Episode 5: Helen Keleher

Top of Their Game — In-Game Learning

"It's not expensive to make sure that the information you're putting out is fit for purpose. It's actually fundamental for an organization — and there are many fundamentals. Hand hygiene, or masks and gowns, or whatever it is: there's a cost to all of those things. They're all about prevention and good practice. So it is about funding good practice."

Bob: Welcome to Top of Their Game, the show where we speak with the people making communications clearer, fairer, and just plain better. I'm your host, Bob Milstein, a lawyer and plain language trainer, practitioner, and advocate. Our guest today is Dr. Helen Keleher. Helen is adjunct professor in health science with Monash University and a life member of the Public Health Association of Australia. She has an extensive background working with health and community services, and expertise in public health, gender equity, prevention of violence against women, and population health. She is first editor of the textbook Understanding Health for Oxford University Press and has written dozens of journal articles and reports that have been influential with generations of students learning in the health sciences. Helen's focus is on fairness and equity, and how we can strive to make the world a fairer place. In today's interview, we explore Helen's career as a passionate advocate for health literacy and clear communication. And now, Helen Keleher. Helen, thank you so much for joining us today.

Helen: Thank you very much, Bob. Good to be with you.

Bob: Helen, what first drew you into public health? Was there, for example, a moment or an experience that made you realize how communication shapes well-being?

Helen: There certainly was, and I'm going back a bit now. I started nursing when I was 17 at the Royal Children's Hospital in Melbourne, and we'd often see children come in with diseases that were preventable. That sparked something in me. But it wasn't until much later that I realized that by doing much better communication with people, we could actually get better outcomes. One of those moments was when I'd stopped nursing but was working for a local shire while I was studying — just very part time. One of the things we did (I was working on vaccinations) was with the grade 6 girls; it was a local school getting rubella vaccinations. The environmental health officer said to me, "Oh, the girls will all be hysterical, you know." And I said, "Well, perhaps I could pop out the week before and just have a chat to them about why it's important." He was kind of like, "Really? Why would you do that?" Anyway, I said "okay," so I got some resources from one of the big organizations and went to chat to the girls. The next week when we did the rubella vaccinations, they were great. They were fine with it. And he was amazed. I realized then that a simple thing like a little bit of explanation can go a long way. Then, in the early 1990s — by then I was doing a masters — I went to my first Public Health Association conference and I felt like they were talking my language. This was my tribe. And it absolutely changed the way I think about not just health communication, but prevention and populations and so on.

Bob: Looking back over your career, what do you think has changed in the way Australians understand the concept of health?

Helen: I think the biggest shift has been from just seeing health as the absence of disease to something much more proactive that we can all work on. The way we talk about health now is about how we can support people to find their own healthy ways of being and doing. So the idea of actually living well — that health supports us to live well and not die too young — I think we're much more aware of what we can prevent now than we were 40 years ago.

Bob: Does that intersect in any way with the so-called wellness movement?

Helen: I guess it does. The wellness movement, to me, feels like it's a big oversized product push. And I'll come to that shortly too, because there's a lot of misinformation in it. Nonetheless, there has been a really big shift towards health not just being the absence of disease — but it has been commodified hugely.

Bob: You've worked across academia, policy, and community health. How have these different worlds influenced the way you think about clarity and access to information?

Helen: Each of them has been full of learning, and they run alongside each other. Academic study changes people's lives. I still run into students today who say, "Oh, I so remember this or that from the learning." What I always tried to do was to make that learning attached to real worlds. You can't just teach theoretically. You have to show people what it means for them and for other people's lives, and the impact that they themselves can have. So I did enjoy that. But I also think policies can have clarity or not, and they can prioritize core information performance in organizations. They can require them to do more in terms of making information accessible. It's shifted thinking from just saying information is available to saying information is understandable and usable. That has now crept into accreditation standards for health organizations — it's coming under the quality and safety domains of accreditation, so it reframes clarity as a requirement. But I think we've got a way to go for that to be seen as an equity issue in organizations, not just simply a communication task. We'll get to that.

Bob: I imagine that need to engage with the relevant reader and make it come alive for them was very much a focus you had way back when you had that initial chat with the girls at school about making it matter for them.

Helen: Yes, it was a real lightbulb moment for me, and I could also see opportunities for how we could work differently in the future. That's why the world of public health actually captured me.

Bob: I know one thing you're very passionate about is fairness and equity as being central to health. I was hoping you could say a bit about what those values look like in practice, in a real-world, day-to-day situation.

Helen: In relation to health information, which is kind of the core of what we're talking about, it looks like services that not only say they're accessible but actually demonstrate their accessibility — that they're culturally safe and responsive to individuals' needs. For about a year I was seconded half-time to a large inner-city Melbourne community health service. This was in the mid-2000s. They had a big public dental clinic, but they'd run it separately, early in the morning on a particular day of the week, for people who had HIV/AIDS, because they'd told the service they didn't feel comfortable sitting in the waiting room. They were always worried about what other people might say or think or do. So they ran a separate clinic. I thought that was such a simple way to say, "We care about you. We want to make this accessible to you. Come and see us." So it's about addressing the barriers to people accessing services — whether it's geographic or financial or in language or social — designing care so that no one's left behind. That's what it means to me. It means listening, involving people in decisions, having those community groups that actually tell you what the issues are for them. Listening, and building on that lived experience to make sure services are designed to be accessible. And then they're fair. And then we get better equity.

Bob: So you've identified the needs of a range of disenfranchised and historically vulnerable groups. What other examples of cultural safety spring to mind when it comes to these topics of fairness and equity?

Helen: I guess it depends how you define culture, doesn't it? But what first comes to mind is the movement in Indigenous health — First Nations peoples' health — to have Aboriginal community-controlled health organizations. That's been so important, because they define what's culturally safe. They know, and they make it accessible to the people who want to use them. I don't think we've done enough for our migrant and refugee communities yet. We're certainly along the way. There are some really good services that know how to work with local people and use community advisory groups to listen to what people's needs are.

Bob: Apart from the obvious issue of language for many of those migrant groups, are there any other core challenges you have in mind when you mention that?

Helen: Well, sometimes — for example, in some cultures men don't like women being unaccompanied to see a doctor. Some services have worked out how to make that work for women, so they can have a private consult with a doctor. Interpreting services seem to be funded sporadically. They don't always work for people. Sometimes it's a child who has to interpret for an adult, and that can be tricky too, particularly with sensitive information. So those things matter. Another community health service I was doing some work for, probably ten years ago, realized that all the photos alongside the health information on their boards in the hallways were of white people. And yet they lived in a community with a lot of refugee and migrant families. So they realized they needed different photo shoots. People need to feel represented. They need to see themselves and understand that this service is for them. I think the imaging is really important too.

Bob: You've got to see it to be it.

Helen: You do. Yeah.

Bob: Helen, I want to take you back to a topic that sits more traditionally with our general focus on communication: health literacy. Let's start with the basics. Hold my hand, please, and take me through your definition — or indeed, if there is an internationally recognized definition of health literacy.

Helen: Okay — in really plain English —

Bob: Thank you.

Helen: — health literacy is being able to understand health information well enough to make good decisions. That's it.

Bob: Okay, give it to me in a little less plain language then.

Helen: Well, there's personal health literacy and there's organizational health literacy. Personal health literacy is about you and me having enough information to make good decisions. Organizational health literacy is more complex, obviously, because it's about how well organizations help people find information — and this applies to health systems as well — how well they provide information people can understand, using established processes for making information understandable, and how people can use that information. What do they need to do next? Not just overloading people with a whole bunch of information, but beginning with a fairly straightforward statement, building the complexity slowly through an information sheet or a website — whatever — and then saying to people, "Here are the helplines, here is what you need to do." Giving people options. Helping them understand that they don't have to live with whatever they're concerned about without support.

Bob: Australia is a pretty developed country, yet despite that, I know from research done over decades by organizations like the Australian Bureau of Statistics that literacy is a challenge on multiple fronts. In my own world, legal literacy is a big deal. Health literacy is a big deal. Why do you think it is so widespread in developed nations such as Australia?

Helen: Of course, there are many types of literacy, as you said, and they're connected — health literacy, financial literacy, digital literacy. But at the basis of them all is literacy: being able to read and write. We have an older generation, many of whom left school very young, who have probably sufficient literacy to get them through. Whatever you learnt at school, you build on if you've got the basics there. But many older people don't necessarily have the skills to navigate what are still quite complex environments. We also have a very high proportion of people who've come from countries where English is not their first language. We have probably one or two generations of young people who were raised in refugee camps, for example, and who struggle to get the basics, let alone do it in English.

Bob: Yeah.

Helen: It's not their first language. Sometimes it's their second or third language. So it persists. But also, you can be an engineer or an electrician and have good literacy skills in your field, but not necessarily about health. The higher your education level, the more you're able to work out what you need to know about your health — you acquire those skills much more quickly. But the lower your levels of literacy, the harder it is to make those connections and make sense of it. And there are high levels of influencers out there trying to sell misinformation or just nonsense. So it's still really hard to navigate and work out what you actually need to know. The system is complex, too. Services are very often fragmented. You have to work out for yourself what your care partnerships need to look like if you've got something serious going on. I've got a friend who's very unwell; she had complex health challenges before she got a serious diagnosis, and her partner has put together a spreadsheet of all the specialists she needs to see and how often. It's huge. Without that, they'd be really struggling from week to week to work out what they need to do next to keep her alive, frankly. It's working for them, but not everybody has those skills to work it all out. And then you've got to be able to talk from one provider to another, often retelling your history to move forward. It is really complicated for many people.

Bob: Absolutely.

Helen: So it is still a complex health system, despite how well we're doing and despite the level of sophistication we have. For everyday people, it's still complex.

Bob: You've explained that the literacy challenge arises for a range of reasons and has a range of potentially significant downsides. Buying the snake oil is one of them, along with the plain old challenge of navigating a very complex health ecosystem. Are there any other big real-world consequences of limited health literacy?

Helen: There certainly are. One issue that's come to light, perhaps in the last six to eight years — maybe a bit longer — is the difference for women experiencing the symptoms of heart attack or heart disease. That hasn't been taught to generations of doctors and nurses, and it's really only becoming clear because there are women now saying, "This isn't the same by gender. It's different." Those messages then need to get through to the general population. Women do tend to ignore it — I know men do too — but women don't necessarily understand that the symptoms men have, which are very widely publicized, aren't the same for them. People can also take medicines incorrectly if they don't understand the labels. The labelling isn't always easy to make sense of, which is why pharmacists are so important now. When they give you the medication, they actually ask, "Now, do you understand this? Have you used it before? Do you need any help? Come back if you need to." That's so important. People also delay care until they're very unwell if they're uncertain or a bit scared. But the most common issue is that people end up not managing chronic disease as well. Diabetes, for example, is one where there's a huge cost to the health system from preventable hospitalizations. It's huge, and it's one of the most common conditions. Asthma is another one people aren't always sure how to manage — they end up in hospital more often than they should. People get confused and overwhelmed navigating the system when they're not given clear guidelines about what to do.

Bob: So let's talk about possible solutions. Do you think health literacy should be seen as a shared responsibility between individuals and the system?

Helen: Absolutely. It's often seen as a personal deficit, and it's not. If people don't understand, it's because they haven't been given the information in a way they can take on board. That's a problem. I think we are seeing a lot more effort now from all kinds of health professionals to make sure the person they're seeing understands what's going on. That has been a big shift. So it is a shared responsibility at that level — but we also can't make assumptions. As I said before, people can have very high literacy skills across a whole range of areas but still find the complexity of a health challenge quite overwhelming. It requires good explanations from health providers to help people understand what their risks are and what they need to do to stay well. So the systems and all providers are responsible for explaining information to their clients and patients in understandable language. That is the big shift that's changed enormously over the last 15 or 20 years.

Bob: Of course, one other communications challenge in a clinical context is that the person receiving the information is often at a point in their life when they are least open to — or able to process — it, because they're just scared or in pain, or both.

Helen: Yeah. So very often the advice now is to bring someone along, take notes, use your phone, record it — and providers are more open to that than perhaps they've been in the past. But there are still a lot of blind spots. Another way we need to think, as people working in the health system, is about what people's experience is. Asking them, "What do you think's going on? How is this affecting you?" and using that as a springboard for the next level of information, and then the one after that. So yes, people do get overwhelmed, but they can be brought along on that journey with the right approaches.

Bob: Helen, a minute ago you mentioned blind spots. Are there any key organizational blind spots that exist in your view?

Helen: Oh, there definitely are. One blind spot is that organizations want to deliver health information, rather than checking whether that information is clear, accessible, and actually usable for people. One way you can do that is to test it with real-world people — consumers who are likely to read it. Another blind spot is designing communication from the organization's perspective, instead of the consumer's. One of the things every health provider learns is jargon. We're terrific at jargon, but we have to break it down and make sure we're using plain English. And, of course, every organization wants to use digital tools now, and they forget how many clicks people are prepared to do to get the health information they want. Usually two or three clicks and —

Bob: Yeah.

Helen: — people go, "This is too hard. I don't want to know." So it's about getting that right. Those can be blind spots. It does add costs to an organization's communications team, but it's absolutely crucial. In the end, it's a core safety and quality issue, and that's the way it's being seen now in many organizations — the work is part of their quality and safety committees, and they hold responsibility for making sure they've got processes in place to review material and make sure it's fit for purpose.

Bob: Your observation that organizations and institutions often write for the purposes of the writer, rather than the purposes of the reader, is a really big issue in a whole lot of technical writing worlds. It goes fundamentally to the international definition of plain language, which ultimately focuses on making the information usable for the target readers — as opposed to fitting the needs, purposes, strategies, insecurities, and exposures of the writing organization.

Helen: Absolutely.

Bob: Can you share an example where improving communications made a measurable difference in community health outcomes?

Helen: For sure. If we think of some of the major public health campaigns over the last 20 or 25 years, the most well known — and the one that's made a measurable difference to people's outcomes — is the Slip, Slop, Slap campaign, which is now also "Seek" shade and "Slide" on sunglasses.

Bob: Now, Helen, just in case we're broadcasting this to millions of international viewers — and there's every chance we would — you might want to say a bit more about that initiative.

Helen: Okay, so it's an Australian campaign to prevent sunburn, which very often leads to skin cancers in later life. It is the most successful public health campaign in Australia, and it has significantly reduced the incidence of melanoma and improved people's understanding of how they can prevent it. Some of the visuals about mental health have also helped. Mental health has always carried such stigma, but there have been really good efforts to ensure the world understands that mental health is something we all carry. We all have moments in our lives — many of us have longer periods — where we feel like we have poor mental health. But it's started to be normalized now, and there are many tools available to say, "It's okay not to feel okay. Do you need help? Here's where to get help." So some of those examples have made a huge difference to outcomes for people. It's not just having words. It's also having images that convey the message and can be picked up quickly, and the words then have to reinforce the image. I've seen brochures where there's a lovely image of something, but the words don't relate to the image at all. So there are some skills in writing good technical information that's also in plain English and makes the point. But I think we're getting better and better at that in public health.

Bob: In your view, how early in life should we start teaching health literacy, and how could schools or media better support any linked initiative?

Helen: Well, we have to start in the early years, don't we? And we do. We encourage very young children to wash their hands and clean their teeth. I keep reminding my grandchildren that their teeth need to last them till they're very old, like me — and then I say how many years that is, and I think it hits the mark. They kind of realize you've got to look after them now. But there's much more to it than that. We need to be delivering the right health messages at every stage of life. Children become teenagers and suddenly they're exposed to so much peer pressure and social media. We need to keep giving them information that's going to help them understand what matters. Respect for others is another really big one that we're learning to reinforce with teenagers, because it's so often a time when they use disrespect because it's funny, or their peer group thinks it's the way to go. And then young adults, where somehow some transition happens and they think they're invincible, that they're not as vulnerable to risks — we need to use plain language to remind them that we're all vulnerable to speeding cars, not wearing seatbelts, getting tanned, drinking too much, overloading on sugar. All of those messages in some way need to be delivered, and they're very simple messages, but they do need to be delivered at every stage of life. So we start young and we go right through life.

Bob: Fascinating. Many health organizations struggle to write clearly. Why is plain language still such a challenge — even recognizing that the general standard is probably increasing over the last few decades — but it still seems to be a challenge?

Helen: I think the system's been built around clinical language, and the people who run the system very often have a clinical background and don't always put in those safeguards within organizations to make it happen. I mean, if you walk into a new wing of the hospital and the sign on the door says "Nephrology," you think, well, the nephrologist knows where to go — but do people understand that's the kidney department? I think that kind of thing is changing. I don't know how many hospitals I've been into where renovations are going on and you're told to follow the blue line, but it just suddenly stops because things have changed. One of the greats in health literacy in the United States is Rima Rudd, and she has story after story about doing audits of hospitals and how easy they are — or aren't — to navigate. I think it's still a problem. You mentioned before that staff often write in language that's familiar to them. Perhaps it feels more comfortable to write using clinical language, and they think they've made it easier to understand — but the best judges are the consumers. So having a consumer oversight process is critical. Whether it's a hospital, a community health service, or local government, having that consumer oversight of the information that goes out is a great leveler for organizations who are struggling to get processes in place. It's about testing material with real-world users, so you understand where people are getting lost and can change it.

Bob: Okay, so that's obviously a key ingredient. But you facilitate lots of organizational change. What are the other ingredients of a culture that values plain speaking, plain writing, and true understanding?

Helen: In many organizations I was working with, there'd be a champion for health literacy in plain English, plain language. But if that champion gets frustrated because there's no systemic approach, or that champion leaves or moves on, then any degree of change they might have managed to make happen will usually stop. So we need systemic processes. They need to be built in. When they're built into accreditation standards, that's a start — but the risk is that an organization will then rush around two months before accreditation and try to make some change happen. I think it needs commitment from the top, and it needs to filter right down through the whole organization: this is how we are, this is who we are, we're here for people, and it's our job to make sure they know we're here for them and that they can access us without fear or judgment.

Bob: So making these changes takes time, effort, and probably resources. With that trinity, what do you need to do to persuade the budget holders — the leaders within organizations — that, yeah, we should do this?

Helen: It's actually not expensive to have consumer groups checking over material and getting back to you. We could have real-world people with lived experience reading things over for nothing — but that's not fair either. They're doing a job and they should be recompensed for it. Most organizations have community advisory groups who could be doing that work as well. It's not expensive to make sure the information you're putting out is fit for purpose. It's actually fundamental for an organization, and there are many fundamentals. Hand hygiene, masks and gowns, whatever it is — there's a cost to all of those things. They're all about prevention and good practice. So it is about funding good practice.

Bob: Let's talk about another fundamental I know is close to your heart. You've said that equity is at the heart of everything you do. How does health literacy fit into that vision?

Helen: It's a good question. Health literacy is an equity issue because when people struggle to find, understand, or use health information, they're at risk of poorer health. And those people are sometimes — not always — the ones facing other disadvantages. But even if people have a good education, it doesn't mean they know how to translate information to manage a particular condition. Diabetes comes to mind, heart disease of course, musculoskeletal things. So access to understandable information that people need to be healthy is everyone's right. That's an equity issue. It's a rights issue and it is an equity issue.

Bob: If you could make one system reform to ensure fairer access to health information, Helen, what would it be?

Helen: I think we need to start teaching students about the importance of health literacy, to make sure it's at least on their radar and part of their thinking for all of their health careers. It is a form of advocacy on behalf of people. If we really want better health in the whole population, then we need to understand that health literacy is one of the tools — and good health information is one of the tools — that's going to make that happen.

Bob: You've been part of international networks in public health for a long time. How do different countries approach health literacy, and what, if anything, can Australia learn from them?

Helen: I think the US has been very influential in the health literacy world, because originally a lot of the work was funded by Pfizer, so it was very focused on medical writing and almost based on a personal-deficit model. I think they've improved — they've come a long way — and that's because of the influence of social scientists like Rima Rudd, who have said we have to write much more broadly than that. But a lot of the research was funded by Pfizer, and they had a particular purpose in doing that. There've been other foundations in the US that have been very influential, and because their funding reaches all corners of the globe, that's how their work in health literacy has also been influential. I don't know about South America, but if Paulo Freire has had anything to do with it, they'll have a very bottom-up approach to learning literacy, and health literacy in particular. So I'm hopeful, but I don't actually know.

Bob: Who is Paulo?

Helen: Paulo Freire was an educator, South American, and he had a pedagogy about community-based participatory learning. He was very influential in research as well. A lot of people coming into social science realized that that kind of bottom-up learning — participatory models of community organizing and education — actually work.

Bob: If you could ban one phrase from every health brochure in Australia, what would it be?

Helen: "Should." The word should. "You should do this. You should do that." I find it very irritating.

Bob: Is that because it's a bit of a finger-waggy word?

Helen: It's a finger-waggy word. And there's a little bit of me that says, "Well, who's going to tell me what I should or shouldn't be doing?" Give me a reason. Give me the facts. Tell me how it is. Yes — I just hate it. I hate it in recommendations, in a report. I refuse to use the words "you should."

Bob: So how would you redraft it?

Helen: Well, it's about saying what the actual problem is that we're trying to fix, and stating that problem. The problem is that without vaccinating children, they're at risk of getting life-threatening diseases. Then you make the point that by taking children to get vaccinated, you increase their chances of living longer and not getting that disease. I just don't like the words "you should."

Bob: What phrase do you most often overuse?

Helen: I think you'd have to ask my children that.

Bob: Okay. Outside of work, Helen, what keeps you grounded, or inspired for that matter?

Helen: Working in activism around gender equity and the prevention of violence against women. I really try hard to stay connected around amazing people whose motivation for justice and equity is so energizing. I'm almost fully retired — not quite — but those people are what keep me going.

Bob: What do you read for pleasure, and does it influence how you write or speak professionally?

Helen: I read fiction and nonfiction. I like short-form and long-form essays. I've really enjoyed the narrative memoir The Salt Path and its sequels, by Raynor Winn. I know there's been a little bit of controversy about some aspects of that, but I found her writing beautifully poetic. I felt like I was there on the salt path. I like a book that takes me somewhere else. Overall, I lean to women writers. I'm currently reading Devotion by Hannah Kent, an Australian writer. In nonfiction, I read politics — the kind of long-form essays in The Monthly and the Quarterly. And every now and then I kind of throw it across the room and go, "No, I'm not finishing this essay. It's rubbish." But I'm a bit of a political animal and I like to know what's going on.

Bob: Australian politics, or more broadly than that?

Helen: Mainly Australian, but also the Guardian, because you get some European and UK news.

Bob: Now, if you wanted to point someone at the start of their public health career to examples of great health or scientific writing, where would you direct them, and what makes those examples so good?

Helen: For an undergraduate student, or a student just finding public health, I'd say subscribe to the daily newsletter called Global Health Now, which comes from the Johns Hopkins Bloomberg School of Public Health. They present the latest research, explain it in a paragraph that's easy to understand, and then link you to the original piece. It's fantastic. I look at it every day. The other one I get is Nature Briefing. Nature is one of the top series of journals in the world, and they have a blog as well that comes out every day. The briefings distill the scientific findings into bite-size paragraphs, and again, the links are there if you want to delve further. So I find them both quite irresistible, really. I browse through them every day. I'd point people to those for a start, and the links they have to various other publications are going to be reliable and scientifically sound.

Bob: So would you point people to those resources as exemplars of what really good writing looks like?

Helen: Yeah, absolutely. Yes.

Bob: I want to close by asking you two more messaging-related questions. First: if you had a manifesto for clear communication in one sentence, Helen, what would it be?

Helen: Every person has the right to the information they need, at the time they need it, and in a form that is usable to them. And if we don't provide that, then it's a dereliction of our duty.

Bob: Wonderful. Final question: if you could leave one message with policymakers, what would it be?

Helen: Health literacy is not something that individuals themselves are expected to fix. It's something the health system must enable. So policies that strengthen organizations and their capacity for clear communication — and services that people can navigate and that are culturally safe — that is in itself essential health care. We can't reduce demand on hospitals for preventable illnesses, and we can't achieve better equity, without organizations taking responsibility for how they and all their staff actually provide information to people. We just can't expect that to happen. So it's really fundamental, and it's not something we can cut funding for. We have to keep doing it, and we have to learn how to keep doing it better.

Bob: Right — a couple more hard-hitting questions for you, Helen. Dog person or cat person?

Helen: Both.

Bob: Oh.

Helen: I acquired my first dog four years ago. I didn't think I was a dog person, but she's very good company. She's very sweet.

Bob: Oh, we love dogs. Coffee, tea, or something stronger when you write?

Helen: I tend to write in the mornings. I can get up with a pot of tea and start. But by 9 o'clock, I need that coffee. One a day — but as my children will tell you, it's a cheat one-a-day coffee, because it's triple strength.

Bob: Well played. If you could have dinner with any writer, living or dead, who would it be?

Helen: I love this question. From history, it would be Mary Wollstonecraft. She was a humanist who pioneered writing about women's rights, and her book A Vindication of the Rights of Woman, which she wrote in the 1700s, was life-changing for me. I reckon we could have a really good yarn over dinner about how things have — or haven't — changed for women.

Bob: That would be a fun night.

Helen: It would be.

Bob: Helen, it's been wonderful to have this opportunity to hear your insights and your wisdom drawn from such extensive experience. Thank you so much for your time and your commitment.

Helen: It's been a pleasure. Thank you very much, Bob.

Bob: Thank you. Helen reminds us that there's a lot of good things happening in the world of health literacy, but there's lots more we need to do to address the challenges of both personal and organizational health literacy. And that's because the bottom line is that better health literacy helps generate better health outcomes — and it's also a human right. To learn more about Helen's work, be sure to check out our show notes. Top of Their Game has been brought to you by In-Game Learning: the most fun you'll ever learn. Visit ingamelearning.com and see just how fun online plain language training can be. If you enjoyed today's episode, share it with a colleague, leave us a review, or — better yet — rewrite something terrible and send it to us. We will love you forever, and so might your target readers. I'm Bob Milstein, and until next time, go forth and clarify.

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