Share Public Health Transcript: The Role of Libraries in Advancing Health Equity

Trish Hull: Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast connecting you to public health topics, issues, and colleagues throughout our region and the country, highlighting that we all share in public health. Thank you for tuning into this series where we explore the benefits of strong partnerships between public health departments and public libraries. This project is a partnership with the Network of the National Library of Medicine-Greater Midwest Region, the Public Library Association, the Prevention Research Center for Rural Health, and the Midwestern Public Health Training Center. We’re so happy you’re listening and learning along with us.

Jill Krueger: Hi, I’m Jill Krueger and I’m an attorney and a region director with the Network for Public Health Law. So we’re a national organization that assists really anyone, public health officials, community members, academics, librarians, anyone who wants to use the law to improve the health in their communities. And we do that through providing legal technical assistance, legal resources, webinars, just a variety of tools to increase people’s access to legal information and legal analysis. And I’m a lifelong reader and fan of libraries.

Trish Hull: Hi, my name is Trish Hull. I am the library manager of the current branch of the Salt Lake County Library system. I’m also very involved in public health and sit on the Utah Health Literacy Coalition. Today on the podcast, we are joined by Jill Krueger JD. Welcome, Jill. I wanted to start out by asking you about a blog post you authored on the public health law network site titled, eliminating library fees and overdue fines to increase health equity. The connection between public health law and removing fines and fees from public libraries isn’t necessarily an intuitive one, but it makes so much sense when you break down what removing that barrier to access could do for communities. How did you first become interested in advocating for removing fines and fees from libraries?

Jill Krueger: There’s a number of connections that I was able to make as I was reading some of the background and I want to give props to the Colorado State Library, Beth Kristen and [inaudible 00:02:38]. I found a study that they had conducted gosh, probably, I don’t know, I think I wrote the article in 2018, so I think their work must have been 2017 or 2018. But for me, it boils down to a couple of things. One of key thought leaders institutionally in public health, I think, is the Robert Wood Johnson Foundation. And so probably five or six years ago, they started an initiative encouraging folks to think about a culture of health that it’s much broader than things we’re thinking about a lot these days. Things like immunizations and quarantine and the like. But public health is a lot broader than that.
And so, one of the things that the foundation’s culture of health initiative talked about was anchor institutions, and named libraries as anchor institutions and communities. So, I’m a fan of libraries anyway. So I took note of that and then started paying attention to how that connected up with the emerging thinking in public health and elsewhere around social determinants of health that where we live, learn, work, play, worship impacts our health every bit as much as our actual healthcare. And so, thinking more about education and looking at the Healthy People 2020 goals. And Healthy People is an initiative every decade or so that the federal department of health and human services launches to set leading health indicators and look at what are some measurable objectives we can set in terms of say major depression episodes among adolescents or the percentage of parents who read to their young kids. So Healthy People 2020 looks at health indicators and sets measurable objectives that would tell us if we’re moving things in the right direction. And when I was looking at education as a social determinant of health, it became really obvious how reading was central to that, whether it’s the percentage of parents who are reading to their young kids, or it’s the percentage of kids who reach reading proficiency in elementary school, third or fourth grade, or the percentage of people who graduated from high school. And graduation from high school in particular is a real demarcation and determinant really of lifelong health outcomes because of determined so much of your access to employment and a variety of other things of those non-health factors that impact your health. Anyway, long story short, the through line there for me was reading. And along about the same time, libraries were having this initiative to eliminate fines. So it seemed to make sense to look at what that was all about. And so, that’s what I was doing in the article you referenced.

Trish Hull: Did you gather data at all on some of that? As far as the correlation between eliminating fines and improving reading, was there any data yet out there where that kind of… The reason I ask, maybe I’ll do a little background here. This is a big issue in libraries nationwide, probably worldwide, but I’m just aware of the nation, right? And even personally, my system has been looking at this and we run into issues with our boards, right? Because fines are a big, not huge, but they are a generator of revenue. And so, for instance in our system, we would lose a million dollars of revenue. Where do we make that up? And the librarian side and the administration side are in favor, but the board sometimes in the larger government, maybe the county government, is a little antithetical. And so, we are always looking for data. And so that data would be really critical.

Jill Krueger: I think that makes a ton of sense. I mean, and in public health, we’re really about fact-based and evidence-based law and policy. So that said, I’m not sure I’m prepared here and now to cite numbers for you, but the kinds of things that I saw both in that Colorado State Library report, as well as more recent analysis from library systems. Another reason I got interested was I live in Minneapolis and our neighboring community, St. Paul, went fine free in 2018. So some of what I’ve seen, the kinds of analysis I’ve seen after a system like Chicago or San Francisco or St. Paul goes fine free is sort of the anecdotal stories about this book from 1964 was returned. But also hard data about the numbers of patrons who were formerly unable to access library services, who are able to return, the number of sort of long-term overdue items that return increases in circulation overall, increases in donations to friends of the library organizations. And there have definitely been communities, I think I wrote about it in the blog post, a smaller community maybe in Florida or Georgia. I apologize, I’m trying to think of what state it was, but a smaller community where they secured an increase in funding from the city council, because city council members were hearing from community members how excited they were about fine free. So I think that kind of data is out there. And the other piece where there may be opportunities for collaboration with health departments is the kinds of mapping that I’ve seen in some communities, including St. Paul and I think San Francisco did mapping about where library patrons whose borrowing privileges had been suspended, the neighborhoods where patrons whose library of judges had been suspended, the greatest concentration of those patrons was in the neighborhoods with the highest concentration of poverty. And for some policymakers, that’s really compelling to say, “Oh, the neighborhoods where we most want to ensure that public services are available, where we could most use library services to correct disparities are the very ones where access is being blocked by our current policies of charging fines and suspending library borrowing privileges.”

Trish Hull: That is awesome. Yeah. I want to do that mapping. That sounds really good. Yeah. So we did a study a few years ago to prove summer reading was effective. And so, we worked with our local university and did some testing of a couple of grades of kids who participated in summer reading. And then we did their scores before they started the program, and then in the fall when they started their reading scores, there’s some different tests out there to use. And we were actually data driven wise able to prove that summer reading stopped summer slide for those kids who participated in the summer reading program, that they did not drop the however many percentage points that usually happens. And so, I was really excited to hear about that. And I was really excited to hear you talking about the healthy people every decade those measurable objectives.
To me, that seems that would be a really awesome way for libraries to make a case for a lot of different programs. If we connect to that federal government initiative programming and say, “This is how libraries can really get involved.” I had not thought of that. So I think that might be a really important way to connect public health, the department of health, and human services and libraries on a little broader scale. Fantastic. Yeah, yeah. I mean, and I hadn’t even thought of that. So, I also sit on my city council. And it’s really difficult sometimes to get some city council members to look at soft issues, right? They’re concerned with growth and planning and zoning and all those things, and the idea of influencing a county or a city to help make these changes. That’s where we get some of our pushback. As an attorney, do you think it would even be helpful to do some kind of ordinance or, I don’t know, ordinance doesn’t seem to be the right word. I don’t know, I mean, is there a legal case that could be made? Like someone could say, “Hey, you are violating my first amendment right to information by blocking me.”

Jill Krueger: Oh, no, that’s interesting. So I haven’t seen a case like that. That’s interesting. So the closest analogy I can think of is in the world of criminal law, there’s a fines and fees justice center. The Uniform Law Commission is kind of a bunch of legal experts, often academics, law professors, and the like. And what the Uniform Law Commission does is appoint committees to study big legal questions. And so, there’s currently a study committee on fines and fees of the Uniform Law Commission. Now they’re focused on criminal law. They’re focused on fines and fees for traffic violations, municipal code violations, court costs, fees, and surcharges. But their essential question is, are these fines and fees really hampering access to justice and creating essentially poverty trapped? Because if you deny someone access to the legal system or access to libraries, you’re further entrapping people in poverty. So anyway, that’s a pending, that’s a study committee with the Uniform Law Commission. So it seems to me, depending on the outcome of that study, you might be able to scaffold a case about library fines onto that. Yeah, I’ve thought about what’s the legal mechanism for this, and often it seems to be just internal library policy. But as you alluded to earlier, Trish, it also can show up in budget documents. So I know in St Paul, the mayor, Melvin Carter really came on board and incorporated adjustments to the library budget in the city budget to account for going fine free.

Trish Hull: We’re looking at least for children, for juvenile, 18 and under removing fines. And we’ve already established a card where they don’t need parental permission to get a card. And there are no fines. They can only check out three things. They can use our electronic resources. If they don’t return a book and it ends up lost, then they’ve lost privilege. But if they return their books, even if they get fines, there are no fines attached to these cards. But we would also to, for regular cards, just eliminate fines for kids entirely. We’re not there yet. But the argument has been for many years that we teach responsibility to people, that by putting a fine, we make them bring the book back sooner and therefore they’re learning responsibility. And that’s been in place for, what, 100 years? And the comment comes back and how’s that working for you? Because people are still late returning things and we still get huge fines. And is it really the library job to teach responsibility? No. Our job is access and I think there’s enough information from people who have gone fine free that books do get returned on time. And that we get more books back. And like Jill was saying, you do get an increase in circulation by going fine free. So, if you can have that conversation with that person and say, “Look, that’s just not true. It isn’t denying access. The data shows otherwise.” But I think it’d be nice to have a clearing house or a place where some of this data is collected so that we could pull on it for these discussions. I don’t know. I’ve always liked that. How’s that working for you? Are we really teaching responsibility? And it’s like your kids. I don’t know how many times you ground them, they still don’t clean their room, right? That’s not the incentive, punishment doesn’t work. It’s the positive reinforcement that works. So, I have a question for you. This is a little bit off this topic, but still because I’m interested in the library public health relationship. You say you really like public libraries. What is your interest in public libraries? Is it just that personal you’ve always liked libraries or have you had partnerships?

Jill Krueger: Oh, interesting. Yeah, I would have to say I have a young child myself. So we’re there constantly, or at least right now it’s kind of grab and go. We’re not there together constantly. So there is a strong personal interest, but I would be interested in increasing partnerships. So just throwing that out there if anyone who hears this has an idea for a project focused on law and policy, I’d certainly be all ears. The other piece that I will say when you asked about connections between public health and public libraries, so one kind of core set of commonalities I talked about in terms of the Healthy People 2020 goals, the other piece that I would add has to do with the creation of the moral imagination which again, might sound very woo-woo to some board members, but it’s essential to our functioning as a civic society. And so what I mean, and you all probably know better, you as a librarian, Trish, might know better than I, but there’s a woman whose name is, I think Rudine Sims Bishop, is that right? Who talks about mirrors and windows, and how books, especially for children can serve as mirrors or windows. And when I think about my friends of color who didn’t have a ton of mirrors when they were growing up, and by that I mean, books about kids who look you, who have similar life experiences to the experiences you have, as well as windows into other people’s lived experiences. And I think we see today with movements like We Need Diverse Books and the like, we see the role of books in creating self-confidence, self-understanding, self-awareness as well as awareness of others, as well as empathy. And that’s so essential as we have a better and better understanding of the role of adverse childhood experiences and lifelong health outcomes. And as we see the role of coping skills in building resilience. And those coping skills include things like self-awareness and awareness of others and ability to resolve conflicts, that understanding, that moral imagination that books can help nurture is really critical. And so one of the law and policy issues that I and my colleagues work at at the network is mental health and wellbeing. And when we look at this last year that we’ve just experienced in this country, whether it’s the Coronavirus and the weight of grief and loss and anxiety and uncertainty and on and on, from both the direct health impacts, and then the impacts of the community mitigation measures, the the staying at home and the like, as well as the economic disruptions, the loss of jobs, et cetera. That’s a lot that people are carrying around. And we know more and more, like the role of things like green space, the role of things like access to stories. And we saw things like people rallying around Mo Willems doing lunchtime doodles and through the National Center for the Arts and such. But there are law and policy elements to promoting, I think, things like access to physical books. It’s great, libraries have done a lot to expand access to their digital and electronic collections, but a lot of parents, especially of young children are looking for access to physical books to have less screen time for their young kids. I mean, if you have 5 or 10 books in your home, at some point, you’re going to want some more to vary things up. So law and policy strategies, including going fine free, but others as well. If we’ve all gone through a collective national trauma, what are the strategies to promote growth and recovery and resilience coming out of this last year? And I haven’t even touched on the racial reckoning that’s gone on in tandem with all of this. And again, diverse books can help create that empathy and that understanding.

Trish Hull: Well, I have a bunch of stuff again. So yeah, I really like that creation of the moral imagination. And even more than that, getting people working in the library who represent their communities as well. We did a program this last year with a public health partner and a community partner called Community Wellness Liaisons. And it was really interesting in my branch. I had a Hispanic woman and a Pacific Island woman. My old library was the one that was at about 50%, we are probably a minority majority. So we had a lot of different people coming in of different color and ethnic backgrounds. And it didn’t matter what their ethnic background was. They almost always gravitated towards one of those two people, as opposed to a Caucasian librarian sitting there. And these weren’t even librarians. They were just people we had hired from the community to help disseminate health information and represent their communities and to try and promote libraries to their communities as well, to eliminate some of those barriers. But it was just fascinating to me to watch people walk in and they immediately went to them. And I thought, “This is such a good example and obvious that we’ve got to get more people of color into our profession.” And we do have some, but depending on the communities you live in, we’ve created a lot of barriers to that. And so, I know it’s something we’re trying to address in our different libraries and I’ve been doing it particularly here, but it’s so critical. But I really liked that creation of the moral imagination. I’m right now attending CADCA, that’s the Community Anti-Drug Coalitions of America, right?

Jill Krueger: Different context, yeah. Okay.

Trish Hull: Yes. Yeah. Because libraries are becoming more involved in these coalitions, one thing that libraries do right now and more and more are doing them, but we hand out free Naloxone and we also hand out free gun locks. And I know as we’ve tried to expand that, there are some libraries who are saying, “Well, if I hand out free Naloxone, doesn’t that give me some liability? What if someone overdosed?” They don’t understand what Naloxone does in the first place, that you can’t overdose on Naloxone. And they think maybe that it increases drug use because you’re giving them a needle. And again, we’re like, “No, it doesn’t work that way, and that’s not a side effect. It just doesn’t happen that way.” And so we do run into that. And I haven’t had anybody really complain about the free gun locks. But I could see that happening just because we had an attorney who wouldn’t let us hand out bike locks, because they were afraid if we lent or checked out a bike lock to a kid and his bike still got stolen, we would be liable, because our bike lock was used and it wasn’t good enough to keep them from stealing the bike. We’re now going around that, but I thought that was an interesting legal argument. And ACEs was a huge thing that came up and I feel libraries have such an important role in helping with all of these areas. Oh, when you talked about access to books and digital collections, you’re right, that’s all well and good, but how many kids don’t have access to eBooks? And what proportion of the world doesn’t have access to eBooks? Again, it’s going to be that the poverty level, right? And the people in the poverty level, which are generally people of color in most communities, although there are a lot of Caucasians who also do not have internet access. Even though providers will tell you, “Oh, no, we have 96% access to broadband in your community.” I’m like, “Well, you may have the broadband there, but that doesn’t mean people have it.” There’s so many kids that we find out they have one device in their family and they can’t afford connections.

Jill Krueger: And that’s something that we’ve been paying attention to with our network as well. One of my colleagues, Betsy Lawton, has been digging into legal strategies to boost broadband access, especially this last year. And that’s just right. What we’ve realized is there’s sort of the infrastructure issue, is there infrastructure and a lot of our policy and law initiatives have been directed toward that. But there’s also the affordability issue. And so then there are programs that she’s been looking at. The federal lifeline program is just wholly inadequate to the need. The size of the benefit doesn’t meet the need of individual families or of the sort of collective need. And certainly libraries have been part of the solution already with the [inaudible 00:26:41] program. And I certainly know just anecdotally of libraries that have boosted their signals so that people are sitting in their cars connecting through their iPads or devices to do work or schoolwork or the like. But absolutely, that’s another reason that electronic collections are not a total solution.

Trish Hull: Yeah. We’ve run into a dilemma. Boosting our signal, we have to do it when we’re open, I guess. But again, you need those signals open at night as well later on because people are working. I mean, I know families who help their kids do their schoolwork at night because mom and dad are working and can’t help their kids have school in the day. And again, that is a economic divide, a digital divide that’s very real.

Jill Krueger: For example, in the last few years, Wisconsin passed a law specifically allowing libraries to place those with overdue fines or lost items for collection, which is kind of moving in the other direction. So, while we have this overall trend led by the American Library Association, the American Library Association, of course, is not a governing body, but is a membership association, professional association, and has adopted a statement encouraging adoption of fine free policies as a means of best serving the mission of public libraries to provide access to information to support informed participation in civic life. And so, fine free is certainly a strong and pronounced trend. I don’t certainly mean to dismiss the concern about budgets. I mean, certainly public health itself has plenty of concerns about how to do more with less than having inadequate budget to perform the tasks that we can see in front of ourselves. And so, there certainly are counterexamples in the world of law and policy. In the last few years, the state of Wisconsin adopted a law, a state statute, to explicitly allow libraries to place for collection patrons with excess overdue fines or lost items. And certainly there is an argument to be made for such a posture to say, this is a debt that is owed, the library needs those funds. I guess overall, in addition to the health benefits for the individual patrons and the community as a whole, of going fine free in terms of allowing another pathway out of poverty, out of supporting that through line of parents reading the kids and kids achieving reading proficiency and graduating from high school, and becoming successful contributing members of societies, which is good for them and for the community, there’s a cost to those kinds of things. There’s a cost to collecting those library fines. In terms of staff morale, it can be really unpleasant to have to be the enforcer and to say, “Oh, I’m sorry, you can’t check out Diary of a Wimpy Kid today. You’ve got too many overdue fines.” Or to a senior citizen, “You can’t check out the latest bestseller in large print because of your overdue fines.” So there’s an emotional toll that’s taken on library staff as well as that can be a really time intensive effort. The fines are often for those of middle-class means. So they’re relatively nominal. So they’re handling a lot of coins or small amounts of money. And so, the time cost of that in terms of salary, time is not insignificant. Much less placing someone for collection, the time involved in sort of the documentation and back and forth for that is not insignificant. So, another piece of the data puzzle is looking at sort of the costs of keeping those fines or placing patrons for collection.

Trish Hull:So that was brought home to us at COVID, because I totally agree with that. We had to make a lot of adjustments with COVID, doing everything digitally. And when we started quarantining books, we had to raise the amount of books that a person could check out, right? Because while they were quarantined, they were kind of in limbo. And so, we did loosen up a lot of restrictions. We increased the amount of fine they could have to check out. And staff mentioned that it was so much nicer to not have those conversations. They didn’t have to have the battle over fines. We could just waive them, or we’ve had a long grace period, right? We’ll backdate to the first of the month. And it’s been so nice to not have those conversations. I have no idea what it’s done to the bottom line, but since circulation is down, the numbers are going to be screened for this year anyhow, right? But yeah, it really does make a big difference on staff. Those are the worst conversations. And generally, the people who have to deal with those conversations are those that are paid less, right? And so, there’s an inequity there as well that they probably aren’t even trained to have difficult conversations and how to deal with it. We just say, “Hey, you’re the frontline staff. You get to deal with this, and be nice,” or whatever. Without recognizing that there is a barrier. The other piece of that is we also have those people in place saying, “Here are the policies and procedures and we want you to be very diligent in making sure you follow policies and procedures, but also be nice.” So generally, it ends up that the poor line staff are having to be the tough ones and then the librarian can come over and say, “Oh, just wave it. It’s okay.” And so, there’s inequity there that I think we all recognize and deal with. When you were talking about the collections, one of the problems I see that boards will have and maybe governments, even most of our libraries are funded by tax dollars. And not fines and fees necessarily, that part I think is separate. In our system, we send to collections or people who have lost items. So if they’ve checked out 10 books and didn’t return them over a four month period, then there’s [inaudible 00:33:45] on their card that’s the cost of that book, right? And so they can get a couple of hundred dollars of fines and then those people are sent to collections. And generally, they’re the people who can’t afford to pay that. But then you have the opposite side where they’re saying, “But these are taxpayer funds, and we need to recoup these taxpayer funds.” And we get this from our finance people, you can’t just say, “Oh, don’t worry about it.” Then people won’t return their books, or their puppy eats them. We’ve seen a few of those, right? Dog books and cat books that are chewed to pieces. So, how do you respond to that? Is there a legal fiscal responsibility versus a responsibility to help bring people out of poverty, to help give them access?

Jill Krueger: I think you’ve just put your finger on probably the toughest issue or one of the toughest issues in this conversation. I think fines for overdue items, the argument about, well, that denies access to the next person in line waiting for that item, not withstanding. There isn’t a lot of great harm from a book being returned late. Other than that, maybe an incidental delay for the person next in line. But when an item is lost, either that item is lost or has to be replaced. So there is a harm. So, many of the policies that I’ve examined do eliminate fines for overdue items and then the associated fees, but do continue to charge for lost items. Or they make an exception for lost or damaged, like board books and picture books saying, “You know what? It’s a cost of doing business. Two year olds are going to chew on books. They’re not going to be long-term items in the collection.” And from a public health standpoint, it’s probably just as well if [inaudible 00:35:52] after a certain amount of chewing. So I think that’s the toughest issue. So some of that is going to have to be localized based on what the community will bear, what the community or what the policy makers elected by the community are going to prioritize. Are they going to prioritize the sort of fiscal responsibility piece or the access piece? And one way I’ve seen the split, the difference, at least in another context, is school lunches. If there are kids who aren’t eligible for free or reduced fee school lunches, I know that some schools or school districts have created kind of funds where maybe more affluent parents or community members or foundations, charitable entities, whoever the case might be. I mean, it’s not a perfect solution. I prefer law and policy solutions that are going to be there and be predictable, and from a budgeting perspective. But it is one mechanism. I’m not sure I’ve really heard of libraries doing that, but it has been successful, I think, to some extent in the school lunch context to say, “Look, kids need to eat lunch. And until we can figure out our long-term policy, here’s sort of a bandaid solution.”

Trish Hull: Yeah. I know that business has the whole cost of doing business. We know there’s a certain amount of loss that will happen. Is there a legal issue if a library takes that same position because they are tax dollars?

Jill Krueger: I mean, I suppose you might have to look at the laws in your state, but if generally accepted accounting practices allow an X percentage loss and there’s a mechanism to account for that loss in the budget. I don’t readily think of any legal barrier, unless there’s a barrier in state law that says you can’t do that.

Trish Hull: And state laws are so exact right across the country. Yeah. But that’s interesting. So you’re a public health lawyer, correct? So you kind of look at that. I think libraries are really interested in the social determinants of health. Something I think would be very interesting. We speak a different language. And if I were to go to a meeting of the librarians and talk about the social determinants of health or ACEs, they would probably have no idea what I was talking about. And yet, if I were to go to librarians and talk about how we want to make a difference in our communities, we’re totally talking about the same things, we want to improve the literacy. Actually, we look at it as literacy, right? We have information literacy and health literacy and digital literacy, regular literacy, being able to read.
And those are basically the social determinants of health, right? We have a lot of those and the seven areas of health that we want to work on. And we all agree on it and we’re all doing the same thing. But I think we have a little bit of a disconnect when it comes to that communication and not speaking the same language. And maybe there’s that problem in not just with public health, but with the legal side of public health as well that we need to maybe just do some education for both sides. Let public health know the terminology that libraries use, and libraries understand the terminology the public health uses. But maybe even come to a consensus that we use the same language, and that this is not an unusual thing, right? That maybe we all could be on the same page. Do you have an opinion on that?

Jill Krueger: I think you make an excellent point. I mean, when I say social determinants of health, I know that a public health audience by and large is going to understand what I’m talking about. But I am also aware that it is kind of jargon, it’s sort of inside the club language. And so, I do appreciate some of the language that the Robert Wood Johnson Foundation has used. The places where we live, learn, work, play, and worship is one of the ways I’ve heard them express it. I think others have said your zip code shouldn’t affect your health more than your genetic code. But again, maybe that’s not especially compelling the literacy. I appreciate your sharing that framing, because that’s something that I can be more conscious of incorporating that as part of how I talk about this issue too. Because I think, yeah, having that common languages is really important.

Trish Hull: It’s interesting libraries are getting involved in health literacy coalitions, which are combined groups of public health and private health organizations, not just public health. And I think COVID really brought it home that there is a big element of disconnect that people don’t understand and they don’t have health literacy. They don’t understand what people are saying. Especially if English is their second language or their education levels are lower, and they’re getting information from their health departments or from the federal government or the state government or their local government that is written on just a higher level that they don’t understand. And then they get this document and they look at it and they have no idea what it means or what to do. And so, as coalitions, we’re trying to work together with every group and I’ve had people give me documents that say things, and I’ll say, “What level is this written on?” And they go, “Well, our medical people insist that it is accurate. And so, it’s written in 12th to 15th grade level.” And we’re like, “Well, my library areas reading level is around a fourth to eighth grade level.” So we have a problem. Vaccinations, inoculation, these are words that people who come from other countries or don’t have a very high level of education don’t understand. But we’re throwing these out all the time and they don’t really know what they mean. Is there a way, do you think, to make that a little easier for people? Or how would you address that from a legal standpoint, even?

Jill Krueger: I mean, I think that does have to be interdisciplinary. I mean, I think that has to be an interdisciplinary conversation. I’m hearing more public health folks talk about getting shots in people’s arms. And I think that’s why. But when we talk about the moral imagination, and I think about the books that are being published today, I mean, thinking about books I’ve read in the last few months with my son, I mean, we’ve read one called Facts Vs. Opinions Vs. Robots. And we’ve read We Are Water Protectors, just announced as the Caldecott winner, which speaks to racial justice, as well as environmental justice and climate concerns. We’ve read Clever Hans, which is actually this great story about this horse and understanding that the horse couldn’t in fact count, but it could read people’s body language to know what the right answer was. So I think books, again, can help us understand information and understand people’s perspectives, but this knowledge that you all as librarians have about health literacy, I mean, messaging is critical to public health. Critical, critical, critical to say at the outset of the pandemic, we’ve got a shortage of masks, please don’t wear masks because we have to save those for healthcare providers. But this advice may change. But our understanding of this disease is emerging and developing and this advice may change. It’s really important to have that as part of the messaging, because otherwise, the distrust that can evolve can emerge as the messaging changes, as our knowledge changes, which is just science. I think that’s a piece of health literacy too. A member of our board at the network is Howard Co who’s a former assistant secretary of the Department of Health and Human Services. And I know he did a lot of work on health literacy. So I think at the highest levels of public health, that is recognized. I mean, the Association of State and Territorial Health Officials has released documents about risk management communication. I know communicators have been part of the efforts, but I think that health literacy piece absolutely is critical.

Trish Hull: So just a quick final question then. So your organization, anybody can contact them about issues like this, is that correct? It’s like [crosstalk 00:45:40].

Jill Krueger: Yes. So, one of our core functions is providing legal technical assistance. So, it’s a basic level of assistance, but if someone has a legal question about a matter that’s related to protecting, promoting, or improving public health or health in their community, we’re happy to assist.

Trish Hull: That wraps up today’s episode of Share Public Health. We hope you’ll join us next week as we talk with Noah Lenstra, assistant professor of Library and Information Science at the University of Greensboro and director of Let’s Move in Libraries about his work in bringing public health to public libraries. Thank you for tuning into this episode of Share Public Health. Thank you to our host, Trish Hull, the Network of the National Libraries of Medicine, the Public Library Association, the Midwestern Public Health Training Center, and the Prevention Research Center for Rural Health. This project is supported by the National Library of Medicine of the National Institutes of Health under award number UG4LM012346. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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