to do it, i'd be buying abunch of those of books. i would make sure that i have[inaudible] beautiful daughters. i would make sure that ihave the people could fly. i would make sure that ihave ezra jack keats' books.

you know, the "snowy day" in winterand "whistle for willie" in summer in perfusion so that every kidwith darker skin in my clinic who identifies as african-americancould have some books like that. i make sure that ihave some biographies of great african-american leadersthat the little kids who i see who filled, you know, sortof disenfranchise can read about malcom x who wassometimes angry, you know, just like they're sometimes angry. but he took and he madeit pretty powerful.

so just to echo, we needit and we need to be aware of it we need to fund it. >> libby dogget: thankyou for reminding us that. i think it's important. do you want to mention something? >> lindsay carter: i thinkthis is a wonderful question because it's a challenge that weface with the mcgovern-dole program. but we're trying very hard with ourimplementing partners to address because not only arewe trying to make sure

that we have appropriate booksin an international context. and this helped by our colleaguesat the usa office of eduction and laura alluded of howdifficult it is to learn to read is we're trying witha lot of these countries where there's usuallya colonial language. and then there's a mother tongue. so often children are beingasked to learn to read in a language theyhaven't even learned or spoken until the age of five.

so trying to-- usually we'rehaving to actually seek out to be very creative and beingable to produce both textbook and fictional booksfor the community in a language that is understood. and there's some very creative waysthat our projects are doing the most as far as finding aaffordable and ego-resource. my favorite is in some west africancountries, peace corps volunteers who are working with a programto help and produce books because they know thelocal language.

they've learned it. they can read and write it andthey're producing these books that can go out in communitiesand then tying and in with the health aspectmaking sure that the message of this book is not onlyenticing to children but making sure it addressissues such as handwashing, improved nutrition, workingwith others in the community. so i think there's thelanguage that we choose as well as how the books look, makingsure they're exciting its--

and accessibility issues. but there are lots of creative ways that we can make theseresources available. >> libby dogget: and we want thediverse books for all children because i don't want myanglo kids to not just see-- >> lindsay carter: right. >> libby dogget: -- themselves. i want them see others. dr. sullivan.

>> laura bailet: and can i justsay one other thing though. >> libby dogget: sorry laura. >> laura bailet: ithink it's important to remember diversity is there'sso many types of diversity. so there's diversityof race and ethnicity. there's linguistic diversity. there's also health diversity. and robie is going to do a talkon her books where she writes about children withdifferent health issues.

but books are a fantastic wayfor children teenagers and adults to see themselves if theyhave a health condition or a learning challengethrough characters in a book and to broaden theirworld perspective. see a world that-- withoutlimits instead of the limitations and the helplessnessthat they often feel when they have a healthor a learning condition. and stories just canopen a person's eyes to broader, a broader world view.

and if nothing else books are agreat companion for sick days. and we don't want to forgetabout the joy of reading and actually an author ambassador,former one for the library of congress, kate dicamillo who wrote the story"because of winn-dixie". she talks about as a youngchild, she was sick a lot and books are whatkept her saying it, open the world of possibilitiesto her. so i don't want to forget that.

sorry dr. sullivan. >> libby dogget: so books arewindows and they're mirrors. way to see out, way to see yourself. dr. sullivan, we'reso glad you're here. >> laura bailet: yes. >> libby dogget: we're all honored. >> louis sullivan: thank you. first of all this isreally an excellent panel and i'm very pleased to be here.

and one of the reasons i'm here is because of the well-establishedknown relationship between level of education literacy and health. and i maintain thatwhile we really have as a nation had tremendousdevelopment of our scientific knowledgeand new therapies et cetera. we really haven't done asmuch or as well as we should on improving healthliteracy and health behavior. well, i'm please that that'sgetting some recognition.

having said that, ihave several questions or comment i'd like to make. first, i have specificquestion for dr. hassink. i'm curious is to whathappen to that grandfather who wanted his grandson heldback, because it sounded as if that didn't happen. and i meant the system was notresponsive here and it bothers me because often we find that rules andour regulations or bureaucracy get in the way of good decisionmaking and that really is one

of the issues that i worry about. the other comment iwant to make is this with tremendous programsthat you have. i'm bothered by the factthat we don't, as a country, support education stronglyas we should. everyone knows that weare really in a new era that we really are movingtowards an educate-- system where those who have goodeducation are going to do well, those who do not reallyfalling by the wayside,

part of the income gapthat we refer to now. so, the question i have iswith the programs that we have, what's being done to really let thepublic know and generate support for them so that our legislators inour states or in our school systems or in the congressreally support them. because the paradox is we havethese tremendous programs. but yet we have a real problemreally getting the kind of support for our education systems. so i'd be interested in knowingwhat have your experiences has been

or what are your thoughts, how can we really take thesetremendous programs that you have and generate the kindof support that we need so that they will reallybe promulgated around the country as they should? >> libby dogget: so, dr.hassink is going to help us. >> sandra hassink: well, but-- >> this was on? >> sandra hassink: i don'tknow if i can help you.

but the grandfather was notable to get his son held back because his was nota behavior problem. and did what-- you know, was a quietlittle boy who sort of was there in class and we tried anddidn't have any other feature that would have allowedus to advocate except that he couldn't readand we couldn't do it. we couldn't solve that problemfor the grandfather, so. >> libby dogget: so,anyone who want to address that complicated difficult question?

>> robert needleman:i am speechless. >> libby dogget: we needeverybody here to help us because this is notgoing to happen easily. i think in other countriesthey do it because of-- it's a moral obligationto take care of your kids. but somehow in unitedstates we've got to proved that's it cost effective,that we're going to save money and even though know, even forsomething as simple as preschool, there are people that saythat the results fade,

it doesn't make a difference,and we're trouble selling it. so, it is an uphill battlehere in united states and we need everybody hereto speak out repeatedly and your voice would be aparticularly helpful one. >> louis sullivan: well, thanksi really would not hesitate to do that in every opportunity. and one other comment for dr.needleman, with lack of diversity, ethnic diversity of your books andthe need for them, i wonder you're in cleveland, i'm sure youknow reverend otis moss.

and the cleveland urbanely iknow for years has been one of the strongest urbanelychapters around the country. so, i guess my question is haveyou raised this question with some of the black leadership in yourcommunity because these are people who really ought tobe responsive to that. and you could tellthem that i sent you. reverend moss happens to bea morehouse college graduate. so, i know him. he was two years behindme in college.

>> libby dogget: so,we have a quick answer and then actually we're out of time. so i'm going to letthe panel wrap but-- >> robert needleman: i will be glad to convey your messageto the reverend. there is a very small healthcenter in the fairfax neighborhood of cleveland called the otismoss university health center and they support usfantastically by allowing as to store our booksin their basement.

just to clarify the reach outand read program as organized through our nationalcenter and is supported in our local chapters doesraise lots and lots of money to purchase culturallyappropriate ethnically diverse books for our target audiencewhich is children from birth to age essentially six. that's the sweet spot for us becausethat's when we see kids frequently. and we think that'swhen the foundations of literacy are laid down.

so, on the good side, i wouldsay, that we do have a wealth of beautiful culturally appropriatebooks, largely through generation-- generosity too of scholasticwhich makes these available to us at great discounts and alsosupports their generation. so that's the good side. and the bad side is we'relimited by our budgets to books that are not terribly expensive. and so the books that we can provideat every well-child visit retail for somewhere betweenfive and six bucks.

and to our nonprofitscost us somewhere between two and three bucks. but that prices thosekids out of a lot of the very best literaturethat's out there for children. so, when i was raising mykid, i didn't only get books that cost five and six bucks. >> libby dogget: right. >> robert needleman: so, there's agreat disparity and injustice even as we try to do our best.

we could do a whole lotmore to make the full range of beautiful literature availableto the full range of our kids. >> libby dogget: so, i told themthey could have one last word. anyone want to last word? >> laura bailet: i just want tothank everyone for being here. i think in response to your question of how can this feedbetter publicized. i think by being here today andthen going out and messaging and continuing to work togetherwill start plant some seeds

and funding is always an issue. but thank you all andhopefully you learn a lot today that you can message about. >> libby dogget: thank you panel. thank you audience. thank you all for being here. >> john cole: thank you. i'd like to thank you everyoneand just make one more-- before we take a little break,

very short break beforewe hear from robie. on the diverse books issue,tomorrow here at the library of congress we will giving the-- hosting an event at whichthe first diversity award in children's books willbe given by an award by the american library association. and this is moment of know, ok,karen is going to correct me. >> karen baicker: weneed diverse books. >> john cole: we need diversebooks is the name of the group

which is carrying onin this whole area and the first awards willbe given and it's going to be called the walter awardin honor of walter dean myers who is our national ambassadorfor young people's literature. and walter sadly passed awaysoon after his two-year term. kate dicamillo followedwalter and our new of-- our new gene yang is ournew national ambassador. but tomorrow, it's a public event. it's at 10 o'clock in theroom where we were last night.

it's in room 119 and you would allbe welcome to come and learn more about we-- give me the phraseagain, we need diverse books which is the name of the group. so this is very a theme ofwhat we're doing and thank you for bringing it up indirectlyand directly to everyone here. i thought robie we're going totake a five minute break and start with robie and when you comebackthe restrooms are right next door. please be back in five minutes andwe'll continue with the program. thank you for the wonderfulmorning and first panel.

well, we have special author'sperspective on our topics today. and from the beginningwe had the notion of having an author's perspectiveand we have been exceptionally lucky to have robie harris here whois known for, to many of you, as a very prolific andthoughtful writer and author about books relating tofamilies, childbirth, sexuality. she, in fact, has beenat this for so long. and some of her books arehaving anniversary editions and there is a brochure for both"it's perfectly normal" and "it's

so amazing" 20th anniversaryof "it's perfectly normal", 15th anniversary of"it's so amazing". and those brochures plus a displayof a number of her books are on the table in the back. when we spoke on the phonewhich is the first time we met to talk a little bitabout her presentation, i was struck how sheemphasized that in the research for her books she often started bywhatever the topic talking to kids and talking to childrenabout the topic

that she was about to write about. and i thought, "well, maywe call this a perspective from the childhood?" and she said, "no, it's going tobe my perspective, but i want you to know that i do mybackground research, you know, with the real thingwith the children." and when i've seen the rangeof the books that she's put out and heard her speak a little bit about these i knowwe're in for a treat.

let's welcome robie harris. >>john cole: i'll take my notes. sorry. >> robie harris: so i'mfeeling a little speechless. and for those who know mewell i'm really not just because so much hasbeen said already, which has been so wonderful. so i want to join dr. needlmanin the repetition model here and john you mentionedthat i might be able to go

on just a little bit longer. ok. so, i have permissionto do that. so it's an absolute privilege tobe here, at the center for the book at the library of congress. and to be able to thank you johncole and i've written at my words, too, so that i won't too, too long. the founding and current directorof the senate for the book for your critical support and thecenter support for the work all of us do in the world of children'sbooks and children's health.

i want to thank dr. bailey, forlast night, for your leadership in the world of child health,the brightstar program, and your wonderful words,"everything we do must be for the child" and i quote here. "if it's not, then we need toreconsider why we are doing it." and also dr. hassink foryour leadership in the field of pediatrics, formentioning the aces study and literacy this morning,which i think is very important. critical work on childhoodobesity and the link between health

and literacy and it goeson and on the toolkit. and all of you in the audience,you know, i'm behind my computer and then let me out every oncein awhile to do-- to speak. but you're on the front lines. and all of you for your leadershipin the field of pediatrics, your critical work on childhoodand to all of you in the audience to care about or give care day-inday-out to our nation's children from infancy through adolescence,and actually prenatally because that certainly is apart of health, to help them

and their family to stay healthy. so i gave john cole atitle which is up there "read well, be well, stay well". and i'm going to continueto look at the question which i also sent to dr. cole. what real can children's booksplay in helping kids of all ages and their families stayphysically and emotionally healthy? i'm a children's book author. i have a strong interest andbackground in child development.

and i think childrenare so wonderful. i can't stop watchingthem, listening to them, hearing their words,watch their play, watch them when they get angry,watch them when they get upset, get worried, concerned, and so on. so-- but in order to creat the booksi write i still find it extremely healthy-- helpful, notonly to talk with kids. and i have conversationswith the kids. i don't sit them down and idon't have a tape recorder

and interview, you know. we just sit and talk about a topic. but i also find it extremelyhelpful to consult with librarians, teachers, scientist, health care, mental health child developmentprofessionals, and also with parents who often know theirchildren the best. i do this to make sure that thenon-fictions books i write have the most up-to-date, age-appropriate,medically and scientificallyaccurate information.

and we do this every timewe go back to reprint on my non-fiction books every time. and if some big change came through,my publisher for those books, candlewick press has said, "yes, wewill go back to reprint right away," because kids have theright to have the latest and most accurate information. and i do this also so that thepicture books stories i write reflect with honesty and that'svery important word for me, honesty. the powerful and yetperfectly normal emotions,

that most young childrenexperience day-in day-out because i think we all in thisroom believe if we're not honest for there kids, then welose them in a conversation, of a book that just doesn't beinghonest in what they know in life, they turn away from the book. the books i write, thewords i write are my way of having a conversationwith children. and they include-- you know,but what i chose to write that includes the valuesthat i have.

so they are my way ofhaving a conversation with children about staying healthy. and as i said earlier thatincludes their physical and their emotional health whicheveryone in this room we all know. we're so interconnected. i've been told that the books iwrite and this is all anecdotal, spark many questions from children. and it's true for manychildren's book authors. so i'm really speaking forall of us, as a gang together.

so it's not just my books. so they often lead to conversationsbetween a child and a parent or caregiver or another trustedadult in that child's life. and that these books that i'mtalking about this morning and-- not only provide access toinformation for a child, but also for that child's parents. information that kidsneed and have are right, and i say that really loud,"have a right to have". so, that they're beable to stay healthy

and eventually make healthydecisions for them selves, not only for them selvesbut for there friends. or the picture book story iwrite sparks a responsive core that is what i hope forin a child that might help that child stay emotionallyhealthy and reaffirm that the strong feelingsthey have and i write about in different books, all ofthese feelings from love to anger to joy to fear, jealousy,sadness, lost, yes, even hate. our legitimate feelingsand more often

than that emotionallyhealthy feelings. and the book about hate isreally a book about love, when those words justpop out of your mouth and then this little child in thisbook, what does he want to do? he wishes that moment he can stuffthem all back in, but it's too late. onward on to some of my booksas examples of some of the ways in which children's book cancontribute to literacy, hopefully, and potentially the otherhealthy or healthier outcomes. and just so have a chance as dr.cole said there are books back there

that if you fee like it, you mayhave time today, you can take a look at and ask me any questions about. let me first note that forparents and for there kids, kids of all ages, andespecially for kids and parent with low literacy skills, hen the words in the children's bookare married to the art in the book and i can't draw forbeans, i work with amazing, brilliant, wonderful illustrators. i'm so lucky.

and they bring a wholenew dimension, but we work very closely together that doesn't alwayshappen for other authors. the art is another way to pass onthe information and could help kids and teens and parents becomevisually literate as well. since today so muchof the information, they and we seek is a visual. and we get it throughthe visual world. together words and art in the bookoften bring both kids and adults

like in-- engage both kids andadults alike in multiple ways. now, i don't travel everywherewith copies of my books, but i-- you can see an image on the screen. i had 200 5-year-olds in a gymoutside of illinois a year ago. and i-- so that i think couldn'tsee a book if i opened it. and i-- what i loved about it andyou'll see this a little bit later, is that, i had-- theyhad a huge screen. and so i had kids come upand hold books and i said "so what's the difference?"

and this child said "you can'thug that" looking at the screen, he said and he went like this. you can hug a book. and that to me-- and it was before-- the last book thati was going to show. it was before i showedthem the whole story which is the last bookthat you'll get to see. that-- i think that tellsus something about books. this book is-- that i'mgoing to talk about.

it's perfectly normal and i have toremember to do two things at once. this is just a range of thedifferent kinds of books i write, but here is the cover for it. it's perfectly normal. it's illustrated bythe amazing friend and my dear friend michael emberley. we worked hand and handtogether on these books-- on this book and onmany other books. but this book is now, talkingabout the international,

in more than 35 languages andpirated in some countries. a country now i can't remember. in eastern europe there's-- do youknow the photographs by ann geddes of a baby in an eggshell, that's the cover which is total not science. he and i-- it's so crazy. i have a copy of it. someone brought it back to me. so-- and the art and text inevery book as i said are vetted

by kind specialist i'vementioned a minute or so ago and if need be areupdated every time one of our books is reprinted,which happens often. you know one such example,but there are tons of them. you know them in the pediatric worldor the medical world, you know, the hpv vaccine and nowwas approved for boys then. you know, we know notenough kids are getting it, am i correct, the pediatric world? so that's in thereplus so much more.

i began knowing that i wanted towrite a comprehensive book though but answer almost not every,but almost every question kids and teens would haveabout sexuality. i chose the title "it's perfectlynormal" because the truth is that most, not all, thingsabout sexuality are normal. except of course those aberrantthings such as abuse, infection, becoming pregnant, when one istoo young to take confident care of a child, the list goes on. but we all know this when thetopic engages kids they want

to know about the topic. and most often so do their parents. so here we have a book thatis about sex and human biology for kids roughly 9, 10, and up. and i would pause at the following. when a preteen-- what preteenor teen does not want to read about the perfect combo,sex and science. in this case humanbiology and, yes, health. this is also a book about themand what they are experiencing

as they begin and then gothrough puberty and adolescence. what pre teen or teenagers does notwant to read about one self, right? a little egocentrism here. i would also pause at the experiencefor an adult who read such a book with or before their child reads. i always-- i give onepiece of advice. i also tell everybody who i'm not. i'm not a pediatrician. i'm not health care provider.

child's book author. but i say one for-- to theparents says what should i do, what should i said? read it through any book onthis topic, not just mine. read it through first on your own, you'll have a temporary legup on your child, right? that's the only pieceof advice i give. so a parent who reads a book with or before their child readthis can help build literacy.

not only for the kidswho are reading this book but for their parents as wellwho use a book such as this to get information they mayfind too difficult to deal with. i understand that completely. it's easier for me to talkabout other peoples children when one talks aboutmine are grown up now. but when my kids we're young it'sharder to talk to your own children. very own children being a parent. so but for parents as wellwho use a books such as this

to get information they may findtoo difficult to deal with or hard to access and going back to trauma or may have had a traumaticexperience in their own lives. we're talking abouthealth and sexuality. it's just-- it's too painful. it's too traumatic. and then they can goto the rest of-- the health world to getthat information passed on. we have told-- been told overand over again that the words

in this book and other books i havewritten and the art michael created, gives parents permissionto talk about. and i hate these word"tough" topics. i talked about-- waswriting about tough topics. these are the normal everyday topicsthat every family deals with and, yes, many of them are difficult. and in this case given the wordsparents, a language they can use to talk with their kidsabout sexual health. this means that parentsare reading, too,

and modeling readingfor their kids as well. a road to literacy. i think i know whatthis room would say. would we call it family literacy? and it's also a way for parentsand kids to become or continue to be emotionally attached to oneanother through a shared experience of reading the same book. and by the way often they're notreading it together at that age. you know, child-- parent--i say to parents--

they say, "what do you do?" i can say that you have morethan one piece of advice. i say, "you know, it's ok if yourchild reads it on their own." you just can say, "you read it. you know, i care about you. i love you. i want you to stay healthy. you might find this interesting and of course the kids all theysay, "i know all this stuff.

i don't have to do it." you know, parents leave themback of the toilet or next to the computer and its gone. we've been told that. so through a shared experience ofreading the same book that can lead to talking together about somany topics including parents on family values. fostering this kind ofattachment between a parent and one's child certainlyseems to me

to be an added positiveliteracy outcome. our children's book librariansand teachers and daycare providers and so many more iprobably not listed, also provide this day-in day-out byhaving my books, but not just mine and others in theirclassrooms as bob said, "if they can afford it [inaudible]." and their collections in an openshelf, not in a hidden shelf under lock and key that thelibrarian keeps up up on top, so-- and accessible to kids.

so here we go. here are some images from therecently completed 20th anniversary edition and i chose these. i could have chosen a million. so let's see. so this is from the firstchapter called "what is sex", ok. yes, these are cartoon characters. i had a boy and a girl andthen i couldn't use a boy and a girl because-- i mean,girls would think one thing

and boys would think others andnot all the stuff about gender. i mean, it gets justvery complicated. so they might not knowthe bird and bee are-- bird, the kid who wantsto know everything, ask every question can't stop. the bee thinks it's all gross and disgusting except getsfascinated by the science. i was more of the bee than the bird. so here is just a littletext from there.

this is the opening. sex is about a lot of things bodiesgrowing up, families, babies, love, caring, curiosity,feelings, respect, responsibility, biology and health. there are times when sickness anddanger can be from her sex, too. most kids wonder about and havelots of questions about sex. it's also perfectly normalto want to know about sex. you may wonder why it's a good ideato learn some facts about bodies, about growing up, about sexand about sexual health.

it's important because thesefacts can help you stay healthy, take good care of yourself, andmake good decisions about yourself as you are growing up and for therest of your life, besides learning about these things canbe fascinating and fun. so on to-- this was a changein the chapter on straight, gay, trans, bisexual, lbgt. and this is just newerart that was done. and here are some texts. many people use the term lgbt, theseinitials l for lesbian, g for gay,

b for bisexual, and t fortransgender, our way of referring to people who are lesbian,gay, bisexual, or transgender. and then i give a definitionof transgender which i'm not goingto go to now-- not. i mean i'm happy to,but we need to move on. and then it goes on to theend of the chapter to say if a person has any questionsthought or concerns about his or her sexual feeling or gender,talking to someone you know and trust, a parent, relative,therapist, doctor, nurse, teacher,

or clergy member can be helpful. no matter what some people maythink it's always important for every person to remember andtreat all people with respect. and it's important to know that aperson's daily life, making a home, having friend and fun workingbeing in love, being single, being a partner, being married, raising children is mostly the samewhether he or she is straight, gay, bisexual, or transgender. ok. oops. ok.

this, five years ago put it inchapter, began about the internet. absolutely critical. the chapter is "becomelarger and larger". and michael and i worked outwhat-- i can't draw as i said. but we work out whatwe want the image to be and then he does his brilliant work. once your words are on theinternet they're there forever and you cannot get these words back. others who we do not want to seethese words may end up seeing them.

there is no way to guarantee whatyou will have sent will be private. and think about theemotional implications. and if you say online that someoneis fat or skinny or sexy or ugly or beautiful or handsome. what you said is never reallyprivate once those words are in the internet. saying-- and here we're talkingabout the emotional health of kids. saying something mean or bullyingsomeone, or spreading any kind of gossip, even sexy gossip orabout another person can make

that person feel really crummycan hurt that person's feeling. when someone does this online bytexting, posting, or e-mailing, it called cyber bullying. to cyber bully means tomistreat another person. cyber bullying meansmistreating another person online, to bully means to mistreat. cyber bullying meansdoing it online. and then here's just anotherway to get information across. and we certainly want topass these on the kids.

these are things thatwere in the book. miss that i'm told. kids still think, right. here's a way to talk about that youneed a condom for protection, right? and it's a smart thing to do. so to call kids smart,if you did this-- this is smart, something you can do. ok. this was where they fit. i think boys, men, as well aswomen and girls, need to know this.

sometimes people don't know it. and this is just one pieceof contraception here. and then this is what our looklike and i have a grandmother. and this is the last chapter called "staying healthy responsiblechoices". and i couldn't write this withoutsaying-- without ending like this. everyone makes mistakes and hasbad judgment once in a while. i didn't want kids to think that,you know, i am through the word that i write saying, you know,you don't have to do this,

and this, and this, and this. i don't want to ask the audience about what mistakes you mayhave made during those years. we won't do that. and you probably will, too,but most of the time you can and will make responsible choices,ones that are good for you, right for you, and healthyfor you and your friends. so that's-- it's perfectly normal. ok. on to some of my-- here'sa quote i just want to post it.

and by the way, i've donebooks that now go down to three to five year olds on this topic. one called "who has what?",naming all the parts of the body. not just the wonderful song weall love it, head, shoulders, knees and toes but seems to memaybe some parts are left out. and the kids, too, theyknow at a very young-- well, they don't immediately,almost right, right, right, infants, that's [inaudible]. so here's a quote fromdr. alicia lieberman

and a gifted clinicalpsychology at ucsf for the book-- for his quote i think it's theemotional life of the toddler about words young children andabout young children and i quote "when a parent is able totranslate" and she says the infants and toddlers and i have theprivilege of knowing alicia. and i talked to her about this. i said, "how about children of allages are able to translate the words of children of all-- able to translate childrenof all ages experiences

in the words of understanding. this helps contain thechild's negative feelings and makes them bearable." in this sense, this is her quote,"talking can represent relief from amorphus feelings becauseit puts some order into chaos." i find these words "put orderinto chaos" central to my writing for children and particular writing about the emotionallife of children. i feel that children's bookscan provide those words,

words that can help tomeliorate the perfectly normal and terrifying feelingsthat children often have. and for most children can help makefearful feelings bearable including the traumas that we talked about. and here, what i want to askyou, it's ok to use r-o-a-r and would mayor tom menino of--the late wonderful mayor of boston. so here's a little bit fromthe incredible illustrator. if you don't know his work, chrisraschka, he's a joy to work with. ok. when lions roarand monkeys screech,

when daddies yell,when mommies holler. there's a lot left out of hereof the pages of the [inaudible]. chris understood that theseparents were not yelling at the child as parents who yell. and it's scary to hear achild-- a parent out of control. when daddies yell,when mommies holler, the scary is near,the scary is here. so i sit right down,shut my eyes tight. go away i say, scary go away.

and then the quiet is back. a flower blooms, an ant crawls by. a mommy sings, a daddy dances. the scary is gone,and i go on my way. chris is brilliant [inaudible]nadine bernard wescott. so i wanted to do a book onhealthy eating and nutrition. and this is [inaudible]gus and nelly and their parents ihope are in here. this fall, here's anotherinitiative, somebody you may

or may not know about maybe you do. first book and the mario batalifoundation, he's the famous, you know, new york city chef. but i think in [inaudible] launchedtheir healthy kids collection. and "what's so yummy?" was one of eight wonderfulbooks for young children on healthy eating and exercise. and it's perfectly [inaudible]i'm proud to say was one of them. and they did that astheir way of ensuring

that all children are well-read,well-fed, and well-cared for and to show kids the importanceof healthy eating and nutrition. i'm just going to showyou a little bit on sugar. i got a lot of help,our wonderful people over in the congress senator-- congressman rosa delauro onthe agriculture committee which was chair, now i forgetwhen you're not ranking member now of the agriculture committee,put me together with a-- consulted on this book we talkedabout sugar but also so many other.

it's fun to eat a sweetlike ice cream or a cookie or a piece of cake, pie or candy. most sweets have alot of sugar in them. but too much sugar is not good foryour teeth or the rest of your body. so it's ok to eat somesweet sometimes but not too many and not too often. and eating a sweet is almostalways a special treat on birthdays and holidays. again, i don't want to putthe shame and guilt there.

and there's gus, these cookiesare done, let's try one. there's nelly, these chocolatechip cookies are so yummy it's time to pack them all for our picnic. and [inaudible] something, ok. and there they areand on their picnic. and it's so it's fruits andjuices also have sugar in them. a lot of fruit drinks and sodaeven have more sugar added. they have too much sugar in them. so it's better for your body to eata piece of fruit and drink water

than have a drink of soda. and there's a whole range of everyissue, water, you know, everything, allergies, you got it in this book. and here is my latest book whichis coming out again [inaudible], which is coming outtwo week-- a week. and i wanted to thankellen oh again, creator of "we need diverse books"for opening out the critical dialog about children's book and diversityand also the publishing world-- the children's publishing world.

they are doing a really fine job. but we're working on all ofthose of getting more people in the publishing industrywho are people of color and therefore more sensitivity ofthe need for books that shows all of us and what americareally looks like. michael emberley and i am proud tosay did that and people stand up and say thank you and wedon't know what to say. we say, you know, it's justwhat america looks like. it's who we are.

here we are with the title. so this is gus and nelly again andi actually sold this book way before "we need diverse books" began. people say it and thatwas fine, you know. we just did it because of"we need diverse books". but i applaud so much what theyare doing because children need to find themselves not justin the words but in the images and it's kids of colorand as libby said, all of our kids need to find them.

so because it has to do with ourkids' emotional health, big time, to find themselves, to validatethem and that you count, you matter. and here's-- and i take on whatsome people would call tough issues. i talk about how youtalk to each other. how a person walks or talks orthe clothes the person wears or the color or shadeof their skin, hair, or eyes can't tell you whata person's really like. these books are for 3s, 4s, 5s,6s, and 7s, it's a big range. the holidays a person celebratesor the people in a person's family

or the food the person eatscan't tell you what a person's really like. that person may be a lotlike you in some ways and different fromyou in other ways. you may have freckles,another person may not. that person may speakspanish, you may not. you may use crutches wheelchair,another person may not. that person may like to sing, youmay like to tell jokes or both of you may wear orange sneakers.

see if you can find two setsof orange sneakers here, or have the same backpacks--see if you can find that-- or brown eyes or curly hair. and then we spend weeks on end. this is published by candlewickpress as with the books in essential healthand "what's so yummy?" we spent ages just looking at thediversity in this art which we did with "it's perfectly normal". and we have people ofeverywhere looking at it and say,

you know, do we leave anybody out? when you meet another kid for thefirst time, you may want to play with that person right away, oryou may not want to because he or she is someone you havenever met or seen before. you may feel furious or evenshy or nervous or surprise, they're a little afraid ofsomeone you don't know yet or who looks different from you. hey guys-- hey, i'm gus. this jogger is so cool.

this juggler is so cool. and if i go back just tothis one, now, he's saying, "all i know about someonenew is what they look like." and gus says, "you may not evenknow strawberry ice cream is their favorite ice cream or chocolate." if you do play with each other, youmight find out that something he or she thinks is scariersomething you think is scarier. you might find out that's somethingyou think is silly is something he or she thinks is easily.

and before now-- know whatyou're talking laughing and having fun with each other. it's possible, often happens. let's-- bob you were talkingabout the positive outcomes, the resilience, butthe-- how kids see it. so i really-- i dida movie years ago. something with thefirst head start-- one of the first head startprograms in the nation of filmes. and we certainly talkedabout these issues back then

and here we are stillneeding to talk about them today in this nation. and i think particularly with what'sgoing on in our nation right now, issues of race and diversity, ouryoung children feel it greatly. and so if this is a way to talk,maybe it'll help some families. that's my hope. so last book, publishedby scholastic. karen, you're from thescholastic, shout out to scholastic and [inaudible] was alsopublished at scholastic

with my wonderful editor ken geist. so, here's a storyabout a pediatrician. many of you may know as the medicaldirector of reach out and read is that still perri klass's directly-- perri klass and the breakfast wehad together several years ago. i have consulted with perrion many, many of my books. and she would have been here todaybut she's out of the country. if she could have beenso she sends her best. and bob we want to give a shoutout to reach out and read as one

of the founders in keeping it going. and brian gallagher who'shere from reach out and read. at that breakfast perriasked me of michael emberley and i would be willing to create anew poster for reach out and read and we can go right to it. just sticking with this slideit really take on all the issues about diversity and i likebooks that are a challenge, but i think they're books thati would have conversations. my kids are grown up with now-- now.

but i would have had-- i did haveconversations with my kids about. and as a grandparent i canknow what's happening today. so, here we go, if we would do aposter for reach out and read-- so perri and i were having breakfast which was the way we mostlymeet talk about nutrition, she also help with"what's so yummy?" and i said, "well, wait aminute, why-- let's do a book. let me do a book." and then i said, "i don'twant to do a book by comedia,

i want to do an actuallytrade book," meaning that it would be abook that i would do anyway that will go into a bookstore. but i will consultwith people on this and this is a differentkind of take. so i said,-- and i came upwith an idea at the table. i have often come up withan idea but then, oh my god, you signed a contract and you haveto write it, none of this really. so i-- so my immediateresponse is why not a book?

it could be about a young childwho loses its favorite book at the moment and can'tgo to sleep without it. i'd have that happened. my kids have that happened. and since this book came out i wouldsay 9 or 10 librarians have said to me-- had librariansat library say, you know, i get to work at whatever timei get to work, we open the door and there are three or four peoplemaybe once a month, you know, adults come in and say, i was justreading x and i can't find the book

and do it and they're totally panic. so it's not just kids. ok. and so the book you love,love, love, love the most it, just to that moment, right, because the next what youlove is coming up soon. before sleeping into bedand you have to have is gone and panic sets in,"maybe a bear ate it". you know, maybe that'swhat it happened. i knew that michael emberley woulddraw the most marvelous bear,

and he would say yes. and luckily scholastic published it. perri and i spoke the other dayabout this book and we talked about how picture book cannotonly help kids become literate but as we talked about contributed to even more kindsof healthy outcomes. just for starters and "maybe abear ate it", feeling that's ok to be very upset over a loss. and then i read a bookcalled "goodbye mousie"

which is a different lossabout a book about that-- a child who discovershis mouse is dead. he doesn't know it. he thinks it's just sleeping. but it's about death. it's not about dying,it's about death. it's a picture for youngchildren over there. learning the bedtime routine suchas getting into bed with a book and other bedtime routines is agood thing and a sleep matters.

giving a child a bookinto a sense of agency, the child in this book whosecharacter right here is-- you know, the child in thisbook really does something about finding his book. so i can do that, too. [inaudible] i answer to suchquestions as who did it? do you think a bear ate it? which can provide the[inaudible] back and forth between a bear and child?

giving the chi-- giving thechildren new vocabulary in the way to understand the story, drift onthe story, you just read to them and then make up their ownstories, or go onto another book to ask questions to fantasize. and as all of you tospoken about so eloquently to help parents have accessto information and kids. so in the end books matter-- we're finishing up here to childreneven more than we ever imagine because they can be part of manyhealthy outcomes for children

and children's familiesand sharing a book with a child can helpthem become literate. and i just wanted to saythank you sandra hassink for your [inaudible]article, literacy and health. it's a must read. sandra hassink and perriare two of the co-authors. it was really importantif you haven't read it. i'm going to end by askingyou to pretend the right now, you're about to hop on the bed andmaybe my talk is making you sleepy.

and if you can't find yourfavorite book at the moment, the book you love so much. well, here's a story about that thati would love to read to you now. this will take about one minute. "maybe a bear ate it". is it moving? ok. so there we go. you can read it. michael calls me up and he said,"how could we do that this whale?"

and i said, "well, that's theway i'll, you know, swallowed." but he could draw a shark andterrible things really awful. all these ridiculousplaces there about be. that's it. >> john cole: all right. robie thank you so much. >> robie harris: thank you. >> john cole: goodafternoon everyone. time to stretch it again to tryto stay close to our schedule.

we're very pleased to havesome visitors this afternoon, some students who areinterested in our-- the topic and we also have part of the panels are stillmeeting getting ready for this afternoon's performance. but we're going to start and thiswas the special brief presentation i told about where we are takinga look at our overall topic which is literacy and health andhow they relate or should relate and taking another look at literacy,health public policy project

of immediate concern and that isthe literacy in the ebola crisis. and we're fortunate to have aspeaker from the world bank. one of our board members miketrucano is from the world bank. but mike having a worldbank member as a panel, as a member of our advisoryboard has great advantages. but a disadvantage is he'straveling a good deal of the time. and he has asked andkaliope azzi-huck who is a senior educationsspecialist at the world bank has agreed tocome and talk to us a little bit

and about literacyin the ebola crisis. so let's give her alittle encouragement. you're all set. >> kaliope azzi-huck:all right, great. thank you very much. hi everyone. i promise i'd only talkfirst about 10 minutes. so i'm just going toset myself a timer. i'm kali and i cover the educationportfolio for the world bank.

i work on a number of countriesmostly slay throughout west and central africa but i specifically coversierra leone portfolio which is the one in question here. so to delve right into it, i just wanted to give you somebackground on sierra leone. it's nothing that you don'tknow because it's been in the news quite oftenat the past year or so. small country, populationof 6 million

about 42% of people are literate. so-- and that number-- sorry-- imeant as high as 75 are not literate in rural areas mostly women. so they're out of school rate whichmeans kids who are still growing up not literate is about25% of school age children. and their infant mortalityrate which given the subject if today is relevantit's about 117 in 1000. in terms of human development impactsierra leone has immense challenges. it's ranked to 181st outof a 188 countries in terms

of human development which meanssocial services, health education, social protection are very, veryweak they don't have the systems for it and they don't havethe infrastructure for it. so when the ebola hit in-- i thinkit arrived in sierra leone in april of 2014 and steadily climbed up. initially it covered the districts,if you that bordered with guinea and liberia and then it's spread. and once it spread to the capitalfreetown then it just became an immense problem and it justclimbed up and up as you know.

so the havoc that it unleashed is on the population 14,000 peoplewere infected and about 4000 death. i think just under that. it faired a little betterthan guinea where, you know, the death rate was much higher,guinea compared to the infection. on the health i just wanted youto give this fact it's a country that already had weaksystems of 6 million people, a 188 specialized doctorsand ebola took 12 of them. to give you an anecdote withthat did for the medical school,

the only one medical school infreetown is basically stopped it. the doctors were also lecturers sonot only did you lose practitioners but now you're losing ageneration of future practitioners. so on the economy, thegdp growth was cut by 50%. i won't bore you with thatbecause it was obvious. everything came to a halt. they were embarking on ahuge economic strategy, iron ore was doing wells. so they had investeda lot in mining.

they had already had diamond miningand the sector basically collapsed. two of the three majorcompanies packed up and went home so people were left without jobsand without any prospect for work. on school children, for healthreasons schools were suppose to start in september of2014 and they did not. and they remained closedfor eight months. so children were left idleand as a sort of aside element of that teenage pregnancyskyrocketed. and this is something that weas partners didn't know either

that a lot of young girlsactually are in school and are de facto protectedfrom all these social issues. it became an issue for these youngwomen who were at home, no income, no sort of prospect of anything and things became really,really challenging. so i'll talk about whythat became an issue after school reopenedat the end of this. and then on physical infrastructurethere just aren't roads. so it's really difficult to get outto people and to get the messages

out to people about whatneeds to be done in order to sort of combat the evd. so how the government responded? there was a national curfewthat lasted for four months. you basically would notsuppose to be out after 7 or 8 p.m. restaurantswere not supposed to be open unless you were a hotel and therefore you neededto feed your guest. traditional burial practiceswere eventually outlawed

and initially there were discouragedand then they basically said, "no, so anyone passed awayyou couldn't touch them. you had to call." and ambulances would come andthey would just take the body. and it was regardless of how theypassed away they fell of the roof. they-- you know, it didn't matter. and you would then waitfor a call from someone to say this body is clearedand you can now bury it. or oftentimes they would justbury it and give you a name

and said we'll deal with it later. and that's what we'redealing with now is a lot of tribes have very uniqueburial traditions and they have to get the bodies back in orderto rebury them essentially. so it's a matter or figuringout what needs to be done there. there was intense collaborationamong partners and government. i think unique to the situation wasthat there weren't a lot of people in sierra leone to begin with. so there were only fourof five donor partners

that were already engaged. so we all kind of worked together. the funds that were provided fundedmedical supplies, that's obvious, food to quarantinedcommunities, medical staff, and local health workers' salaries. because unicef was on theground, unicef took the lead in the implementation and thecoordination and the world bank and [inaudible] andothers basically we work through them and withthe government.

so overcoming the crisisgiven the lack of literacy in the country, we used radios. we procured radios, used radiomessages, used television messages. we hosted talk shows. produced jingles anything thatwould get the message out. this-- some of you may know this. but your cellphonesin other countries, actually all other countries exceptthe us has a radio transmitter. so we were able to get outto people with radio messages

as long they had a cellphone. we also bought as donor partnersabout 80,000 radios for household that mostly for the rural areas. we also brought cast lessons. and in those lessons it wasthe core subjects as well as psychosocial messages aboutebola, about five times a week. and these lessons ransort of on the hour because the government wantedthe kids to get as much education as they could during the closure.

so they initially had said,"you will still be required for to complete the academic year." we also use image-basedmedia campaigns. i think you've seenthese on the internet. so instead of saying if you havesymptoms of vomiting or diarrhea, we actually had cartoon images ofsomeone vomiting and the diarrhea. and that was the most effective wayto get the message out especially to those who couldn't read. we used the communities.

there's a lot of socialmobilizations. so basically it was thetrickle down effect. we used the paramount chiefs. it's a country of 149 chiefdoms. so all of them came to town andthese are the elected official so to speak but alsotraditional leaders. so they can read and write. they came to freetown and therewere workshops that they attended and then they would go back andcarry up community mobilization.

and so that when that seem to beonly some what successful and it was in december i believe and thenumbers were still climbing. the government tooka drastic measure of doing this [foreign language]. it's basically house-to-houseebola talk. and there was a national quarantinewhere everyone was to stay home for three days unless you were oneof the volunteers that were moving. we used a lot of youth and they wenthouse-to-house with two objectives. one was to identify if youhad sick people in the house

and bring them to treatment centers. and two was to communicatethe message about ebola. and this i think was themost affective way to do it. it was a lot of manpowerand it was drastic. but it seemed to then work because the numbers beganto go down after that. there was diligent contact tracing. so as soon as someone wasdiscovered to be ill a team of contact tracers wouldgo out into the community.

the community wouldhave to be quarantine, so one of the major investments that the donor partners didwas food for these communities. i think you heard a lot of-- and at least we heard alot of anecdotal stories about people trying to escape simplybecause they had run out of food and they needed to get out. so, with these contacttracers, there's also a lot of messaging that was involved.

and then there was a dedicatedhotline that was involved. if you suspect someone ofhaving ebola or being sick or if someone diesthere were hotlines. and the hotlines werewell-funded and well sort of oiled to move very fast. so coming-- sorry. so coming out of the ebola crisisbecause education is my background so i could speak to you aboutwhat we did to reopen schools. one of the major concernswas the safety of children.

given the infrastructure and thefact that children share everything in the classroom including seatsand you have four to five seating to a seat and ebola is transmittedby touch, all you needed was for one kid to transmit it topotentially an entire classroom. so, there were workinggroups established that focused on everything. there were protocolsthat were developed and received certification from who. and then we implemented a systemof distributing wash buckets.

i don't know if i have-- somewherein here i have the photo of it. it's basically a plasticbucket with a little spigot at the bottom that'sfused into another bucket and you put a littlebleach and soap in it. and every child have to washtheir hands coming into school. we also procured tonsand tons of thermometers. every school received at least twothermometers for 50 kid and then for every other 50 kids i thinkan addition of thermometer. and kids had to betested every morning.

communities, not the schools,were tasked with recording that a school is ready to be opened. so we used social mobilization. and if a community felt that schoolwas not cleaned it was not open, they would report itback to the ministry and then we would engage the-- sothe ministry of health to make sure that it gets cleanedbecause the ministry of health took care ofcleaning the schools. we also used the radio to informparents that schools are safe

to reopen that they arebeing sanitized the-- their children willbe ensured safety that there are measures in place. and then we trained atleast one teacher per school to understand how todeal with ebola. the reason i wanted to put tosay that we covered psychosocial and technical areas is we wanted tomake sure that if a child is found to just have a fever that they arenot stigmatize it's very likely they have just put out in the field inthe sun until their parents came.

so, we wanted to make it understoodthat there is a lot of compassion that was necessarygiven what was going on. ok. what we did not do. we did not evacuateour international staff and that helped significantlybecause we still have the manpower. on the bank side we did notrequire the staff travel there if they did not feel comfortable. but if they were able to, everyonewas coming and going regularly. we did not establishisolation rooms in schools.

and this was importantbecause as we went to reopen schools the governmentreceived 4000 mattresses that they wanted to put in schoolsand the decision in the end was that you can't build minitreatment centers in these schools and you can't give the impression that this can be taken careof at the school levels. someone who is expectedof having ebola needs to come off the premisesas quickly as possible. we didn't open schools that havebeen used as holding centers prior

to who certified sanitationthis was obvious. so we need the ministry of healthto clean it and then someone to say this is ok becausethere was a lot of-- there was a lot more diligence thanjust cleaning up of that school. we didn't taking unisexual approachand this is often what happens. so i can only think about education. in this case, we figured outthat health needs to step in. social protection, the ministry ofyouth needs to provide the manpower and education needs to come up withthe plan and deliver information.

we did not address the issuepregnant girls from the start. we knew that the pregnancies wererising and as schools were announce to be reopened on april14th, the ministry announced that pregnant girls couldnot return to school and they could not take the exams. and the reasoning was that theywould give the wrong lesson or there would be wrong role modelsfor the other girls in schools. the donor partners and many felt that this was punishing the girlstwice once for getting pregnant

and once for now losing outon potentially education. there was a lot of back and forth and in the end what we now have isa program for the pregnant girls and those who gave birthin the last eight month to do alternative education. and once they have their child andthey can catch up they can return to school assuming that they havenot following too far behind. it's a reasonable kindof catch up effort. but i think if we haddealt with it early

on this wouldn't have been a biggerissue now nine months down the road. and that's the extentof my presentation. i put in some pictures thatyou can see of the students and the wash buckets that were-- students having their temperaturetaken and the wash buckets. ok. so that was 15 minutes. >> john cole: kalithank you very much. this is insightful andinteresting and brings us kind of into a different part of thesubjects and we appreciate it.

we have to move on to try to keepup on our schedules so i'm going to have jeff come up and bringhis panel and we will get started. and give mike our best as well. and our chair is jeff carterwhom many of you know. jeff is been deeply involvein all aspects of literacy but especially adult literacyand he is the executive director of the national adult educationprofessional development consortium and the national council of statedirectors of adult education. i know him best and hehad another role of his

and that is he is currentlypresident of the national coalition for literacy, which is one ofthe center for the books' reading and literacy promotion partners. so we've come full circle andi'm turning it over to jeff. >> jeff carter: thank you john. thank you john. and thank you everyonefor coming out today. this has been an incrediblystimulating half-day so far. i'm looking forward tosecond half of the day.

as john mentioned ihave several titles. if you work-- i said thisis to someone earlier. if you work in adult literacy youhave usually have two or three jobs. you know maybe a couple to pay you and several volunteerjobs at the same time. i just want to sortof set this panel up. we're going to be talkingabout adult literacy and health during this panel. and i thought it might be helpfulto just give you very briefly of--

some review of thelandscape of adult literacy in this country right now. many of you i hope everyone actuallywould find it shocking to know that according to thelatest data that we have from an international surveyconducted by oecd a few years ago, they estimate thatapproximately 36 million adults in the united states havelow literacy or math skills. our federal system of adulteducation talk a little bit what that looks like servesabout 1.5 million people.

and in that survey that oecdconducted, they ask people, "would you like to attendan adult education class?" and they estimated as much as3 million people would love to attend an adult educationbut cannot access one. there isn't one where they are. and that probably is just--that's probably a very undercount of the actual demandfor these services. so, that's the landscapethat we work in. let me tell you a little bit aboutthe kinds of programs that work

with adults and adult literacy. they range from community-basedorganizations, volunteer-based organizations,faith-based organizations, schools including charterschools and community colleges. so it's a system that a lotof people are not as familiar with just compared to k through 12or higher education because it is so diverse and many of ourstudents of course are-- they come for all kinds of differentbackgrounds and they're not as easily identifiable or as visibleas in our other educational sectors.

i want to talk briefly aboutwhy i think a discussion around adult literacy andhealth is so important in this-- in the context of our day-to-day. and i was thinking aboutthis as i was listening to the speakers this morning. and one of the first statistics that was mentioned earlierwas this issue that-- and, again, talking aboutanother staggering number that 48% of our children are growingup in low-income households.

so why are adults critical there? well, educational attainmentis directly correlated with earnings power. so when we educate our adults weeffectively can address the issue of children growing inlow-income situations because we empower those adults toearn more and raise their incomes. so that's one factor. of course, the other one,parents are a critical influence on a child literacy development.

and frankly, if we are going tomake a significant impact in terms of health outcomes as we look atthe connection between literacy and health, we can't ignore those. there're too many of them, asi mentioned 36 million adults. if we put all our energy just inthe children we would disappointed by the outcomes because we wouldnot be addressing the needs of those 36 million adults. and then lastly, and this hasbeen touched on a little bit, i'm really glad to hear it.

i think we have moralresponsibility. one thing that's really importantto remember about a lot of adults who find themselves in the situationis that that's related to factors that have-- that are relatedto issues about inequality and historical vestigesof discrimination. robert needleman mentioned this. this is a very strangecoincidence i hadn't thought about. you mentioned how reach out andread had to change their acronym because it was being used by anorganization that was protesting

in boston during theboston crisis, roar. i didn't thought about thatin years, i grew up in boston. and it mainly reflect thefirst time i got involve with adult literacy,i was this tutor. and i tutored a guy who wasevery bit as smart as i was. everybody is engage andcurious and hard working-- probably more hardworkingthan i was. the difference between me andhim is that he grew in the city that was practicing systematicdiscrimination for people of color

and he did not receivean adequate education. and that's why he endedup where he was. so i've mention because i thinksocial justice and in equalities and important part of thisdiscussion and i was glad to hear some people touch on ittoday and i think that's something to think about as wecontinue the discussion. that said, i like to introducemy panel, my esteemed panel. to my left robert logan isa member of the senior staff of the us national library ofmedicine and a professor emeritus

at the university of missouricolumbia school of journalism. i'm always worried but-- whenseniors staff i think that's-- i was weary of those title because it makes you soundold but you're not old, see. >> robert logan: iagree [inaudible]. >> jeff carter: well. to steve's left-- i'm sorry. to robert's left is steven rush, the director of theunited health group--

health literacy innovationsprogram an enterprise-wide program to help consumers understand and usehealth and wellness communications, and the former directorof physician engagement at unitedhealthcare health service. to his left, michele erikson,is the executive director of wisconsin literacywhich supports, develops, and advocate for literacyorganizations across the state of wisconsin. her work with wisconsin literacy hasfocused on health literacy and ways

to improve health outcomeand reduce health care cause by educating both providersand patients on more effective waysto communicate. and we're going tostart with robert logan. and we're sort of organized this is that robert is going give us the10,000 foot, look at this issue. and then we're going to have stevegive us the 1000 foot issue-- foot perspective. and then when we get to michele,

she's going to give us theperspective from the ground. so with that said takeit away robert. >> robert logan: thank you jeff. thank you jeff. and i appreciate theopportunity to be here. our lawyers say wehave to say in public. we speak for ourselves. we don't speak for thenational institute of health. we don't speak for thenational library of medicine.

and i don't speak for theus department of health in human services either. or i also don't speakfor the national academy in medicine health literacyroundtable that steve and i are very active in. steve i guess you could speakfor it if you wanted to. i'm also the editorof the first book on comprehensive healthliteracy international research that i hope will bepublish in about 18 months.

and before i go on, thank youdr. sullivan for your leadership. the national library of medicinewould not be what its today had you not been at the us departmentof health and human services at the time you were there. very nice to see you as always. let's-- this is the front entranceof the national library of medicine. walk 9 miles that wayand you'll get there. ok. it's part of the nih campus. look at our unambitious mission.

that's a joke at thebottom in the page. nlm is pubmed. ok. it's all i have to say. i mean that's what we--need more-- more i have to. if you don't need-- if youdon't know what pubmed, quietly don't let dr.sullivan know that, ok. and that we're also thepublisher of medlineplus. something that dr. sullivanhas been a long advocate of. medlineplus is it trying toprovide health information

down to the level of consumer. i'm not going to show that today. but nevertheless, that is-- if you're not familiar withthat website all of you who are interestedin those go there. please don't tell me that thereare not efforts to explain health and medicine in a broadcomprehensive scale in american public. there are and they've beenthere for about 20 years.

by the way, if you to medlineplus, you'll see a lots oflinks to nemours. in many of medlineplus siteswe link on various issues to websites that nemours has. i'm going to talk briefly aboutone topic how health literacy-- adult health literacydiffers from adult literacy and educational attainment. the second topic i would-- i'vedecided, for the purpose of time to discuss during the q&a assumingthat jeff ask me the right question.

on-- >> jeff carter: i mightsurprise you. >> robert logan: who knows? >> jeff carter: theytrusted me way too much. >> robert logan: on the screenis the calgary charter definition of health literacy. as you read and i'm notgoing to read for you. as you read it, remember this, that every single word you seeis the most expensive real estate

imaginable, ok. people fought overevery syllable on this for months before it wasactually published in 2012. there are more than 50definitions of health literacy. this is just one. but this is the onlyone i know that was done by interdisciplinary consensusof people from around the world, which is why i haveit up in the screen. here's my wonderful friend ceci doak

who was the pioneerof health literacy. this was taken several months ago. ceci and len doaks were health--adult health educators in the 1970s. and they discovered there wassurprisingly little research about how to best explainhealth and medicine to patients. so they decided todedicate their career to professionalizing adult healthliteracy health education, research, and practice which they laternamed "health literacy." they coined the term.

here's some of the doaks'discoveries in the 1970s. first, person withbelow 8th grade reading and other literacy skillsrarely understood health and medical information. so low adult education attainmentthey believe was associated with low adult literacy. low educational attainment and lowadult literacy also were associated with less understandingof health materials and also health informationseeking, which is just as important.

the doaks' other discoveriesin the 1970s that medical and health informationwere not presented. so they could be readby low literate person. for example, the term"avoid" the term "prevention" alone weremeaningless to most of the people that they used. if you'd put the word "pre" that [inaudible] any wordimmediately they said they argued about two-thirds in the americanrepublic have no idea what you're

talking about. to stop-- just think aboutthat right there, ok. medical jargon was anobvious, very understanding. here's just three examples. i'm sure we can come up withseveral hundred among us, ok. routine medical jargon which waswell-intended was significant barrier to understanding. and they argue that clinicalmaterials need to better-matched to patient's skills, somethingthat we still very much believe.

and they began-- planned intervention tomatch materials with skills. in the 1980s afterseveral years of many years of practice the doaks hitan interesting confound that well-educated literate adults,i said well-educated literate adults and young person, oftendid not understand health and medical term either. often they had as little interestin learning or discovering how to seek health informationas low literate persons.

they conclude the association amongeducational attainment literacy and understanding of an interestin health maybe one directional, which was the first timethat was even postulated. yes, low educational attainment wasassociated with low adult literacy and less understandingof health and interest in health information seeking. yes, higher health education-- educational attainment wasassociated with higher literacy. however, and here's the key point,higher educational attainment

and higher adult literacy werenot consistently associated with more understanding inhealth and more interest in health informations seeking. and that was jarring tothis day, ok, hypothesis. the confound. why are the associationsnot bidirectional. this troubled the doaks at first. for years they try to explain it. and then they began tonotice that it helped explain

that this informationand this information about vaccines, for example. this is one example amongvery well-educated americans. that's the only way youcould possibly explain. then they begin to-- say, theconfound also provided insights such as why english is secondlanguage adult learners often are helped by using health materials. while other adult learners, people who speak englishwell are not helped

by using health materials. again, they couldn't explainthat until they begin to realize that the-- what they assumedall along wasn't not necessarily the case. soon, ok, the doaks started touse the term health literacy to describe the underlyingdynamics they were experiencing. in the 1990s, the doaks arguedas a dynamic of personal learning and constructive interventions. adult health literacy might beindependent of adult literacy.

they began to argue forthe first time that we need to assess health literacy onits own merits on its own terms as an independent researchconstruct. and intervene with strategiesto impact literacy as well as strategies to impacthealth literacy. not to one or the other but to both. twenty-first century research, whichis now abundant, suggests strongly that the doaks' observationsare correct. health literacy is apparentlyan independent dynamic,

at least the evidencestrongly suggests it, that should be assessed separately from educational attainmentin adult literacy. health literacy is an independentresearch construct that's separate from adult literacy andeducational attainment. while health literacyand literacy are similar and are highly complementary,there are times when they diverged from each other andthey can be different. the national assessmentof adult literacy

and other findingsconfirmed about in 2003. it is important to respectsome inconsistencies and think in terms of dual strategies. work on both literacy andhealth literacy simultaneously. here are some current healthliteracy research issues. there less about acknowledgingthe differences between literacy andhealth literacy. i think that era isbasically over now. and most people instead focus onhealth literacy and health outcomes.

health literacy and the utilizationof the health care delivery system. and briefly, here a few findingssome of clinical benefits that have been link to healthliteracy interventions include reduce mortality, improved patientadherence to medical instruction and overall patient safety. the health literacy interventionscan therapeutically assist patients with cancer, diabetes,asthma, and hypertension and at least 11 other diseases. the specific healthadministrative benefits link

to health literacy interventions,again, these were all-- i'm just making it trying to-- a lot of research more than60 papers in a few moments. some of the healthadministrative benefits link to health literacyinterventions include; improved diabetes patientself-management skills, much more use of preventiveservices, as well as a significantreduction in hospitalization and rehospitalization rates.

as dr. sullivan knows well,the letter has a direct impact on the cost of health care. here's a glimpse of why it is anabsolutely fastening time to be in health literacyresearch or practice. health literacy interestscover the waterfront. they include all the variousstakeholders you've seen on the screen. the interests is welloutside the united states. there's very active healthliteracy research now

and several other countries here,four prominent ones on the screen. michele and i will be on aconference call, i think, it's a week from tuesday,where there'd be at least six or seven other people from aroundthe world on and it's normal. health literacy-- the roundtable of the national academies activelytakes a leadership role in this area and has for now for 11 years. here is their website. sorry. it's long.

and i'm afraid-- i'm embarrass totell you they're about to change it. >> steven rush: theychanged it yesterday. >> roger logan: thank you steve. you can follow the field'sprogress, of course, in pubmed or medlineplus.gov. here are three resourcesto cover the field. the first is how you cover thepubmed with the special curated area that does nothing butprovide articles-- excuse me-- referee journal publicationsabout health literacy.

here's medlineplus' health literacypage, which for those of you who are not a health carepractitioner, i encourage you to go. they'll make much more sense to you. and finally, there's an excellentresource which we have nothing to do with in harvard universityabout resources. and the reason i put that one onthe screen among many is that-- this particular one specializes inhealth literacy and adult education. i went through my referencesreally fast, but that in-- that i certainly have them andi thank you for your touch.

>> steven rush: thanks. >> robert logan: yup. >> steven rush: so, i'm steverush and i'm the director of the health literacy innovationsprogram at unitedhealth group and you'd said, "why is ahealth insurer interested in health literacy?" and in the next fewminutes i'll let you know. i don't want to-- out of the bed. let me just to ask a question.

how many of you havebeen faced with decisions about buying insuranceor using health care? how many of you know what yourcertificate of coverage says about getting a ride to thehospital in an ambulance. nope. how many of you trulyunderstand everything your physician has told you? guess what? we all have low health literacy. low health literacywe've talked about it

and it is really interesting. people have talked abouthealth literacy last night. dr. bailey talked about it. this morning we've talked about it. and i wanted to share with you thathealth literacy is not a trait. it's a state. it changes. and i'd like to thank thelibrary of congress and nemours for inviting me here todayto talk a little about that.

this morning dr. needlemantalked about bookkeeping and basically talkedabout downstream costs. and i'll be addressingthat in a minute. but what i wanted to tellyou was that health literacy at unitedhealth group reallybegan about seven years ago. and dr. migliori who's shown hereis really a very big proponent of that at unitedhealth group. we have the "just plainclear communications" program where we're attempting tocreate health communications

that are simple, accessible,understandable, and actionable. so, why is health literacyimportant? we've talked about it a little bit. we all know that healthliteracy is transient and people have difficultyunderstanding and using health care. and in today's healthcare environment more and more responsibilityfor utilization of health care is being puton the consumer, the patient. and it's difficult.

it's really difficult tounderstand all the intricacies. we've talked a littlebit about people with low health literacy having agreater risk of hospitalization. at the cost of the healthcare system using 2005, 2004 data was up to$238 billion a year. i think it's more upwardsof $240 billion a year. and we do know and robjust talked about it that health literacy is relatedto medication and treatment errors and medication adherence and abilityto follow treatment recommendations.

health literacy by the numbers. it's a minimum of 77 millionadults in the united states have-- don't have basic literacy skills. from a payer standpoint the averagemedical cost per year of a person with higher healthliteracy is about $3000, while the average costper year of a person with lower health literacyis $13,000. that's a different of about 433%. we did some research and wefound that taking the look

at people utilizing health carewithin a low literacy community versus the higher healthliteracy community, the difference was amazing interms of unavoidable admissions to the hospital, utilizationof the emergency room, following treatment recommendations. the average reading level for a lotof health insurance documents is-- was at about 10th grade,10th grade wow. we have states that are requiringhealth information to be written at the third grade level.

most state require people tohave written communications about the sixth grade level. and realistically not choosing and using health care isreally very difficult. the patient protection affordablecare act defined health literacy in the law and it'sbeen talked about here. but people in the healthliteracy community talked about that definition is notbeing quite enough because-- just because you make a decisiondoesn't mean you're actually able

to take that decisionand then actually use it, take put it into action. i like the definition that rimarudd, one of our colleagues talks about and she says that "healthliteracy happens when anyone on the receiving end of healthcommunications and anyone on the giving end of healthcommunications truly understand one another." there's no blame here. early health literacywere blamed the person.

you have low healthliteracy, you're dumb, you don't know what's you're doing. no; it's an equal bidirectionalresponsibility. so we-- and i did help fill that health communicationshould be simple, accessible, understandable, and actionable. so why is there a healthfocus on health literacy other than all the cost while the patientprotection affordable care act 2010 defined health literacy inthe law for the 1st time.

and then they're followedfederal rules and guidelines and now accrediting organization andquality organization are demanding that health literacy be acomponent of the way people in the health community do business. state agencies are mandating thatliteracy level to be put into play. customers, people who are payingfor health insurance, cms, and larger corporationseven the employer-- other employers are saying you got--give information to our employees and consumers rememberthis, say it too.

and there's that gentleman inthe lower right hand corner. and most of all providinginformation that's simple, accessible, understandable andactionable is the right thing to do. so why is there-- what's the linkage from health literacyto health outcomes? you'll notice thatreading isn't there. but that's something that is--that i point out because reading is in fact a very important segmentsbut so as race and ethnicity, again, language, and age, vision, hearing,

verbal ability, memoryand reasoning. and one of the things that idid when i was talking to one of our leaders was to say,"hey, look at this over here." and he said, "i didn't knowthat vision and hearing and verbal ability,reasoning was in there." "oh, yeah, it is." but take a look at how healthliteracy impacts how people choosing to use health care, take a look athow health literacy is important for that provider, health careprovider and patient interaction.

and if people can't understandhow is it that they're supposed to be able to takecare of themselves? the many, many-- today's healthcare environment really focuses to a greater extent than in thepast on chronic care conditions, diabetes, heart, asthma,other pulmonary problems. the day-to-day care that needs tobe done for that person is provide by that person or their personalcaregivers, 95% of all chronic care on a daily basis isprovided by that person or their personal caregiver, 95%.

so kathleen sebelius at one pointsaid, "if people can't understand, they can't decide,and they can't do." and that's-- that's what shown here. there are number of factorsaffecting health literacy, one is the general literacylevel of the people, experience with the healthcare system, physical and psychological factors,culture and language, aging, complexity in information. and my god, i can tell you thathealth insurance information

and health care informationis so complex. i wish i could saythat i had a full head of brown hair before i startedworking in the insurance company. but i can't do that. learning style is really importantand how information is communicated. so reading is really importantso as listening and math, math is really becoming a veryimportant factor, speaking, writhing, thinking, health careproblem solving, health literacy, think health care problemsolving and remembering.

and if these skills doesn't need tobe put into consideration to think about what member does,or a patient does and then the health care system. so here's some startling facts. $240 billion a year inmedical cost are associated with low health literacy. recent research showed that 4 in 10 uninsured don't knowbasic health insurance terms. wow. yet these people are going tobe responsible for the medical spend

and fewer than 4 in 10 understandcomplex coverage concepts. this is an amazing fact. millennial may have--maybe the best educated. but they have hugegaps in their care. and choosing and using healthinsurance creates cognitive burden. but the other pieceto that is many people over estimate theirknowledge of health insurance. three out four peoplesay, "hey, i can do this. i know this stuff."

but when push came to shove, only one in five reallydemonstrated the capability. so what does that meanin terms of literacy? so jeff talked about piaa thatwas the international program the assessment of adult literacy. three components to it,understanding written communication, working with numbers,and then using computers for health problem solving. take a look at where the us isrelative to 24 or 20 countries.

what does that mean for literacy? us is tied for 7thlowest of 24 countries. we're 3rd from the bottom in mathskills and we're 3rd from the bottom in 20 countries when itcome to using computers for problem solving,very interesting stuff. what's the implication? health communicationsand learning style. we did some research and we foundthat in a general population of 18 to 49-- to 64 years old,60% were visual learners--

60% were visual learners, 15% wereauditory learners, and 25% mixed. take a look at whathappens when people aged. it's really different. so that's-- i'd like youthink about cognitive burden. cognitive burden has two parts. one is the burden of illness. boy there's a lot stuffthat you have to remember when you're a diabetic. and it changes the wayyou live your life.

and then there is theburden of treatment. when i wok with our telephonicpharmacist training them to communicate in simpleunderstandable and actionable ways. i say, "to what extent are youadding to the burden of treatment when you use terms like"--you-- there's a medic-- we have a medical class or a medication classcalled angio tension, beta blah, blah, blah, blah. and they go.

i was just put on the medicationand than i could barely say it. so health literacy another look, i really like this cognitiveburden piece on the left hand side. basically it says, "when you loadmy brain up with confusing choices, ambiguous phrases,unparasable sentences, you impose a cognitive burden. you make me think, andnot about your subject. you are making me translate,transform, interpret what you say. and this distractsme from your point."

and then there's always georgebernard shaw with his statement about the illusion thatcommunication has taken place. i want to share with you aresource that we've created. it's free. it's done as a social responsibility and that's the just plainclear english-spanish glossary. no one will call up and say,"hey, you use our glossary. you want to buy our insurance?" no-- that's not what it is.

what we've done is taken over3400 complex health insurance, healthcare terms and otherterms, and put them more simpler, understandable language and wecross walk that with complex banish and complex and moreunderstandable spanish. and we're going through a redesignright now where we're going to hook up into images andto movies and pdfs. the just plain clearwww.justplainclear.com, we've use this withenglish as a second language with adult basic educationprograms and because it's

on our responsive platformyou can open it up. and when you're seeing the patientand you can't remember the english or spanish term you can lookit up and it really does work. i appreciate your time. >>michele erikson: so-- good afternoon. my name is michele erikson. i have been involved in adultliteracy for quite a while, longer than i'd like to admit.

but about 30 years now. i started in adult literacyjust of out of college. i got a call from the boyd publiclibrary asking me for money. and i said i have two college loans. i have no money. but i probably could help someone. i've been in the libraryand saw advertisement to become a literacy tutor. i thought i might beable to do that.

and so i went to the trainingand met my first student, bill. bill was a 39-year-oldfather of a 9-year-old. and bill did not knowthat names of the letters or the sounds that they made. and he just got-- he just beenlaid off from his job as a welder. and we started-- we are goingto meet at the public library and he told me we couldsit outside in the bench but he would not go in the library. there are far too many books for himto feel comfortable in a library.

so we sit outside in the benchand we talked awhile and started to meet at his kitchen table. not long after we were meetingand some trust was built he shared with me a letter that he had in adrawer for about two and half years. it was from the dmv and the lettertold him what he needed to do to get his drivers license back. it had been revoked. and neither he nor his wife couldread the letter nor did they want anyone else to know theycouldn't read the letters.

so there it sat. i was thinking about that. i'm really glad it wasn't a letter from a doctor telling him whathe needed to do to take care of his health or hisfamily's health. so we started working towardgetting bill his driver's license and moved on from there. but that's how i gotinvolved in this. and it just stuck withme ever since.

i did not realize as a collegestudent there were adults that didn't read and write. it just never ever occurred to me. so i find myself atwisconsin literacy. i started there in 2005 and beenworking a lot and health literacy. we're a coalition, a statewidecoalition of 78 agencies that provide directsupport for adult learners. and we-- what we do is providethe capacity building and training for those agencies, to help themtrain more volunteer tutors.

we work also as an advocacy agency. we worked around workforcedevelopment. so we're helping our agenciesprepare their adult learners for the workforce andjob readiness skills. and then our biggest division is-- area we're working is calledwisconsin health literacy. it's a division of itself underour wisconsin literacy, inc. umbrella and it has its ownwebsite and has really been working in this field since about 2003.

a lot of growth since 2003. we have services that we provide. we do a summit every other year. we have one coming up in april 17. and these have become largerand more comprehensive. now, there are national summits and we've had internationalguests as well. and it's a wonderful opportunity tobring health and education together under one roof and we spendabout two and a half days

and we learned a lot aboutthe things that are going on in our country andin other countries as well around health literacy. we do a lot of awareness building. we started out just educating ourstate about what health literacy was and it's impacts and implications, we do a lot of communityhealth projects where we go into community agencies. primarily, we started withour literacy agencies.

but now we've now we've branched outto a lot of social service agencies that are serving vulnerablepopulations and do community health projects. and then on the other side of this,we worked with providers and a lot of education and training,how to speak plain language. as you-- the definition that robprovide in the calgary charter talks about the communicationpiece of health literacy and it really is a two-way street. it's really important that whenproviders are communicating

that they understand how tocommunicate in health literate ways. and so we work on trainingalong those lines. so, again, you get to learnthis over and over when-- it's a repetition thismorning is one way to. so you've seen this but 90 millionamericans trouble understanding and i think that is reallyimportant to remember. there's just so many areas in thisfield from insurance to, you know, taking your medicine at home thatare impacted by health literacy. so i wanted to focus, juston one of our projects.

we do many differentprojects out in the community. but the one i'm going totalk about today is called "let's talk about medicines." it's actually-- we had one-- before this we worked on called"let's talk about the flu." so these are community projectsthat are funded by, this one, by security health planand insurance company in our northern part of the state. and we looked to agencies where wecan go out and provide information

in a health literate manner at alevel that everyone can understand. these call-- or this project westarted out working with seniors because seniors are utmost atrisk for health literate behaviors that can have great consequences. they take more medicines andother things that are happening at that time affect this. so we've gone from seniors andi'll talk a little bit later. we're now working with refugeeswith the same project on medic-- let's talk about medicine.

so these are the goals of the project really understandingwhat a medication label looks like, the dosage, special instructions,feeling comfortable talking to your pharmacist, remembering how to take your medicineand where to store them. we usually do this inopen hour workshops in different community settings. so we've been everywhere from,as i said, senior centers. we've-- we're in salvation army.

we're in our literacy agencies. we're in neighborhood centersand providing this information. this particular projecthas a pill box incentives and this is a workbook thatwe developed for this project. there are some on back. there was the let's talk about fluand let's talk about medicines. but basically we developed this. it's written about a 4th gradereading level and it goes through the many project goals thati had just talked about previously,

lots of pictures, easyto understand, writing, lots of white space. so this is the tool that weuse similar one with the flu. but we started in 50 workshoplocations across the state and deliver the workshop. we've had-- every time we go theyask us when we can come back. we are on working developingother things with the workbook. so examples of what that lookslike inside, types of medicines, prescription medicine and labels,and the medicine reminders.

each participant is-- getsincentivized with the pill box that they get to take homeas well as we do other things like we do a preimposed test. so each participant comes inwith a very simple pre-test and then this post-tested. so we can get somemeasurement on understanding and knowledge gainduring the workshop. we develop some card games thatthey do during the workshop as well that give situations aboutmedication use and safety.

we've also worked on some videosthat are posted on our website now. there's three of them. these two here, "whento take your medicine" and "how to store your medicine." they're just abouta minute and a half, really short easy tounderstand videos. there's also one abouttalking with your pharmacist. and we promote thesevideos during the workshop. we've done online aswell as a printed quiz,

so that participants can take thathome and use it with their family. and we're also now training thetrainer on these workshops so that when the funding runs out thatorganizations are equipped to care on the workshops on theirown with as many resources that we can make available forthem with very limited cost. so here are some ofthe things we learned that there's a really big gap. and in this particular projectwith seniors what they really know and what they think theyknow as you had pointed out,

everyone can thought,"yeah, i can do this." and then all of a sudden whenyou're asked to demonstrate it, it becomes a little different. medication storage is an issue. there was just something ongood morning america today about children accessing pill boxesand medications and how easy it is to had all this little kids openingup a child proof pill boxes and, you know, very easily like one kidhad it done in nine seconds and-- >> steven rush: andthese were child proof?

>> michele erikson: theseare child proof, yeah. so, yeah it was veryreally interesting story. so medication storageis a really big issue. the label instructions haveoften caused confusion. those are the ones on the side to the special labelsare often a source of confusions for many people. and remembering when to take themand how to take them and reluctance to ask pharmacist,we show a lot of--

we show this video a lot fromthe ama where people talked about their own health literacyexperience and, you know, knowing when to take your medicineis not something that's easily understood on the label. so take two tablets twice a day. that doesn't register with everybodyand there's a little video clip of a woman saying i take, you know,i have 16 pills a day that i have to take and i don't want toforget and i'm not sure exactly when to take them, so i justtake them all in the morning,

so i make i've got them all in. and so, you know, thishappens and it's very real. so these are the resultswhere again trying to-- measuring health behavior outcomes and changing health behaviors,a very difficult thing. this is just the results frompreimposed test, understanding or identifying the number of pills,like i said people think they get it but when they ask it like putthe number of pills correctly-- the correct number ofpills in their hand

and it becomes a littlebit different. so 72 were ok in thepre-test, 85% on the post test. i should also say that thissimilar study done in 2006 with intermediate bothlimited literacy intermediate and proficient literacyadults was done. and even the proficientliteracy folks that were asked two tablets twicea day, there is consistently one or two mistakes outof that group that-- whereas the high literacy group.

so people make mistakes as well. and then again as i mentioned the when to take medicineis a huge issue with understandingmedication labels. so these are just acomment that some of the difference theprogram has made. lot of people didn't understand about not storing yourmedication in the bath room. that's a really convenientplace for most of us to store it

but really not a good placeat all for so many reasons. we had another story of participantwho just happened to be going to the-- her doctor andthe pharmacist the next day after her workshop and felt veryempowered be able to ask questions and felt in a muchbetter place in terms of understanding what sheneeded to know in order to correctly take her medicine. and then lastly oneof the things about-- as i mentioned we spent a lot oftime on just raising the awareness

in our state about health literacy. a lot of small implementationprojects like this. and these projects, haveallowed us to expand. so we start out withthese pilot projects. and this medicationone in particular was-- we applied to wisconsin medicalsociety foundation and they end up funding all the countiesthat the insurance company that funded the originalproject wasn't able to fund. they were outside of theirservice area and so we're able

to do this project andget statewide coverage. the same medical societyasks to apply again for more funding thisyear to continue it because they were veryhappy with the project and the impact thatthey were seeing. we got funding from ourdepartment of health services then to expand this medicationworkshop to refugee populations, which is we're learning wasjust a whole another challenge in a different audience interms of the language barrier,

in terms of the culturalbarriers and being so new in understanding ourhealth care system. so we're-- in that project rightnow, it's a two-year project and we're about halfwaythrough our first year and learning a lot withthe refugee groups. and then wisconsin health literacyis also, starting a second phase of a project whereall this information on these medication workshops hashelped us to develop a white paper. and i have some atthe back of the room.

i have another one here,if you haven't seen it. but we are trying to adapt aneasy-to-read medication label in the state of wisconsin. and the us pharmacopeia in2013 put out new standards for what a medicationlabel should look like. right now the biggest thing on that small little piece arereal estate is the pharmacist logo. and so that's a bit of ourproblem as well how the wording for the label and for thedirection is mentioned.

so we're working onthis project right now. and the second phase wehave three pharmacy networks that are actually implementing anew prototype label we're designing and we're going to beable to measure how through health insurance network, how these patients dowith the new label. so exciting work. i wanted to thank nemours forhaving us here and for the center for the book, for john and julian[assumed spelling] all your work,

as well as pro-literacyfor inviting me to speak. >> jeff carter: thank you. that's a great panel. and i want to-- you know, john askedme to trying to keep us on time. we're little behind starting. i do want to give you all anopportunity to ask your question. i have a few i could ask. but i feel like this opportunityfor you to get your question. and so in the few minutesthat we have left,

i throw it up into the floor, any questions for anymember of our panel? yes? >> i'm [inaudible] with pediatricianand medical editor at [inaudible]. and we produce thousands of articles[inaudible] instructions and, obviously, literacy, they needto focus for us because all over [inaudible] the adults. so i'm wondering how acrossthe board of a large library to ensure consistency with literacy.

a lot of the tools [inaudible]different literacy tools are not applicable to medical terminologyand have some of the patient. so i was wonderinghow you manage that. >> robert logan: notas well as it'd like. the-- by the way herquestion is very good one. the question was thediagnostics, ok, that you can use to help you assess, ok, thegrade level, ok, of various types of efforts to try to explainhealth and medicine to the public. most of the diagnostictools are not designed

with health and medicine in mind. so as soon as you have theword in there like pediatrics. immediately-- you're at the collegelevel, ok, and it completely skews of all those diagnostictools as you know, ok. and we have never comeup, ok, with a-- what i consider to bea good substitute, ok. there is a private firm in this area that does sell softwarethat they allege, ok. it enables you to get a good reading

that is not thrownoff by medical terms. so i'm giving you technicalanswer because unfortunately we-- i don't have a good solution foryou other than the private firm that sells software, the nameof the company is called, health literacy innovations. no, we do not use that in ourown work for variety of reasons. on the other hand though-- and i'm going to giveyou a direct answer, ok. i distribute strunk & white,"the elements of style"

that everyone i worked with, ok. and i make sure that whenever iedit or whenever anybody else is in a senior editorial position,i make absolutely sure that "the elements of style"is foundational to what everybody does, ok. and i'm not going to go in detail. those of you who neverseen that book, that's still the best thingever written about how to write in plain english.

but still we got waysto go and i think-- i wish we had betterdiagnostic tools. >> jeff carter: yeah steve. >> steve rush: yeah, that's reallygreat question and it's something that we need to do forlots of reasons not only for patient education but there wasa federal district court stipulation that came out of louisiana thatsaid, "if you're going to deny care to somebody, you haveto do it in ways that people could understandit," which is really very good.

one of the things that we have to doand we've been training our people to do is that if you're goingto use a term like pediatrician. maybe you put in parenthesisa doctor for children. and then you could use theterm pediatrician again. and part of it is to in thecommunication is not only to make people aware of certainterms because they're going to have to become aware of itbecause it's common usage within the health care environment. so with taking pains to not onlyuse the term or terms and define it

but also to make sure that there'scorrect flow of information. and i'm seeing the, your kidsand teen information website which i think is absolutelytremendous and gives the term, the definition and the usage of it. but it's very difficult particularlywhen states are saying you got to have a certain readinggrade level but it doesn't do anythingfor comprehension. >> robert logan: it just occurred tome that there's a part of and answer that i didn't give thatwe should acknowledge, ok.

i'm so impressed by how improvednatural language processing is, ok. i mean we may be talking about anone issue in several years, ok. >> jeff carter: interesting. >> robert logan: becausenatural language processing is-- becomes so sophisticated thatit may very well take care of this issue by itself, ok. i certainly hope so thatwould be a nice solution but i can't guarantee that. >> jeff carter: let'shave one more question

or two really fast questions. who else has a question? don't be intimidated becausei said the two fast questions. just anybody, any other questions? yes. >> here at library we aretackling health and literacy here. because dr. charles's office heathservices, we started a forum here that is on health and wellness. and so we've been doing thisfor about a year and a half

and the surprising amount ofstaff that actually doesn't know but now knows much moreof because of the programs that we've been havinghere to actually to conquer that situation abouthealth literacy. >> jeff carter: well,i want to close. i'm going to just take themoderator's privilege here to close with this one thought, whichis that i'm really glad that we have this panel talkingabout both health literacy and how adult literacyimpacts health.

the reason i think that'simportant because it's a-- i think it's a good reminderthat, you know, we're all learners to one level or another and i thinkto the extent that we can identify with each other as we learnabout our own health care. you know instead of startof thinking about our-- the folks we serve in adult literacy as being these othergroup over there. i think it kind of bringsus all together as learners so i think that's kindof how the spirit i'd

like to close out this panel with. and i'd like to thank the panel. and i'd like to thank you for yourattention and center for the book and everyone who organizethis thing. thank you very much for having me. it's been a great privilege to beable to work with this group here and i look forward tothe rest of discussion. >> john cole: well, i'd like tothank, thank the panel tonight. we're going to move right intothe next panel discussion of that

as i said the restrooms are outside. you can come in. but we're going to keep moving because our panel members are herejust for limited period of time. i must say i'm verypleased that the library of congress health services hascome into this and is joining us. it's terrific. and i had with one thingthat i've kind of hope for but had followed up on.

it was great to see you. our next panel is going to be on--we call it after some discussion, business perspectiveson literacy and health. and our moderator nancy fishmanis going to bring her panel up right now and introduce them. this is a unique panelwith some people that we are very pleased havetaken the time to join us. i'm going to let nancy fishmanintroduced them or get them started. nancy is the deputydirector of readynation.

and i'm also going to havenancy tell you about readynation and it's importance towhat we are doing here. let's give nancy a handto get everything started. there you go. >> nancy fishman: thankyou very much and thank you so much for having us. readynation is an organization ofbusiness people across the world who support investments in qualityearly care and education programs as a way of building theirworkforce in the economy.

and we partner withother business group and organizations acrossthe country. and yes, i said acrossthe world earlier. we are doing some workinternationally. and readynation is very honoredto have had an opportunity to help put togetherthis panel today to talk about business perspectivesin this topic area. very honored to have with usthis morning, mike edwards, the retired state supervisor ofbanking from washington state,

that is, who flew across thecountry to join us today. we have karen baker, the director ofcommunity affairs from scholastic. next to karen, we have dominicrobinson with centerstate ceo. vice president of economicinclusion, director of work train and the director ofnorthside urban partnership. and on the end here we havedana conners the president of the main chamber of commerce. so we are from allover the country today. we are thrilled to be here.

readynation is part ofcouncil for strong america. that's our umbrellaorganization that in addition to bringing the businessperspective to this issue, we have a sibling organizationfight crime: invest in kids that brings a law enforcementperspective. their members are district attorneysand sheriffs and police chiefs. we have mission readiness. a group of 600 retiredadmirals and generals who find this issue important inmilitary readiness perspective.

shepherding the next generation,group of the angelical pastors who bring families togetherto support these efforts. and we have champs, elite athletes,and coaches to talk about nutrition and physical activity andteamwork as part of these efforts. we know that high quality earlychildhood programs can lead to a host of better health outcomes. it's for that reasonthat we're here today to share with you some examples. since we know that readingproficiency is a predictor

of overall health. we'd like to talk to you how thebusiness community has gotten involved in this subject area. we're going to make ours alittle bit more of a panel. we're going to address certainquestions to certain panelist, give them an opportunity. since we're crowded up herethey may choose to stay seated to answer the questions andwe'll leave a few minutes at end for some questions from all of you.

so we're going to startat the very beginning. mr. connors, when we spoke earlier,you mentioned that you had an "aha moment" that camewhen you first learned about early brain development. we know that the foundation of many critical workplace skillsis established in the earliest years but what's really happeningthen and how does that relate to success in school? >> dana connors: you'reasking me to explain that?

>> nancy fishman: i am. i'm asking you as achamber of president to-- how about why it matters toyou in your role at a chamber. >> dana connors: i didn't tellyou i have to leave the airport about five minutes ago justbefore you ask that question. my "aha moment" was not aroundexplaining brain to you. but i can tell youexactly what it was. it was 2007. it was a september day it wasabout this time in the afternoon

and the-- oh, that would help huh? and the speaker was a professor from harvard who'sname was dr. yoshikawa. and i had-- well, first of alllet me go back to set it up. the governor at that time,governor baldacci, asked me to come to the blaine house with probablya dozen other people to talk about a conference that he was goingto hold at one of our prime location in the state along the coast. so i tended because i hadgreat respect for him,

we had a great relationshipso i went. the subject was earlychildhood development. and i confess. you've heard these words and it'shappened to me more than once, you don't know what you don't know. well, i really didn't know whatearly childhood development was and i probably should not admitthat in front of this group, but in truth before that momentin 2007 i really didn't know. i thought it was more like daycare

and medley there's an aspectto that but it was much. my understanding wasfar, far immature and not really aware of its value. so he asked me. i went there i listed to discussion. i really could reasonably followit but wasn't too tuned in. until he said to me, "dana, i wantyou to be the final wrap up speaker on friday," to whichmy million thought was, "what the devil am i going to say,"

because i really don'tknow the subject matter but i respect to thegovernor i went. i'll make the story shortbecause i could move-- i could make it last forever. so i go and it's not myhabit to attend conferences that last three or four days. but in this one i figured i bettergo to learn the subject matter so i can wrap up the session. so this thursday afternoon itstarted tuesday night i'm speaking

at friday noon so farit hadn't click. my "aha moment" hadn'tcome and i wasn't so sure that it was going tocome, but it did. it happened i was sittingin the conference room, the professor was speaking andwhen he approach the subject of the early childhood developmentand spoke in terms of the formation, the architecture, thebrain development, 85% occurs in the first threeyears, 90% by the fifth year. and then he went on both in sciencein terms of the number of neurons

that a young person atbirth has a hundred million, a milky way as manystars in the milky way, i can't remember that term. and then he went on to explain thesynopsis and how important that was, those connectivities and youreach the peak of those synopsis about time of your85% brain is formed. he went into more detail becausehe knew a heck of a lot more about the issue than ijust expressed to you as you could obviously tell.

but i was so struck by itbecause he went on to explain that those three years muchlike a house when you build is that you start with thefoundation, you frame in the house, you do your electrical system, the circuit is reallywhat he was talking about. he went on to explain it becomes thefoundation for your intellectual, your moral, your emotional,your physical, your health, your psychological. and i remember saying, outloud, to the person next

to me heard, oh my god, i get it. i know exactly what i needed to say. and the guy next to who was amaine senator, not a us senator but represent us the ledger saidto me, "what'd you say that for?" so i explained his name wasrichard, "i said richard, didn't you just get that?" and i went on explainingwhy i felt that way and he said, "dana, you're so wrong. that's parent's responsibility."

at that moment i realize part ofthe debate and as time has gone on it's-- i've cometo really realize as i've heard the speaker sand mayi say, very inspirational day today. i'm grateful that i had theopportunity to get here early because it was very heartwarming but also informative. i've come to know that it'snot about one or the other. it's clearly about both of us. it's a community conceptbut we ignore it. we have ignored it for so longthat we start with k to 12

and then expect by the fourthgrade we're going to be at the national standardon reading and math and you really investing toolittle at the early stages and expecting too muchin such a short time. so to me it became almosteverything that i do and work for whether it's growing the economywhether it's dealing with skill in the workplace, whetherit's productivity, whether it's helping a kid, a youngperson achieve through aspirations, through educationalattainment that lowers crime,

it lowers remedialeducation, special ed. productivity is up, oh my god. that became the "aha moment". and to me it was so significant. i can-- and later on if i'masked the question and even if i'm not i may go there just asi did on this one is that to share with you what happened since. because i'm really-- it's arace that has no finish line but i'm very encouragedby what the state is doing

and what the business communityhas stepped up to do since 2007. my final comment in this,that afternoon when i stood up i didn't tell you this or it wasn't mentioned,there's no reason to. but previous in the presidentstate chamber which i've been for 20 years i wascommissioner of transportation. yeah i know i'm only 30 but i-- i was commissioner for 11years of transportation. and i used to always say,you know, the foundation

of our economy is our transportationsystem moving products, people safely and efficiently. and it cost a lot to build andmaintain a good transportation but it cost a lot more not to. you've got to maintain it, you'vegot to invest in it or it's going to cost you more whenyou try to fix it. well that afternoonthat was my message but it wasn't transportation, it was early childhoodquality care and education.

it does cost money to do it,but it cost you a lot more if you don't invest in it. that was my message then,that's my message now. that's my "aha moment". >> nancy fishman: thank you. mr. robinson, you've just heardabout how the community can benefit when we get kids off toa good start in life. we know that your work involvescommunity and economic development. can you tell us how you thinkbusinesses can get more involved?

for example, are you just-- are we just talking aboutbusinesses making donations to worthy programs or is it more? >> dominic robinson: sure. well thank you for theopportunity to speak here today. just a little bit of contextfor my position up here, i'm a vice president for aregional economic development agency and chamber of commerce in centralupstate new york based at syracuse. and for many years the organizationi represent has operated

like a traditional chamber ofcommerce representing the interest of its members and promoting whatwas kind of conventionally thought to be what was in the bestinterest of the regional economy. we have kind of headedevolution and leadership overtime which is also included my comingon board which is really been about thinking more broadly aroundwhat economic development means. and in the case of my role,very specifically trying to connect the dotsbetween economic development and community developmentand community investment,

and what i really think about ourwork is that we're actually trying to break apart of a false dichotomyin our public narrative which is that the interest of businessor economic interest are at odds with the community interest. and i think, you know, muchlike what dana was saying that there's profound businesscase to be made for investing in communities, investing inchildren, investing in education. and i think that weneed to do a better job as a business communityof articulating that.

and so it's the work we do isboth kind of advocacy-based and programming-basedbut ultimately is about leveraging the self-interestof our businesses and our region and is also interest of those we'retrying to drive the regional economy in order to make smarter, more effective investmentsin our community. the work we do ranges from programmatically wedo workforce development, we put together workforcedevelopment programs and initiatives

that connect the needs ofour employers to the un- and under employed and distantfranchise, members of our community. we foster entrepreneurshipin low income neighborhoods, we help spur neighborhoodrevitalization and we ultimately are looking forways to advocate and echo policies that we think align ourcommunity's business and economic interestwith community impact. and so, when we think aboutthe role of business in all of that there's really a lot ofdifferent ways that that can happen.

but i think what we're ultimatelytalking about is a shift away from what many of us might be alltoo familiar with which is kind of the corporate sponsorship model. you carve out a little piece ofyour budget and you send some of your employees everyyear to some, you know, really bad convention center dinner. you get, you know, yourcompany's name in a program and you may be even go and sendsome of your employees to go clean up a neighborhood for a day.

i think what we can allbelieve in this room is that those things arefundamentally paternalistic. they actually disassociate thebusiness owner and the workers and the business with thecommunity and with the problem. it creates an otherness. and i think what we're reallytrying to do is create a space where business owners andbusiness leaders can come together and own some of thechallenges in our community. so that really ranges.

one of the things we're doing around workforce development issimply saying to our employer in our region, youhave hiring challenges. you have high rates of turnover. we have the 23rd poorcity in america and some of the highest concentrations of poverty among minoritypopulations in the united states. there's a supply anddemand challenge here that we can knit together.

let's figure out how we meet yourworkforce needs and better prepare and equip a pipelineof workers who need it. and, you know, we've had greatsuccess piloting programs with this philosophy in mindfor the last several years and i think fundamentally what we'reable to do is get our businesses to understand that they canact in their self-interest and yet contribute to solvingthe community's challenges. so, you know, when we thinkabout things like early childhood or we think about literacyin general,

we are doing all kinds of stuff. one big effort on behalf of myorganization was contributing to a campaign among ourlocal businesses to invest in something called the syracusecollege promise which is a program that allows for any city ofsyracuse school district student who graduates whose parentsmake less than $75,000 a year to attend college for free. so we've been able to help raisethat money, it's not been-- it's not our program it's notour effort we have been able

to be an organizing forcefor our local businesses to get them to invest in that. we also are starting to jumpon board to advocacy efforts around early childhood educationinvestment expanding the facilitated enrollment program in new york statefor middle and low income workers. and what's really powerful aboutthat is when we get our businesses to stand up for that and we get--and we use our voice for that. it's a voice that peoplearen't expecting. so our, you know, our republicanstate politicians suddenly

pay attention. we're also thinking about howdo we get our employers to think about their workforce andsome of the challenges that they're facingat a family level. so right now we're actuallyjust yesterday we partnered on a grant application to thefederal department of labor with out local workforcedevelopment board for something called thestrengthening working families initiative in which we would,you know, be able to have access

to underwrite workforcedevelopment efforts here in our community the kind ofbuilding i said we already did but specifically to underwritethe workforce training efforts for parents and children underthe age of 13 who are low income. and specifically to addresssome of the child care and early childhood educationneeds of those individuals. one thing that we havewritten into the grant would be that we would actually be ableto place and ombudsman of sorts or navigator in some of our majoremployers, you know, who could go in

and actually consultwith lower wage workers about their child careoptions and opportunities to better facilitate childcare enrollment or utilization of the child care systemespecially if they are trying to embark upon ongoingtraining and education in order to move their way up a clear ladder. so, you know, to do that thoughtit requires willing participation from our employer partners, we weretalking to our employers asking if this is somethingthat we could do as part

of our an incumbent workeradvancement strategy that, you know, we've been working out with them and they were open toit, receptive to it. and so i think it's really gettingemployers at the end of the day to become part of the conversationand see themselves as part of the solution beyond theobligatory check writing and the superficial, youknow kind of engagement. >> nancy fishman: thankyou very much. mr. edwards, you have an amazinghistory with the banking community

so would you talk tous about some numbers. what can you tell us about return oninvestments made in young children and how that mightimpact our economy? >> michael edwards: thank you nancy. the amazing historyis out there you read about it everyday inthe banking world. i retired me for most of thatcame around, i'll have you know. i am one the-- in fact, i amthe only legally declared, governor declared, sob inthe united states today.

each state has one, but in my stateit was a supervisor of banking. everywhere else it's bankcommissioner or whatever and i was appointedby two governors, two of the said i was an sob. i also found out todaythat i'm also learned that i'm a health care practitioner. i didn't fully realizethat but listening to the speakers this morningon the earlier panel i find with having six grandkids i find that i'm--

you know, often in a healthcare provider position. it also gives me the perspectiveon what these growing kids need. the youngest i have is3 and the oldest is 13, adorable children of course. but i find too that in the courseof working with them and caring with them i find that i'm also-- well, i'm having some literacyproblems because in the course of things my little 5 year old atbreakfast one morning was just-- we were just finishingup and i said--

she said, "well papa i'll savoryou-- save this for later." and i said, "well, you don'thave to save it honey." i said, you know, "there'splenty there. i'll have more for dinner tonight." and she says, "no papai am savoring my food." that's a 5 year old. they're in preschools and inow watch them very carefully but it is amazing whatthey have, you know, versus the bankingindustry that i came out of.

the literacy there is, my gosh, youhave to be a philadelphia lawyer to have open a checkingaccount nowadays. and then it doesn't do too much good and usually it comeout on the short end. but anyway, i willshare a few things. i was drafted a coupletimes in my life. well, i avoided the first draft, i signed up for the militaryrather than getting drafted. but this program here i wasdrafted into after i had--

mostly i had actively retired. and it was for the advocacyof these younger kids that we're talking about. anyway, i was brought in bythe law enforcement people. my brother was the electedchair for 20 years in our county and through the fight crimeprogram for the law and justice folk that have gone out with earlylearning messages they-- we-- in our state we evolve in abusiness community having sprung off of that same concept.

so we now have three-prongedapproach, we have the retired militarythat nancy talked about earlier, and we have the business community and then we have the law enforcementincluding the prosecuting attorneys. all three have already taken off anddone extremely well and the messages that are able to deliver have beenvery well received everywhere we go as you can imagine. the problem is most of our-- well,a lot of our parents aren't aware of the fact that they need the pre-keducation quality and they have--

that's the first problem. so we have a message todeliver to the parents as well as elsewhere in the legislators. and it's often the case that ourinvestments go to the way say side because we're not inearly enough on our own. if you don't get these kids early into the program you'remissing a terrific opportunity because of that, asi learned as well about early brain growth issomething you can't reverse

and come back on. so it's really importantto get them. when i'm in the legislativebody asking for some funding for our state programs we have astate program called e-cap program, early education andassistance program. and until last year whereit was not very well funded, our state is having a difficultyas you can imagine as a lot of states are on thek through 12 programs. in fact, we just had a statesupreme court decisions come

down that said there was aninequality and funding in our state because the state was notmeeting its basic obligation across the board and alot of the dependency for education was followingon local levies. and so that would takedisadvantaged communities, lower income communities they were--they can't just spring forward and, you know, do the levy actionto bring it up to speed. so, a long story short we're stillin the legislative sessions trying to resolve that issue which is abouta $1.2 billion additional burden

for that educationprogram to bring it up correctly where it needs to be. so you can well imagineis a business community i and others we broughtin to the program as we go before the legislator. you know, we're very well received. i've been in the legislativebodies for a long time and not always well received andi was an sob for a good reason on many of those occasions.

but when i appear up there witha message for the legislators on the need to fund thispre-k and the state program, i can tell you i'm--it's a fun thing to do. you get up there and the legislatorsare actually anxious to hear from you, they're anxiousto hear the message. it's a bipartisan acceptance and-- not this year's session but theyears before for biannual period. we were actually in our state ableto get $160 million to the program that we hadn't really had before.

so that was a major step upon the part of the legislator. i'm having a hard time thisyear getting them to follow with that good recordbut sooner or later if we don't get it thisyear we'll get it next. and that's one of the thingsthat we find too is you have to be steady in your course. you have to be steadyin your message and now fortunately we have some 130business people throughout our state that are carrying forth themessage not only in the communities

that they're in but into thelegislature when we call on them. so it's me and these otherfolks, community leaders that are going before thelegislator and face it. you know, their business,their known, they get there, these people are in office because somebody supported themusually it's the ones that we have in the cavalry of our group. and so we do get a real goodhearing and get a good reaction. but i can tell you that it'svery severe and i know it is

in other states as well is to getthe funding for these programs. and it's just desperate. but early learning as you've heardearlier starts at a very early age. we get a return on investmentwhen we start them off and that in our state we've got a prettywell plan down to 4 to 1 ratio that we get $4 back for everydollar that we've invested. and it keeps from repetitiveneeds for going into additional years of education. we actually had about 2000 people--2000 of our little people that had

to go back and to remediationback in from the kindergarten. so the kindergarten program isimpacted in our state to have tune of about 5700 student-- perstudent or 10 million in reeducating and retaking thosepeople through the-- young people through the course foranother year is a $10 million issue. so we use that kind of example. you know, it pay us now, or itpay us greater amount later. and so really when i was inasking for $10 million, you know, the message i was giving tothe legislators was, you know,

this really isn't new money. i mean, if we don't come up with the10 million you're going to spend it on remediation the next year. and we know that about 44%of our little youngsters come in that haven't had the advantageof early education aren't really up to speed by any means togo on into the k through 12 and they fall behindand the result are poor. and i guess we could go onwith the stats for that forever but we've only got a shorttime today but i will tell you

that it's known through studiesso it's valid, it's there and we bring the message,the legislators listen. so we get-- when i come in and ask for the $10 million even thoughi didn't get it this year, we'll get it next year. it's really money that it'sgoing to be spent anyway and it's a lot smarterway to spend the money. and it's just been fun. it's been a neat experience now asi've retired from my banking career

to come into this endeavorespecially being the grandfather of six growing smart kids. ms. baicker, scholasticis interested in innovative educationalpartnerships with the focus on corporate social responsibility. can you explain how your communitypartnerships promote literacy and health? >> karen baicker: yes,thank you nancy. it's a pleasure to be here today atthis symposium and on this panel,

so i want to thank the library ofcongress, the center for the book and readynation for bringingtogether this group of partners. i arrived yesterday and i didn'tknow anybody and thanks to the, you know, good will and relationshipof scholastic with great partners like reach out and read andreadynation i piggybacked on that god will and i've met a lot of great people andi've learned a lot. and a lot of what i've learned inthe past day and a bit is stuff that i think most of us alreadyhad a pretty good idea about--

i think that very few of usin the room who didn't know that literacy has a great impact onoutcomes on health, on economics, and we could-- we mightargue and research about whether it's a direct causalrelationship or a marker or, you know, how thoserelationships work. but what seems new in what i'mhearing today one i'm excited about is the increased urgencyacross a wide range of specters-- sectors in collaboratingand integrating our efforts and approaching it innew and innovative ways.

so that's what i'mexcited about and what i'd like to tell you a little bitabout is a little bit of background about scholastic and our businessmodel what we're looking to do and how we're looking totry to break this cycle that we've all been describing. some of the shifts in our model andthen also a couple promising pilots that we've been doing, so thank you. it's interesting and unusualfor me to be on a business panel because i don't associate scholasticvery closely with the business.

and-- yes. >> michael edwards:probably a good decision. >> karen baicker: yes, well i think that we get remindedthat it is at work. but the fact is we are very,very mission driven business and that mission is literacy. so there is a high correlationbetween the work that we all want to do here and our business model. so, you'd like to ask me at lunchwhether we were for profit or not

for profit and i-- it's sortof a nonprofit and i have been to be the director of communityaffairs which has like privilege of corporate socialresponsibility without the burden of directly like revenue bearing. but-- so that's-- i'llget a little bit more into my role in community affairs. but we are business and a successfulbusiness and this is a great time to be in the literacy businessbecause of the imperative that i've just been describing.

because we have new tools throughdata, new research neuroscience, we have all sorts of newmechanisms to look at and education itselfis right for a change and the educationalpublishing business again needs to be part of it. so i'm glad to be hereon some business panel. a little bit of backgroundabout scholastic, is everyone here prettyfamiliar with scholastic? ok. so i won't say muchbut, you know, clifford,

the magic school bus, harry potter and we also createeducational curriculum material, professional training andother forms of outreach. but we're the largestchildren's book publisher which robie spoke to earlier. so, the mission ofscholastic-- scholastic has had, i don't know if you know this,they've had only two owners, maurice robinson and his son dickrobinson have been the only two owners in the 90, 95 yearhistory of scholastic.

so, that's unusual sort of familybusiness perspective right there. and it's been the entiretime based on emission of teaching all children basedon equity teaching all children to learn to read andto love to read. it's heavily focusedon independent reading, the joy of reading,the choice in reading. so we are not so much in the educationalpublishing space the same that a baso program is, but.

we are in schools and in fact wehave an enormous reach wherein 95% of the schools nationwidein one form or another. so that might be our bookfairs that everyone has and certainly nostalgic memoriesof, or the magazines or books. so having that kind of reachinto the school is also as i see it an opportunity andobligation to do something. you know, we're there in the groundin a lot of struggling regions. and we have the opportunity totry to do something more than just for books in the hands of kids.

so that's the otherthing i want to speak about briefly scholastics reachin terms of access to books. so we've long known that this iscritical there're sort of studies about the number of books in thehome and the correlation to literacy and we've done an amazingjob at that from the corporatesocial responsibility. point of view we've donated morethan 40 million books since 2000 and we have a family and communityengagement department just focused on getting books into homes and ourpartnership with reach out and read.

so that something for scholastic and me [inaudible] prettyfeel really good about. we have a lot of knowledge abouthow children best learn to read and that changes a lot andwe've swung with the pendulum from whole language tophonics to, you know, and just we keep amassinga body of knowledge and communicating itbetter and better. and i think we do a pretty goodjob in the schools of teaching kids to read and helpingteachers teach kids to read.

nonetheless we still havethis interacted problem we have not seen readingscores improved. we haven't seen the achievement gapclose, despite not just scholastic but the whole world of education and education publishingand all the efforts. we haven't moved the needle much. and so the question is with likethe power of our trusted brand of scholastic and clifford andthe platform that we have and all of the schools whetherwe're going to do about it,

you know what's our contribution,that's part of what i seeing. you talked a little bit about notjust writing a check and i feel that way also about donating books, like i'm very pleasedthat we donate books. i want us to continue to do thatbut it's has to be beyond that. so in a minute that's going to bringme to role in community affairs and how i'm hoping tohelp drive that to be. but, first, i just want tomention a few of the shifts. am i ok, 10 min?

>> nancy fishman: youcan have 30 more seconds. >> karen baicker: ok. ok. all right. well, the shifts i'm seeing inthe education space at scholastic and in publishing are towardsmore towards early childhood and by early we mean, early, wemean from birth and the importance of talking too and singing too andplaying with your child [inaudible]. the importance of out toreach outside the school kids. a school age kid is only inschool 20% of the hours that he

or she is awake overthe course of the year. and so what are we doingin these other channels and times toward personalizedtowards personalized instruction instead of, you know,someone made the analogy that if we treated kids-- or we'retreating kids if someone came to the hospital or a doctor andwe treated all of those patients by saying, "ok, you're all gettingthis treatment and you're going to-- it's going to go onfor this amount of time and then we're goingto discharge you.

that's kind of what we'redoing in the education system. we're giving everybody the same. so there needs to be a trend towardscustomization of individuals. so i'll stop with the-- >> nancy fishman: sorry. >> karen baicker: i'llstop with the trends. you can ask me more abouttranslator if you'd like to. and i'll just really quicklyjust describe the pilots and that we have going.

so i guess i'll just talk aboutour most exciting pilot to me which is called discover together. and it's a partnership we startedin conjunction with linda mayes, dr. linda mayes of the yale childstudy center to test the hypothesis that we can use literature andliteracy to build resilience in struggling communities. so we joined forces in ruralappalachia and piloted a program that we've been doing forthe last several years that i think has veryexciting potential.

and what we are doing thereis we're pairing literature with very place-based experiences. field trips to sources of localpride like a worm farm or bakery or the railroad or a nature trail. pairing those with literatureand field trips and activities and helping the communitycome together to celebrate their own storiesaround the idea of literacy and the power of narrative andwhat we notice in grande county is that that wasn't the onlything that they wanted.

it was helpful. but we just began a long processof listening to the community. and so now that program consist ofa family coop, early childhood coop from zero to five where we bringpants and use the same of curriculum in model reading and work withthe multigenerational approach and it just keeps expanding. and so that's the other trend iwould highlight is customizing to the communities we're serving. i apologies for rushing you.

i wish we had aboutthree more hours up here. now i'm going to addressone question to all of you. particularly just tell us howbusinesses, business leaders, and business groups canmore actively collaborate to help more young peoplehave access to the programs and dana, i know your flightis first this afternoon. so why don't you start? you each have about two minutes and we'll just work ourway down the line here.

>> dana connors: just about it givesme time to get to the plane at 4:30. so i appreciate. i'm very grateful andplease forgive for having to rush of the platform here. that's why they put me to the side. hopefully i just push me off here. the business communitieslike i mentioned it earlier, i mean i have found in my 20 years to get the business communityinvolved particularly in something

that begins as a social issuewhich most business see this as. is you build awarenessas to what it does or why it relates thenin the economy. you got to give them some action. we can't just talk it to death, which is characteristicof a lot of issues. and thirdly, there hasto be accountability. and when i can put thosethree things together, i've got a secret formula.

and once they started to becomeaware and how we became aware is that we're very involvein readynation. readynation is a tremendousresource. a lot of our business signed up,our law enforcement investing kids, fight crime, mission readinessfor our military people, they're all very engaged. that in itself is a communitybecause there are so many of them and we have a very passionate personthat represents all three in maine. so she's fantastic.

we have a group of businessleaders that took upon themselves-- we did this researchproject right here. it's called make a name work: critical investmentsfor the main economy. a partnership to the researchempathy very well respected research entity. we put this together it tells-- it'sall about early childhood the facts, the facts drive thesolution in instance because it's more than emotion.

it's more than feelgood as much as it is. the facts help drive this success. that helped bring theawareness to the forefront. this group a business leaders callthemselves main early learning investment group mainlyhave raise over $10 million. that's the check bookthat's putting money there. but it's not sponsorships. they take that and they'veworked with educare which most of you are familiar with.

we have one in our state. they designate a community. they are committing, i think, it's$4 million to address a number of kids with the communitywith family. the boots are on the ground. they're very involved. i can't ask for morethan that on any issue. and here's an issue thatat first blush they saw as social and not economic.

now they see as economicmore than social. our challenge is what mike saidis that we don't have enough money for k to 12 and higher ed, and we'vegot some to the state government but it's a race thathas on finish line. it is sunk. you got to be constantlypersistent about and you got to stay on message. that's my story and i'm stickingto it and i appreciate it. and if sneak out it's only because ihave to make a plane because i have

to speak at a funeraltomorrow morning and i can't afford to miss it. so thank you very muchand thank you. >> dominic robinson: thank you. >> karen baiker: it's ok. >> dominic robinson: well, ithink my job got a little easier because he stole half the thingsi'm about to say, which is great. so i guess i wouldecho a lot of that. i think that one thing i liketo reinforce, repetition,

is i think for business ownersin particular business leaders, engagement in a partnershipthat kind of takes them outside of their kind of coremission or core focus. in an ideal scenario youground that in some form of self-interest for them. but i don't think that thatis ultimately critical. what i do think is criticalis that whatever it is that they are being asked to dois able to result in an outcome. i think business leaders are muchmore prone to be thinking about kind

of i do this and this happens. they want to see you knowkind of cause and effect. and i think that too often inthe world of nonprofit in policy and in the worlds that mostof us probably operate in, we do perhaps get alittle bit too comfortable in the conceptual, in the ethereal. and i think business leadersthey want to see something. there's an instantgratification that they're seeking. the other thing that iwould just kind of bring up

and i think it's really importantand it certainly speaks to the work that i'm doing with my teamis playing the role of broker. i think that you-- in order tobuild unconventional partnerships that are advancing mission aroundoutcomes relative to early childhood or health or literacyand you're trying to bring these desperatepartners together. you have to recognize thevery different languages that a community college will speakcompared to a business compared to a social service agency comparedto a governmental organization.

they have different outcomes. they have, in some cases,very different motivations. and they by all means usedifferent terminology. and it's very difficult to putthem in a room and expect them to kind of make magic happen. so whether that's through someform of formal facilitation or it's just identifying peoplein coalition who have that kind of translator capacityor capability. i think it's reallyinsuring that there is kind

of that brokerage rule embeddedin those types of partnership. so i think that that'sreally important because too often you bringthose different types of partners in a room and they'reconceptually on board but they really don't have anyway of finding a common language or create in commons base. >> nancy fishman: ok. go ahead. i think in terms of gettingbusinesses more involved

in the issues of literacy andhealth, one of the first things that we need to dois listen to needs of a particular community,look at the data. and before we ask abusiness to get involve to know exactly what will be mosthelpful because they agree with you that they are not necessarilylooking at roi in the traditional way. they do want to be helpfuland we need to use-- show them that we're going to usetheir resources most effectively.

i've found in the work thati'm doing for the research and development labthat the combination of having a research institutionlike and academic or university, a business, and schools, and cbosall involve together is the most powerful way to have a commonpurpose and affect change. >> michael edwards:i just add to that. that, you know, really we're in-- iknow this is an energy in the room because you brought me into moreliteracy, hopefully, in your program and in your talks earlier today.

but, you know, health is animportant thing and we view at readynation with ouractivities of how important it is. and we include that in our programs, we make sure the kids get themeals the parents understand the importance of, and they can't learnif they're hungry and they can't if they don't get thatearly development. you'll lose them inthe succeeding years as they into their k through 12. so health is a definite play in thisand i think you could be and i'd

like to solicit your supportgoing forward and keeping in your mind the benefits ofwhat we hopefully help shed on with light the foryou today is the benefits of bringing those kids early on,getting the parents to understand. if you think-- if-- you know, ifthey're in your office and they're in for a medical reasonand they're in discussing-- just if you can get any kind ofdirect or indirect message to them. the importance of those kids gettingin to an early education program, i'll bet you many of ourstates i haven't research

that have an earlyeducation program. and if they don't you havemany community members that do have an education program. and often the church ora paternal organization or somebody that's recognizedit in your community. if you can get together with themand cause us an energy between you to go forward for betterhealth and for early education. you know, our researchshows that this is going to be one of the-- [inaudible].

one on the first generations livedshorter lives than their parent. well, these ones are coming up. and a lot of it has to do withhealth and a lot of the ability to reach good health carewhich is very expensive depends on good business and earlyeducation of these kids and putting them in the workforce. we in the business side are lookingfor growing our future employees. we have a lot of problems. i've noticed this in theindustry we have people

that can't basicallycount back cash. they can't convey in a comprehensiveway their ideas bringing forward. you may have people that arequite bright and do what they do but they can't convey their ideasand their smartness, if you will, on because they can'tconverse and they're not-- they're literacy is lacking. starts with educationand good health. so being nancy is up here goingto be evil eye on me pretty soon. i'm going to seal it off at that.

but i would like to recruit eachof you in your own communities, in your own way toimpose on the parents and your community how early thisearly education program business is. thanks pretty much. >>nancy fishman: thank you. i love being the bouncer. so a couple ways that youcan get involved and get some of these information go toour website, readynation.org. sign up to get ourresources and information.

there's no cost, wewon't sell your name. we're not going to haveyou come to meetings. there's no obligation. one of the resources that we haveavailable on our website is a brief that we did for businesses talkingto them about how they can talk to their employees andsupport their employees in high quality reallyeducation opportunities. that brief along withlots of other information and resources are available there orjust seek kali-- kali are yo here?

kali or i after the eventtoday and we can connect you with this valuable resources. we wanted to leave a minuteand half for questions. so if a couple of you have aquick question about the rules? two fast questions ibelieve are allowed. >> it's a challenge. >> nancy fishman: it is a challenge. in the back. >> for the first time you justmentioned quality and i think

that was missing fromthe discussion earlier. and i would argue or want you togive thought to how it's not-- you talk about how parents wantwhat best for their children, but the data shows that parents wantaccessible, affordable quality-- not quality-- accessible andaffordable care for their children and so then it's, i think, ourjob to bring in the quality and make sure that that's a part of everything that'savailable [inaudible]. >>nancy fishman: and you're right.

and much of our researchdoes cite the quality. they are familiar with thequality aspect of what has to be. and we did not highlight that today. it's an important distinction. different states definequality different ways. some states don't evendefine quality. all the research shows that thebenefits are greatest for those who participate in equalityor high quality program. and it's those high quality programs

where parent engagement is aninherent part of the program that we also have an opportunity toaffect two different generations. thank you so much. we should have called that earlier. i appreciate bringingthat to our attention. and do you have a quickquestion, sir? >> well, i try to make it quick. first of all, excellentpanel, i agree. i appreciate this every encouraging.

one of the things that ifound in trying to work to support various educationalprograms at least dealing with governmental bodies. the state legislators are concernedthat if they invest in education. they say that we don't know that these young people willbe here 10 years from now. why should we be training youngpeople who will end up in california or in new jersey et cetera? so my question is have you come incontact with that kind of sentiment

and how do you counter it andpart of my question also is with the chamber of commerce do youinteract with the national chamber of commerce so they couldreally help get that message to our members of congress as well? >> michael edwards: now let me justshare with you quickly the message that i try to giveto our legislators. if we don't educate the kidsand start them off early, we're going to be lackingin our workforce. and we're already lackingin our workforce.

seattle as you know isa high tech community. we got microsoft, amazon,expedia, you name it. but the fastest answer to thatquestion when i get to ask is if we don't educate them and givethem an early opportunity we will continue to import people fromoutside of the united states to fill those critical positions. and it isn't only thereal high tech community. it's other things ofmanufacturing just like we had the solar power becamean issue in our state where--

in our nation where weneed to have an increased. and a lot of our linemen, andpower people that are out there in our infrastructuregetting the retirement age, we can't even find peoplethat are trained well enough, for school well enough comingout of our school system to put those people into thoseprograms to make it happen. so, if you want to retainyour intellectual power and your brain powers and yourresources start them early. it's like growing a garden.

you put the seed in theground and you culture it and take care of it all the way. and if you don't some-- yeah, in some ways it's a long rangeprogram that you're looking at. but if you don't doit, you'll end up short and you'll have to import them. >> nancy fishman: you wantto close us out here dominic? >> dominic robinson: surejust one quick into that and then i also put the chamber.

i would say that the otherargument relative to, you know, why would we invest in these folks when we don't know we'regoing to able retain them. statistically speaking, youknow, yes, there's always kind of churn in the population. but the majority of thepopulation is raised in a geography doesin fact stay there. so i think you can alsojust point to the statistics that in fact more oftenthan not that's a good bet.

and i would agree witheverything you else-- you said that, i think that yourquestion around, for example, our relationship to theus chamber of commerce or other national chambertype organizations. it's an important question becausewe often associate chamber voice, especially nationally, with avoice that isn't always hospitable to these types of conversations. i think that it's aslowly changing dynamic. but i do think that there'sat least a greater awareness

that these things cannotbe disconnected forever. i was invited to, but was not ableto attend an event here in dc. i think in the fall thatwas a co-sponsored event between the us chamber and naacp,i believed, kind of talking about where their organizationalinterest might align. and i thought that was areally encouraging sign. so i think that the reality isthat we often feel like outliers within a broader kindof chamber conversation that only underscores our needto kind of continue to kind

of use our platform as best we can. >> nancy fishman: thank youall so much for having us. we appreciate your interest. >> karen baicker: thank you. >> michael edwards: thank you. >> john cole: well, that wasa wonderful different kind of insight for all of us. and i want to thank readynationand thank our panel so much. our final panel is also goingto be different and interesting,

technology and otherinnovative solutions. as tony brings his panel membersup, let's take a brief three or four minute break as they getsettled up here and we will conclude with technology and otherinnovative solutions. thank you again. it's my pleasure to-- one of theways that we put this together is through partnerships that alreadyexist and through new partnerships and i want to thank laura nemours for getting the lastpanel helping us so much

which i think willbe a new partnership for the center for the book. but we also are making use ofsome of our own board members, laura is one and tony bloome who ischairing this panel on technology and literacy is also part ofour literacy advisory board. he works for aids and has awonderful project that is going to be described aspart of the program. i'll turn it over to tony. tony? let's give him a littleapplause to get him going.

>> anthony bloome: all right. i haven't really done anythingyet but i appreciate it, so. all right. so it's the last panel of the dayand so you guys have been faithful to sit through a bunch ofinteresting conversations. but there's probably somebodyin the room that you don't know. so i'd like to use five minuteof our presentation time for you to introduce you somebody inthe room that you don't know and tell them about a favoritebook that read recently.

you have five minutes please begin. so great. i wanted to start withthat because obviously being able to meet somebody new be ableto share your experiences about the book that you've read andhow important obviously the theme of today is about literacyand how important it is that we can extend the opportunitiesfor individuals around the world to have acces to literacy. i'm excited to have the threerepresentatives of the organizations that will be speaking with ustoday to talk about various uses

of technology that wecan make access to health and the general literacyavailable to a variety of learners and using some creativetechnology options as well. so typical with the other format. we'll start with a few commentsfrom our individual panelists. but then i would really liketo open it up into a dialogue for organizations here to be ableto share their own experiences around a specific concept of howcan we use technology cost effective and sustainably toreach this audience

to promote and accelerate literacy. and so can learn as much from you about the work you'redoing as you can from us. so i'm delighted to welcometo my immediate left, judy dixon who's a consumerrelations officer right here judith did i see you that you'vebeen working here for 35 years? that's enormously exciting. who you can't see is herfriend potter who's i guess on the other-- oh, you can see that.

so we're going to haveyou invent a story about what the tale camefrom, but you can-- so. and judith will be talkingto us about the services that her office provides includingfor braille and talking books. and then has brought some toys, somedevices that she'll show us as well. so judith in just a moment welcomeyou to walk us through that. and then next to judith islinda harris who's director of health communicationsand ehealth, the office of diseaseprevention and health promotion

at the us department ofhealth and human services. and linda i know you'll betalking about designing access to information for individualswith limited literacy, in particular in termsof health literacy. and then finally to my far left isa good friend and colleague of mine, rebecca leege who'sthe project director of an initiative called the allchildren reading grand challenge for development4, which specificallyis looking at the use of technology to advance early grade reading

in developing countriesaround the world. and rebecca i know you've been atorganizations like world vision but also world relief ina variety of capacities, exploring how to bring education to marginalized populationsaround the world. so without further ado, judithcan i turn it over to you just to walkthrough, tell us aboutsome of the toys that you have. >> judith dixon: down here? >> linda harris: it's-- yougot it on the front-- yes.

>> judith dixon: oh, there, ok. good afternoon everyone. i am from the national libraryservice as tony indicated, at a national service for theblind and physically handicapped. we're part of the libraryof congress. we've been in existence since 1931. and our role is to createtalking books and braille books. what we do is select them andproduce them and then we give them out to libraries around the country

who actually circulatethem to individuals. so the idea here is peoplewho don't read print either because of a visual or a physicaldisability are literate, yes, no. we have this debate allthe time in my office. if somebody doesn't read printbut they access information by listening, are they literate? i would say yes. there are people whoactually would say no. but literacy is a challenge

because the world isdesigned for print readers. so this is health literacyin a different way. it's not just peoplewho can't communicate, most blind people cancommunicate just fine. it's a matter of not beingaccess-- able to access print. so we do braille and talking books. and we do have books about health. as a matter of fact, idid a search this morning. and in our national collectionwe have 1168 audio books

and 381 braille booksspecifically the topic of health. we have player, ourtalking books are-- i'm going to hold this up andthey are recorded on a cartridge which that actually isjust a usb flash drive. most of them have labels. this one isn't because icreated it this morning. >> player on. health and nutrition newsletters. february 2016.

current position, jogging andhealth, easier than you may think. jogging and health,easier than you may think. >> judith dixon: now,we can actually-- >> reading time six minutes. >> judith dixon: wecan skip through. >> second opinion. special report, supplementto mayo clinic health letter. vision. article jump. i health section.

jump. phrase. bookmark. jump. unit. jump. as-- end of book. within. mayo clinic health letter. scientific american health after 50. >> judith dixon: so what thisis is a monthly compilation of health newsletters. one of the reasons we don't havemore health books than we do is

because health topics come and go. and our library andthey're very concerned about the books being up-to-dateand accurate and current. so magazines and current healthnewsletter type items are a good way to do that to give peopleup to date information. so that's one way that ablind person can access print. another way-- thereare many other ways. there are actually lots of ways. and it's a matter of what isthis information available in.

so people can use computers toaccess material that's online. smartphones, we actually have an app for our talking bookscalled bard mobile. and people can download our booksalso through a service called bard. and i normally make thispresentation in about two hours. so i'm trying to summarize thati can tell you so much more about anyone of these things. but i did bring some handouts. there are fact sheets about ourprogram, application for service

and things like that backon your handout table. so the program, there's lots of ways that have blind personcan access information. now, what you may not know is thisis an iphone, a regular old iphone that you get at the apple store. and every single iphone has on ita screen reader called voiceover. and every iphone can talk. >> messages, contacts. >> judy dixon: fortunatelyi hope i don't--

>> double tap to open, messages,double tap to open, app switcher, blind fold solid, messages,act digitize, mail, active, igloo, webmd, active. >> judy dixon: so-- >> medicine button,webmd, icon nav, button. >> judy dixon: i knowyou can't see the screen of this iphone so youcan just listen. this is probably a little fast. actually let me--

>> language. >> judy dixon: i caneven scroll it down. >> headings, audio ducking, volume,speech rate, words, speech 51-- 46%. >> judy dixon: there. that might-- >> icon nav, button searchwebm-- symptoms checker, button, medication reminders, button,conditions, button, medicine, button, refill andtransfer prescriptions by-- first aid information, button.

>> judy dixon: so this is webmd, a regulator mainstreamoff the shelf app. >> etn back arrow. >> judy dixon: i candouble tap on it. >> first aid, button, searchfirst aid, table index, adjust abdominal pain in adults,abdominal pain in children, acetaminophen, tylenol,poisoning, alcohol intoxication, allergic reaction,amputation, accidental. >> judy dixon: i wasreading this this morning

and said amputation,accidental, oh my. that's sounds rathermajor, you know. >> judy dixon: i'mgoing to go to my iphone if i'm accidentallyamputated something. you know. so-- >> 41%. walk-- have theinjured person lie down. if possible don't reposition theperson if you suspect the head, neck, back or leg injury. >> judy dixon: if ihaven't fallen down.

yes. so-- but that'san incredible tool for accessibility of information. finding-- it can do tonsof other things, too. but just a mainstream app like webmdthat has good health information. hush now, you're done. so that's another. accessing printed materialis one thing. but another major issue for peoplewho don't see is identification of things, labels allthis print, its--

everything is labeled in print. one way to identify kindof mainstream items. this-- [ music and machine talking ] this is a barcode reader. but it's special barcode reader. so i have this box. what is this box? who knows?

i just damn no idea it's just a box. and so i can-- i'll try to do this. [ machine talking ] i should be able tohear what it says. now that speech might beslightly off putting for people who don't listen tosynthetic speech all the time. but for someone who does it'sactually pretty understandable. there's a lot of informationin a barcode. so it tells you how to take it,how often all the things about it.

and this-- you're done, too. these things don'tknow when to shut up. there are barcodeson tons of things. i mean, i actually take this alittle device to the grocery store and use it on items and justregular items in the grocery store. and there's also apps on myiphone that can do the same thing. they're a little bitmore difficult to use because they're little bit moredifficult to find the barcode. but the process is the same.

so now we have-- this isdevice called the scripttalk. coincidentally madeby the same company that the barcode reader wasmade by en-vision america but this is a device for readingthe labels on prescription bottles. it has to be createdevery rite aid pharmacy in the united statescan now provide this to their subscribers or customers. and the way this worksis with rfid tags. >> scriptalk station ready.

>> judith dixon: right. so all i have to do is putthe bottle on the device. >> patient, john jaysmith medication. amoxicillin 250 milligram capsule. instructions; take onecapsule three times daily-- >> judith dixon: and againyou can skip through. >> prescription date. use by march first 2017. refills remaining, prescriber,scriptability pharmacy.

to reorder this prescription,prescription number, warning, important, finish ofthis medication. >> judith dixon: so theyalso have other kinds of pill bottles with large print. this bottle has a largeprint and a brand label. brand label only saysthe name of the person. i hope they actuallyput more on it than that because the personprobably knows who they are. it's the name of themedication that would be useful.

but these rite aids now can doeither large print brand labels or use-- provide theperson with a scripttalk. and the last items-- there arelots of talking devices these days. there are talking glucose monitors. there are talking thermometers,talking scales, talking everything under the sun. this happens to be-- >> low. >> judith dixon: -- talking.

>> your body temperatureis 98.1 degrees fahrenheit. >> judith dixon: it's close enough. again, the speech-- where thespeaker in this foolish thing. looks like i'm going to do it again. come on you can do it. >> your body temperatureis 90 degrees fahrenheit. but if you use it rightit probably will work. so this is just-- again there istalking blood pressure monitors and talking, you name it,there's talking almost everything.

a lot of this stuff-- one ofthe challenges is for people who are deaf-blind because thereis a bazillion things that talk. but it's a lot harder forpeople who also don't hear. so there are devices likethat have-- that are-- this is refreshable braille display. and the pins raise and lowerdepending on what's on the screen. and the downside of thesethey are very, very expensive. but it is device that'sreally useful and can be paired viabluetooth with a smartphone

or with some of these other devices. not our talking bookmachine the best example of the things i have here is thatit can be paired with smartphone and anything that'sdisplayed on the smart phone or anything that's displayed on a computer screen canalso be read in braille. so this is a way that peoplewho are deaf-blind have of accessing informationthat's typically in print. >> anthony boome: great.

well, thank you so much judithfor brining a bunch of toys to share with us important. and i wonder if you ever in your office do they starthaving an exchange with each other? >> judith dixon: nobut they do at home. >> anthony bloome: you haveto tell them to all be quite. and so we will have an opportunity for questions and answersafterwards. so with a hope that youwould have some specific

for judy i know i haveseveral as well. judy thanks for kicking us offwith really important discussion about range of technologies thatcan make a literacy materials more accessible by variety of learners. linda, can i turn it over to you? i know you have some slides aswell to talk to us about access to health literacyand other resources. >> linda harris: yeah,i think i can-- i will see if i can see the screen.

is that the title ofmy presentation? ok, good. i'm going to talk aboutwhat we can learn from people with limited literacy aboutdesigning the interface for the technologies that we useto access health information. and it turns out we can learn a lot. i'm the office of diseaseprevention and health promotion. and so the consumer is reallyan important part of being able to prevent disease andpromote their own health. so that's why we pay a lotof attention to the consumer.

and so what i'm going to talk withyou about real quickly is that some of the research that we've doneon people with limited literacy and limited health literacy, so the first thing i thoughti would just kind of share with you is the difference. you'll see that-- you'veprobably heard that half the populationstruggle with reading. but-- oops. i'm sorry i can't seewhat i'm showing you.

[ inaudible discussion ] can you -- hold on. ok. so this is the slide--oh, great thank you. yeah. so this is half thepopulation struggles with reading. but 90% of the population struggleswith health literacy that is that only about 90% of us. 90% of us struggleat sometime, 10%-- about 10 to 12% of usare always proficient and understanding thecomplexity of health information.

and so we have a lot to workwith because of this challenge that almost all of us have. health information is a littlebit different from other kinds of information is thatit's inherently complex. it comes from the medicalkind of language. and it's also inherently stressful. so when we're trying tounderstand health information we-- even if we have-- those of us whohave advance degrees and we think that we're really very literate whenthe time comes to get that diagnosis

and it's really personal andeventful for us then our ability to process informationkind of goes up the window. so we designed for everybodyand what i'm going to talk about with you about is how we-- how our understanding ofpeople with limited literacy and limited health literacyis helping us create that sort of that cyber curvecut for all of us. i'm going to show just acouple of screen shots. this is in our research,our usability research.

and this is a picture,a graph of what it looks like when you're tracking-- doing eye tracking of just aregular person who's fully literate. so you can see how they'removing their eyes along the page. and now i'm going to showyou eye tracking of somebody who is challenged with reading. so you see how inefficient theyare, how they're struggling to try to find the point. and so this is accompanied withusually with limited memory.

and so what am i reading and howam i to understand this information and then once i think i've got ithow do i remember what i've read. this is a question that lotsof people with limited literacy and limited health literacy areasking themselves all the time. so, we know that we have an enormouschallenge to work with people with limited to providemeaningful access to health information among thosewho are limited in their reading and limited in theirhealth literacy. but we've learned some reallyinteresting things about those folks

because we've really startedpaying a lot of attention to them. we have been interviewingand working one to one with over 800 folks most of them have either limited healthliteracy or limited literacy. and so here are some a fewthings that we've learned. people with limited literacyare willing to use the web and it's important to them to usethe web for health information. they're able to accomplished tasks when the websites are designwell and this is really key.

we can make this accessible topeople if we really make the effort. and then the third thing thati'm drill down on a little bit is that people with literacyseem to prefer mobile. so i'm going to just gointo that a little bit more and i tell little bitwhy we think that's true. people with limited literacyusually prefer mobile. it seems that the readingis easier for them. we think that may be becausethe sentences are short. and there is some evidence thatthe tactile experience also helps

process that information when you'reusing a mobile app or a phone. so i'm going to quickly share withyou what we think is the definition of health literacyonce-- now that i've kind of told you what we are learningabout people with limited literacy and limited health literacy. we do not think that it is all thatuseful to defined health literacy as a deficit that those of us whoare struggling have with reading or with health information. we prefer, we at hhss, and thatincludes rob and logan and those

of us who are in the departmentof health and human services. we prefer to think of healthliteracy as defined as that match between what the healthorganization or the publisher, or the source of health informationprovides and the way they provide it and our ability to find, understand,and use that information. so, what's that means for us is thatthe responsibly is really on those of us who publishedinformation to design it well. and that's why we have startedwith people with limited literacy and limited healthliteracy to define--

to develop a guide we callit health literacy online: a guide for simplifyingthe user experience. and that's where we brought these800 folks together-- not together-- but individually theseare not surveys. these are actually working with people watchingthem use the technology and the interfaces for websites. and this guide is--was just published in october the second version of it.

and it offers those folks who are developing anyinterface whether it's a web or a mobile app ways that we candesign that interface in ways that almost everybody whocan read, who can understand, who can process information at a simple level canfind meaningful access to the informationon that technology. so, it we-- it comes witha checklist that i have-- i brought the checklist withso want to take a look at it.

i'm not going to gointo that right now. but you'll see that's it's base-- it's an evidence-based guidebased not only on the folks that we've been telling you--that i've been telling about. but also on the literature thatwe've been referred to people with limited literacy,people with disabilities, and people with limitedhealth literacy. so i'm going to just finallyclose with giving you an example of the kind of interface that we'reworking and judy we should talk

because we'd love to have thisat the library of congress. our-- as i mentioned toyou we're in the office of disease preventionhealth promotion. one of the websites we have for thepublic is called healthfinder.gov. and so we've used theseguides, these criteria to develop health literacyof healthfinder.gov. that website is really thedepartment faced to the public for the preventive services thatwe all need are covered by aca. so, it's really importantthat we get that right and so

that everybody needs tohave the preventive services and because they're free. it's really important for us tomake it so easy to use that anyone who can use the web or can usean app will find this very easy to access. so as i will close by saying,there's a lot more work to do, we would love to work with thedisability community as well, work with the children who are actually helpingus understand about design.

because what we really believeis that if you design with-- forget about grade level, you reallydesign by engaging people who have-- who are challenged with readingand with health literacy, ask them to help youdesign the interface. that's really the mostimportant thing you can do. so all of those of you whoare working with people with limited literacy, withlimited health literacy, and with disabilities, we hope thatyou'll encourage them to be a part of the design processand the information

or health informationthat's important to them. >> anthony bloome: thank you linda. and then a really nice seguefrom talking about devices that can make information accessiblethat judy was talking about to those who are creating the content, linda, to make sure that it'salso accessible. so obviously the connectionas you've mentioned in terms of the types of audiences. so rebecca, let's just-- let's gooverseas and talk about sort of some

of the challenges we face as part of the all children reading grandchallenge and our literacy efforts that are involving technologyfor all the grade learners. >> rebecca chandler leege: great. i'm going to take a pulsecheck, who has worked in an office overseas in the room? one person? great. have anybodyvisited programs overseas that work on literacy projects?

ok. thank you. so as tony mentioned, i'm rebeccaleege, worked with world vision. for those that may not befamiliar with world vision, we are an international relief anddevelopment organization and focused on multi-sectors, educationbeing a key component of ours. we join the all children readinggrand challenge five years ago at the partnershipbetween usaid, world vision and the australian government. and it was really premised onthe notion of, can we use science

and technology to offerand breakthrough for early grade readingin developing countries? we as three agencies with verysimilar strategies weren't cracking the code. there were still 250 millionchildren as we know without reading. there are one in-- or 80% ofchildren with disabilities are in developing countries, 3% ofthose have access to school. so many opportunitiesfor trying to make break through advancements in that space.

so as i just mentioned, we'vebeen around for five years and we have started to see somevery interesting application of technologies in various sectors and i just though ihighlight three of those. the three areas that we wantedto focus on to help improve because we know as listening evento the business panel and apologize that i cannot be here all day. but it is about parentand community engagement. it's about having the right qualitymaterials and it's also ensuring

that we have inclusionof all children in that process thatno one is excluded. and we all know it's ourhuman right to have literacy. we also know it unlocksour potential. and listening to the business,we're constantly trained to make that case overseas as well to thosecompanies in developing countries that say we don't have the workforcetalent and we say to ministries but you're also not investingin the education system to build that next generation.

so these are three focus areas. for those of you who have grown upin the states, we've quite familiar with sesame street, right? and they have done a great job in helping educate manychildren in this country. they have taken their model in manycountries but primarily in india where they have developedrecognizing one their population need to improve reading inthat country, they have taken and developed and contextualized thewhole sesame street messaging called

galli galli sim sim. it rolls off the tonguevery nicely, too. they have done everythingfrom creating e-reader, i mean e-publish books fore-readers to just simple games. we had asked for their hightech version of a phone, one of those [inaudible]and they sent us pvc piping. and i thought, oh, this was notwhat i was expecting to see. but how clever, somethingthat is very low tech, affordable that can besourced in the community

so that children can start to hearthemselves, practice their reading. they're currently working ona mobile app which is designed to be utilized at the home, they're working self-help groupsprimarily women that are focused on health issues orlivelihood issues and introducing it theirengagement in the reading process with their child and then givingthem tools through an application on a very low-end smart phoneto begin practice their reading. we're really excited tosee how that will roll out.

with any of these projects, onething that is lacking at least in the developing countriesis research. research to say, does thisapp really make any difference or is it-- i mean we know it'sgreat, the kids like to play on games and that has value. but can it demonstrateany improvement in their reading outcomes. and so we are tagging allof our grant programing to some robust research on that.

and we hope the findingsare positive. but, you know, it's a good thingto at least start to define what that process is, thecontextualization of the assessment process,and so forth. the second one i wantedto highlight is related to our children with disabilities. this is a group idrt, institute fordisabilities research and training. they're based out ofin wheaton, maryland. it's women owned businessthat has worked

with the national sciencefoundation and others. but they have partneredwith a group in morocco. and they feel very passionatethat there's software application that was really trying to articulatea way to document sign language of a language to be utilizedto create materials for deaf and low hearing invarious countries. so they're partnering withthe institute of morocco. the next slide kind ofshows you what it will be. so you get an idea of just definingwhat it is, how it can be used

in the market place and thenthey actually have a video of someone signing it. and then their training teachersand the deaf associations on how to create their own stories andbegan to allow material for deaf. it's also a way for them toteach many parents sign language because many of them don'tactually know sign and even how to teach their children, right. so it serves multiple purposes. usaid morocco is highlyengaged in this in funding

and it's been really supported bythe ministry of education there as they're seeing it asa potential model to roll out throughout the whole country. we also see it as anopportunity to replicate because it's also based offof modern standard arabic which is used throughout the wholenorth africa and middle east world. my last example is really on howto use source a new technology and i really appreciatelinda's focus and attention on user experience andsimplifying tools for those

that have low literacy levels. we put a challenge out 18 monthsago, almost two years ago to say, can someone source an authoringtool that could be used in developing countries byindividuals with 20 hours of training but embedded inthat technology is the decoding and leveling framework of books. there are lot of authoring toolsout there, some are very fancy, but when you're in themiddle of south sudan working with an elementary school teacher,it's unlikely that she's going

to navigate a device that requiresconnectivity as well as something that is highly-- i'm going to sayfancy, right, it has all the bells and whistles and it'salmost overwhelming. so we put this challenge out. we had nine different teamsaround the globe that competed. and we ended up-- we havea demonstration to hand. we'll do that in a second. we awarded it to agroup called silv. for those that may be familiar

with silv are a linguistorganization that's been around over 60 years. they're probably are the ones thathave documented the most languages. they have also worked atthat very grassroots level to know what could beachievable in a software system. and so what we do like about it,though it looks kind of low tech in some ways is that it is easy toadopt-- i mean it's easy to learn. we run our first training on itin ethiopia at the end of january and we did a usability studyand assessment process.

and it scored quite highbecause they said it's simple, we can master it, we understandwhat we're supposed to do and it already identifiesthe decoding and leveled elements for us. so we're not questioning, is thisbook appropriate for grade one or grade three, it'sdefined in that space. so we're very excitedabout this tool for beginning to roll out process. we think it has multipleusages, one even here in dc.

we know that there's like-- if we look at diaspora herein dc we can envision engaged in the ethiopian community tocontribute back reading materials. basically, as we lookat the vast materials and i don't scholastic still in theroom but great to hear it from nancy that i know they do a lotof work overseas and partner with many of us as organizations. but even with large publishingfirms, there are no resources and enough or little resourcesin local languages are we need

to ensure that children actuallyhave something that they can hold and read and practice in alanguage that they understand. i think that's it. tony has a thumb drive here andwe've been passing these out and i didn't think to bring,so if anybody wants it. the software is free. if anybody wants to-- onlinelet me see if i put it in here. i didn't put it inhere, sorry, bloom-- i can give it to you but it's,you know, if you're interested

in downloading it it'svery simple to open and start to create your own book. it might be kind of fun to do withany children that you might have or some youth that youwant to give them a task to write a book for a child. >> anthony bloome: thank you rebeccaand maybe just a round of applause for the three presenters. so i'm going to putthe honors on you guys. we've heard about somereally interesting examples

of assistive technologies,designing content that it could be accessibleparticularly for a low literacy audiencesand international projects that are looking atthe use of technology to accelerate early grade reading. do you have any questionsfor our panelist in regards to what you've just heard? >> yes. >> anthony bloome: and if youcould please introduce yourself

and your organization again forour benefit that'd be terrific. >> thank you those were all really,really informative and great. i'm laura bailey i direct ina morse brightstar program. i'm also on the literacyawards with tony and, you know, the winner of the rubinstein prizein our second year was room to read. and i don't know if yourorganization works with room to read and all that i know one componentof their program is they train-- they work in third world countries,mainly southeast asia i think, and they train local peopleto write children's books

in the mother tongue, itseems like there might-- and they're pretty techshabby too, so i didn't-- that's just a connectionpoint so i don't know if you guys are working together-- >> rebecca chandler leege:we do connect with them and we do greatly valuetheir expertise in what they're producing, yes. >> oh, good. that's great to hear.

>> rebecca chandler leege:they'll be working with us on a writer's workshopthis summer in cambodia. >> and then i just had a questionthat it's kind of been percolating through several of the sessions thewoman who spoke about the response to the ebola crisisearlier today and maybe some of you may not have beenhere for that, but she talked about the importance of publicmessaging through radio. and, you know, that audio for people with visual impairmentor low literacy.

audio i think is such a great andreadily available way to message to large numbers of people buti don't know that we're using that in the us very much anymore,it seems like everything has gone to texting and visual ondevices so i don't know if anyone in the audience has aperspective on the value of audio for public health kinds of things or other internationalexamples of that. >> anthony bloome: boy that'sterrific and just noting relations and partners the importance andthen maybe judy a question for you

in regards to audio as wellas others in the audience. let's take a few questions andthen ask the panelist it looked like there is somebodyelse who had-- if you could introduceyourself that'd be terrific. >> sure. actually it wasa comment and invitation. i'm dr. sandra charles,physician here at the library of congress running the occupationand health services office and that we each may have a wellnessfair in which we invite a number of different organizations,vendors to partner with us

and have an exposition wherethey off-show their services. and i'm thinking also diseaseprevention would be an excellent partner in helping peopleand spreading the word about what's available for peopleto use in terms of literacy and health literacy in particularbecause that's one of our main for us wellness and health promotion and we are constantlypromoting health literacy. and in fact in addition tothat wellness fair in august with your family health and wellnessday where we ask employees to bring

in their family membersto also be exposed to the different things availablein terms of health and i think both of those would be excellentfor expounding in health literacy and improving it. and we certainly would like tohave judy bring over so the rest of the library becausewe know she exist. we go out there to the nationallibrary but i really think the rest of the library ought to be awareof those things too, so thank you. >> anthony bloome:thank you dr. charles.

great. >> rob logan, nationallibrary of medicine. i think this one is more forlinda but anybody can answer it. one of the challenges that i thinkthat we have when we do medlineplus and i think it's similarto what challenge you have in healthfinder is it wouldbe a much better website if we knew the role in whichpeople were using it were in. are you here as a caregiverfor example, ok? are you here as a patient, ok?

are you here as a parent, ok? and i believe if we could providea totally different website with different orientationbased on the role and the reason why people werethere in the first place, ok? i believe our materialswould even be better utilized than they are now. i think that's beyond our technocapacity at the time but it occurs to me that i still haven't seenanyone, you know, take advantage of the fact that our needswith health information

or requirements differeddepending on the role that we're in when we're seeking. >> anthony bloome: thank you rob. ok, so i heard a few-- first of all a great recommendationsin and suggestions. so i heard three questionsmaybe i'll address to each of the panelist. linda, clearly in terms of therole of the audience that's coming to the websites, judy ifyou wanted to elaborate

on perhaps some other radio oraudio laced related technologies. i heard you mentionedwas it bard mobile, so that'd be interesting maybe tomention a little bit more about. and then rebecca just on the subjectof partnerships, we heard an example of a partner but what rolepartnerships have in regards to the activity ofall children reading. so maybe let's start with judy. >> judy dixon: yes thank you. audio is certainly animportant way to communicate

to everyone including peoplewith visual impairment. you're right in thatradio as certainly in commercial radio is notused as much as it once was. i don't think people listen toradio as much as they once did. but there is also a network of radioreading services throughout the united states that is usedto communicate various things to the visual impaired audiencebut these are primarily people who are long time well-establishedvisually impaired people not so much reaching people who justhave a little difficulty seeing.

that's the population that'svery difficult to reach and that's a population that reallyneeds that kind of information. >> anthony bloome: iwould also give you-- >> judy dixon: oh, bard mobile, yes. it's a mobile app and i'mwondering i had a question for linda as far as mobile apps. there are mobile apps that are notpossible for me to use on my iphone so i'm hoping thatwhen you provide advice about developing mobile appsyou also make sure to point

out that they need to be madeaccessible with voiceover because not all apps are. so that's an important thing. but we have an app for playingour talking books and real books on smartphones and all of our audiobooks and real books can be played on that so that's possible. we have the ios version of thatit's been out for about two years and we just releasedan android version. >> anthony bloome: thank you judy.

linda? >> linda m. harris: yeah i wouldjust-- to judy's point, you know, we are really committed to complyingwith the 508 kind of regulations and rules and so thatis a part of everything that we design and recommend. and i only wish thateverybody was willing to step up to those kinds of standards. to rob, to your question,actually rob and i together i guess representtwo of the library sources,

sources of informationto the public. our healthfinder isreally about prevention and of course the medlineplus atthe library of medicine is for kind of managing chronic conditions and understanding how therest of the health span. so, we are often in conversationsabout how do we do better at understanding our audience. and i think what we've kind of cometo the conclusion we and our part of the department is thatthat is you really want

to have a trusting relationshipbetween the source and the audience. and that's probablynot the best role for the governmentto try to fulfill. and so as a result we have reallybeen focusing on partnering with others who havewebsites and we have content-- we've indicated our content so that other websites cantake it into their websites. they are the ones whoare on the ground. they are the ones whohave customers,

constituents who already trust them. and so i'm, you know, we'rekind of thinking if you can-- we, the government with the, youknow, the nih of the department who have the science backing thatinformation can make it available and it's indicated to those folkswho have the personal relationship with those folks then that smartinterface could really be useful so that you get to know thepeople that you're talking with. we do that in partnershipwith cvs for example if you go to the minuteclinicyou'll see my healthfinder

on the minuteclinicyou will, you know, it'll be easy to usethere as it is here. so i appreciate your question rob,i think it's a really important path to go down but we've chosen totake that partnership path rather than trying to do the whole--create those trusting relationships between the federalgovernment and the individual. >> rebecca chandler leege: andpartnership, partnership is key and it's kind of the premiseof a grand challenge is that we much work togethercollaboratively we must seek new

problem solvers. we've used prize competitions really because it attracts the privatesector, attracts entrepreneurs, attracts those not typically in thespace to help us create a solution and i really appreciaterecommendations that's part of our goal as an entity asan initiative is really just to start creating the voiceand starting to understand where we can be at a catalyst fornew partnerships in collaboration as well as start to replicate andadopt promising practices here

in the us or in other places that can be replicatedin developing countries. >> anthony bloome:thank you rebecca. so i wanted to ask a questionof each of the panelist as well. we're in this center ofknowledge, the library of congress. we've just created a library ofcongress magic wand, right, john, just being a questionof another prize. so what would you like to see as abreakthrough activity or innovation in your respective areas thatcould help you accelerate your

own initiatives? i know i had askedthem this every time and it'd be interestingwhat they come up with. but what would you liketo see just as something-- >> rebecca chandlerleege: if i do let's start. >> anthony bloome: -- yeah, something transformativemaybe it's a technology, maybe it's a user linda or-- and rebecca maybe it's a newpartner just what is an example

of something you'd like to seeonce we've made wave the magic wand for library of congress. linda you got something? >> judy dixon: i'll go first. >> anthony bloome: judy. >> judy dixon: i think-- just we were just talking aboutaccessibility and linda mentions that they use 508 but the current508 guidelines were developed in 1998 and they have been workingon a refresh for the last 18 years

and they're supposedlyclose but who knows. accessibility is a very complex isvery complex and very thorny issue and extremely frustrating. it's frequent that i can goto websites that i can't use. it's frequent that i can downloada mobile app that i can't use. so, if i was going to wave amagic wand i would just get rid of all the accessibility barriers,get rid of flash and get rid of java and all these othertechnological barriers that are used to make websites always banging,pretty and exciting and fun

and our-- for the most partbarriers to blind people. >> anthony bloome:great, thank you judy. >> linda m. harris: well i thinkthat the reach of the library of congress is just remarkableand i've been trying to think about how could we bettermake our information available through the library of congress? i mean, we have the websites andthe sources of health information in the department, isreally precious i think. it's updated constantly.

it's the best of the sciencethat we have translating that into understandable and actionable informationis what we try to do. but our real limitation isreally reaching people who are, you know, where they live. and if i had a magic wand iwould distribute the library of congress' reach, i mean,facilities and capabilities for making that information moreaccessible to people where they are in their homes notjust here or not just

in their library but in their homes. >> anthony bloome:great, thank you linda. >> rebecca chandler leege:maybe a little bit on that line of accessibility just for yoursay linda is i think i would love for there to be some approach orbreakthrough for urgencies creating that urgency that we need to be educating our nextgeneration in a way. and i struggle withtrying to articulate that message we know reading isa long process it doesn't happen,

you know, take a pilland we all read. i wish it were that simple. but really creating that senseof urgency for our future because of the trend is thatwe have more and more countries with children that cannotread our world is not going to become a more stable place andwe need to figure out ways fast in which we can make thatbreakthrough and really start to change generations that are goodto move forward and be our leaders. >> is it ok to have an audiencemember to answer that question?

>> anthony bloome: oh yeah. >> ok. because i got a totally[inaudible], right, medicine, totally different answer, ok,and i think there is something that could be done that wouldbe i think transformative. one of the most impressive healthcare organizations in the us in my opinion is the southcentralfoundation in anchorage, alaska. and i won't go into detail towhy they are impressive but one of the things that they do isthey serve a medically underserved population mostly native alaskansand what they gone out to do

in order to improve health carethere is to first give the people who live there a senseof pride in who they are and their own heritage,their own background. they have begun to realize thata sense of pride in who you are, a sense of your own history,a sense of your own community, a sense of what theirchallenges are and i'm not going to go more detail about it. it's fundamental to giving peopleinterest in their own health, taking care of themselves,taking care of their families.

you can't put the cart beforethe horse is what they've argued for years. now translate that intosomething that the library of congress could uniquely do. why should you be proud if you're from a low income areain philadelphia? why should you be proudif you're in to it? why should you be proud ifyou're this providing a place where people could go?

the story of various differentdemographic wake grounds and groups people in this country,something they could look at and really develop some pride,some ownership in, some interest, tell people how to-- where theycan go from there to learn more. i'm not going to go inmore detail about it but i don't know whatresource like anywhere. i don't know any organizationin this country or frankly for the ed med or any countrythat has the kind of resources that this place had thatcould do something like that.

>> anthony bloome:well thank you rob. so john, all these peopleare waving their magic wands. our session is done but i wouldsay in this period of partnership, you know, we found particularly with the [inaudible]grand challenge model. if you have a problem there's goodwill and there's people out there that are probably have some ideasto help you achieve a solution. so i want to thank once again andask you to please join me in a round of applause for our three panelists.

and invite john to come back up. >> john cole: well first acouple of thank yous to everybody for sticking it out with us. gosh, we've had quite a day. it's been a wonderful day. i am going to respond but first i'dlike dr. sullivan said he has been with us all day and i'm lookingaround and i wanted to ask him if he's willing to make somecomments on what he's heard and maybe present another challengefor the library of congress

to which i will attempt to respond. would you mind? would you like-- yes,let's get a microphone. >> well, let me say again for methis has been a very exciting, very rewarding day and ithink i've learned a lot from all of the presenters here. i was thinking it was backin 1979 that joyous richmond when he was surgeon generaland assistant secretary of health issued a reportcalled healthy people.

that was a prescription for indeedpeople taking responsibility for their own health insetting goals for them and it's been my pleasureand opportunity as secretary to issue an updatehealthy people 2000 which we issues inseptember of 1990. it had grown then. we had some 298 objectives forpeople really taking responsibility for their health and showingpeople the power that they had to indeed protect their healthand project their health forward.

that has really now it itscurrent iteration is now healthy people 2020. so this has been a growing effort. it has become much-- the publichas become much more aware of this, individual citizens, companiespromoting health behavior in their employeesand the recognition of the business communitythat a healthy work for us is a positive for them. i was pleased to see the businessrepresentation here today.

so, i think that with the growinginterest and focus on this as well as the fact that with the affordablecare act we've now provided added resources for this. this is a great opportunity soi think we have a lot yet to do, a lot of challenges but i think theenvironment is much more positive. twenty or 30 years ago much ofwhat today's discussion was about, people would have interpreted aswell kind of feel good activity, something that makes you feel better but we don't reallyknow whether it works.

but then now have beenenough studies showing that physical activity reducesdeath rates, reduces heart disease, diabetes make slow the progressionof development of alzheimer's. so, i think we have enough nowthat the kinds of activities that have been describedtoday really should go forward and as we heard from ourbusiness colleagues return on investment is nowvery much documented. so i think this for me hasbeen a very enlightening day, a very encouraging day and icertainly think the library

of congress is a great place to really help get this movementfurther around the country so those are my comments, thank you. >> john cole: well,thank you very much. and thank you for joining ustoday it's really been a joy and you've made a majorcontribution. i see a couple of other peoplebefore i present we're not going on much longer it'sbeen a wonderful day but laura bailey hasbeen with me for this.

we have done the planning withhelp from many others for this. i'm wondering if you might wantto say a few things about today and robi would you like to say a fewthings in a minute and then i'll try to rewind this up and get us out ofhere with promises for the future that i hope we can follow up on? >> well, i would alsoto thank john and all of his helpers at libraryof congress. i was kind of saying to john andothers at a meeting in february here that i don't think you alwaysrealize the power of your brand

and the library of congressis a brand like no other. and i think when you put your namebehind the cause really great things can happen and i so appreciateeveryone who's been here all day, all the speakers, all the planningthat went in to your comments and i hope it was agood for everyone. i certainly learned a lot. i do think that the theme of urgencycame up a couple of times jeff and i talked about that at lunch and then rebecca mentionedthe urgency is her magic wand,

how do we keep this issue presentand have that sense of urgency. we really do know enough to certainly make thingsmuch better than they are. and so, where do we find thaturgency and will to work together in some new ways to getthis done, so thank you and i'll pass it to robbie. >> john cole: thank you very much. >> robbie harris: it's a privilegeright now to say a few words, just a few, at the end to be here.

i'm just sitting thinkingabout the fact that as authors and illustrators as imentioned this morning we're on our own room working a wayand then with our publishers and editors and wonderful people. but we're not out there doing thework that all of you are doing so what i hope and what i learnedfrom today is that i want to go back to my friends and colleaguesand everybody in the field of children's booksand all even apps, people are creating apps what'sgoing online and say, you know,

there's something about healthout there that all of those can do and continue to do if wereally, really care deeply about the children inout family and certainly, thank you all who've talked aboutour most vulnerable families and ways that hopefully one can helpthose families move out of poverty. and i think this iscertainly that's the record-- that struck a chord in me, so manypeople talked about it so thank you for all that all of you do. >> john cole: and finally-- jeffwould you like to say something

at the end today and thiswill be the last person call-- >> oh that's pressure john. >> john cole: no, no. i'm putting the pressureon myself jeff. i just want you folks to geta chance to say something. >> well i just want to thank againeverybody for participating today and as i've said to severalpeople during the day. this is really one of the fewopportunities, unfortunately one of the few opportunities wehave for so many people who look

at this problem from so manydifferent place whether it's working with adults as i do, whetherit's working with government, private sector, business,children's literacy and in health and it doesn't happen oftenenough and i think, you know, when we saw the connections beingmade and the recommendations that you're talking about tony, you can see how much valuethese kind of discussions have. and i guess i would just endwith, you know, i hope we live with that spirit that thisis a collective issue.

there's a lot of energy andit's incredibly important, we talked a lot about earlychildhood and how crucial that is. but it goes beyond. it goes also to older children,teenagers and of course adults and we've got to lookat this problem from all those perspectives i thinkfor us to make significant progress. so again thank you to everyone who put this day together itwas wonderful and thank you john and i look forward toyour closing remarks.

>> john cole: i'm going to promisethings right that, who knows. also however tony thankyou, i mean we've-- it's been a wonderful experienceinside the library to do this and i'll just sharethat with you a little. first we have three or four boardmembers from the literacy board which is i'm going to say a littlebit about the literacy project and how we might withliteracy awards program and how we might carry forward. but even within the library ofcongress today and i was so pleased

that we had our own,dr. charles was here, the people from healthservices i learned a lot about what the library of congress. we are a big organization,3800 people spread all over this area and in other places. and i was so pleased in theirinterest in this and i learned and that's another example of, youknow, we need to get to talk more and learn about our ownorganizations and see which way they're headed.

now the library of congress has-- is an exciting part of our historyright now because the new librarian of congress has been nominated. we are hoping that there will behearings soon and i was so pleased that the department of educationhad a hearing on a new leader and nobody stop thatand it sailed through and we are hoping fornew leadership. it also has to be confirmedby the senate which is i'm pausing a littlebit here but we have great hopes.

so here are some ofthe opportunities and i appreciate what people said. i see them through my job, mytwo fold job for which i'm paid and my other job for which i'mnot paid which is as a historian of the library of congress. i can see an opportunity cominghistorically for this institution with new leadership because a lothas happened in terms of outreach and those of you who were able tojoin us last night met the person who introduced dr. bailey, janewho is the new director of national

and international outreach. and this is the new departmentcomes out of a larger department but it indicates a new interest inoutreach for the library of congress that is above board, it's the nameof the organization is outreach. and the library of congress hashad a lot of outreach going on but it's been segmented and it'snot really been up front in the way that it needs to be nowbecause as an institution as we've developedwe had 5200 employees in the library of congress in 1992.

we now have 3800. we have not given upa single function. we still have strong prestige. we still have dedicated people whowere working on each of these areas. one of the reasons that numbers gone down is a good reason it'scataloging it's been centralized they are-- automation has helped us but we're also doinga lot of outsourcing. so we haven't lost any functions andin the mean time outreach has grown.

and part of it is ourpresence on the website. when we first develop thenational digital library of and then eventually theworldwide web came along, the library of congress did sometesting for the digitalization that we've been doing and hadstruck a bargain with congress about funding yet another new officeand the bargain that was struck was if we paid with private moneywith a madison council group that supports us to get startedwith the national digital library and then did some testing aboutwho is using our digitize product

which turned to be american historyamerican memory would congress go along and help fund the developmentof this national digital library? well, we succeeded in that butguess what the new survey did after two years. it showed us we had a wholenew class of users, students and teachers were usingamerican memory and some of our digitized products. and one of the resultswas the creation of something callededucational outreach.

so for the first time we have amajor outreach function funded by congress to reach outto teachers and students. and they bring students here tolearn how to use online resources. i'm going towards this idea ofreaching out internationally because our internationalrole has grown since world war ii thesame time the worldwide web and this new educationaloutreach has started. and our new emphasis has got to be and i'm sure the new librarian willrecognize this on the education side

and in the areas-- so this isactually impart why the center for the book was created withdr. boorstin [assumed spelling] where he looking aheadwe were reaching out to promote books in reading. and one of the answer actually wheni'm thinking of rob in a way is that we have established centersevery state, we don't pay for them, they are partnershiporganizations that have the job of promoting locally books, reading,literacy and libraries in that area and that's closelyassociated with state pride.

and each state wants to have andkeep a state center but they have to do something and they have to really reevaluateafter every three years. and as the installation of the pridein the state and put it together in our country but it'sthe state pride issue which we also are capitalizingon in such a way that we have in alaska center for the book. they tell you what work they do,they promote reading and literacy in alaska but they use it with thestate library and they do data basis

about alaska writers each state. and we have helped develop through our national bookfestival a whole system of state and regional book festivals. we don't run them they'relocally done. but it's a long this idea of rebirthat the state level of activities that are related toeducation, books, reading, literacy and libraries. and i think that if i have, youknow, i have much to say about it

and i'm working hard at it is thearea with this where we are headed. david rubenstein hashelped us immensely. he the benefactor i talked aboutearlier today by doing the funding for the national book festival, imean, for the library of congress to have a national book festivalfree that celebrates readers and writers and now has movedto the conventions center. and last year the conventioncenter put out a news release, we moved from the mall onto the convention center. it said that one day crowd wasthe largest crowd in the history

of the washington convention center. they estimated 125 to 150,000people came to that program which now mr. rubenstein with thedevelopment of the program part of today also is helping with theliteracy corner at the book festival and with the outreachthat we are doing with the literacy awards programis being tied in institutionally in ways that i think giveme hope for just some of the suggestions that were here. i didn't mention judy isstill here but i mention--

should have answered withhaving nls as part of this along with health servicesthe center for the book. we are able to pull the librarytogether in this area of reading and literacy promotion inways that we've not done. now, this isn't a complete answerbut it is an answer i think to the hopefulness of carryingon with some of the ideas that we've talked about today because mr. rubinsteinis quite interested in helping support this kindof activity and with the help

from our partners and our advisoryboard members who are here today, we continue to stretch literacy andthe library of congress in new ways. last year's symposium was literacyin poetry, this year it's poetry, it's literacy and health and we'vemade new friends and new partners. there'll be another one next year,two people and are meeting on, the day before yesterday, theysay it's got to be on literacy and technology and we'llhave another board member who really thinks it should be onliteracy and indigenous cultures which would bring us intoa whole another range

of partners plus we have picked uppartners along the way, reach out and read was here today and, youknow, the fact that it not only, you know, was-- it isn'there because it was a winner of the rubinstein award,it's here because its work is so important to what we're doing. and so we're going to be using theliteracy awards program also funded by mr. rubinstein as partof this outreach effort. . and i explained, i-- well,other some of people weren't here and i'll slow down in a second, butwe're expanding the number of awards

that are organizations that arerecognized through their work in literacy in this program, i talked about that alittle bit last night. and we would be able to expandand to include the range of organizations that are here. and we also want to look backto past winners, if you are part of the network now andeven though reach out and read has always been a readingand literacy promotion partner to help with this new outreach.

so i end up, i'm sorry i'm goingon a bit but i'm optimistic and this kind of meetinghas teach me optimistic because i can see partners andinterest and i also as a historian of the library of the congressknow its potential in terms of international outreach. i know its potential in terms oftechnology and part of this is-- and i also know the potentialof having new leadership in an organization like this. library of congress was createdin 1800, we've had 13 librarians

of congress, it's a long termof offices especially who one of them only lasted a yearand a half, he died in office. so you're talking about,now there's a limitation which i think is a good thingon the term of the library and of the congressto a total of 20 years with 10 year and a 10 year renewal. but it is a period historicallythat is will be a revitalization for the library and your presencein the planning that's been done in bringing us all together, iconsider to be an important part

of it and i would challenge myselfand i challenge the rest of you to keep us on the trackthat you've helped us step on today and move ahead. so i'm going to end, thank youall for participating especially to laura and board members, the nemours was we couldn'thave done this without nemours and we're just very pleasedwith everything that's going on and i think we have a numberof our participants here and let's give them a hand and thankyou very much for being with us.

we'll be back in touch but let's-- >> this has been a presentationof the library of congress. visit us at loc.gov.