In recent decades there has been an explosion of comics exploring medical experience from the point of view of patients, family members and health care professionals. The term “graphic medicine” was coined by physician and comics artist Ian Williams when he began to catalogue such works. The website he inaugurated, www.graphicmedicine.org, has evolved into a robust, multi-faceted resource for anyone interested in learning more about the field.

And what a rich and varied field it is. There are graphic memoirs (“graphic pathographies”) about almost any state of health or illness you can name for example, cancer, bipolar disorder, infertility, Parkinson’s disease, epilepsy, addiction, spina bifida, HIV/AIDS — and in a wide variety of artistic and narrative styles.

While it may sound strange to create or read comics about something as serious as a life-altering medical condition, comics is, in fact, the perfect medium to capture the ambiguities, contradictions and occasional absurdities of the illness journey. The interplay of image and text can communicate in ways that text alone cannot, and the comics medium, as a familiar and non-threatening form of narrative, can possibly ease the discussion of difficult topics.

For patients and families, reading graphic pathography can provide reassurance that they are not alone in what they are going through. For readers with no personal experience of an illness, reading graphic pathography can educate and promote empathy with others — as well as providing the same human interest and narrative pleasure as all other kinds of memoir. For health care professionals and students, reading graphic medicine helps to promote empathy for the patient experience, and stimulates reflection on topics such as ethics and communication in health care. And for scholars in the humanities and social sciences, graphic medicine provides a powerful lens for the analysis of identity and culture within the context of health and illness.

In addition to reading comics, making comics is an important feature of the graphic medicine movement. You don’t have to be an artist to “get out your crayons,” in the words of graphic medicine pioneer MK Czerwiec, and draw your story. In some medical schools, students are invited to create comics as a way to reflect on formative experiences; in two recent initiatives at a children’s rehab center in Toronto, nurses and the parents of pediatric patients attended comics-making seminars to tell and share their stories. In other instances, cartoonists work with patients to document their health care stories, as in the wonderful “Sketches from Outside the Margins” initiative in Seattle/King County.

Visit graphicmedicine.org to learn more about the field and the annual Comics and Medicine Conference, to find reviews of works of graphic medicine, to check out “This Week in Graphic Medicine,” a regular blog post by medical librarian Matthew Noe that highlights the newest relevant books, articles, events, podcasts and other media, and for information about the “Graphic Medicine” book series from Penn State University Press.

Shelley Wall, MScBMC PhD, is an Assistant Professor, Biomedical Communications Program at the University of Toronto.

The post A Prescription for Graphic Medicine first appeared on Public Libraries Online.

In the book, you go over the scientific research that shows how childhood adversity is a risk factor for many of the most common diseases. When did you first make the connection between childhood adversity and a patient’s physical health?

The first time I started putting it together concretely was with Diego, who is a seven-year-old boy I first saw in 2007, which is actually the first year the clinic was open. His presentation was so striking—he had essentially stopped growing—that it really made me ask that question about whether the two could be linked. I feel like the trauma he experienced, I don’t want to say it had to be connected, but looking at the pattern, it looked very connected. This was not a coincidence; this was actually having an impact on his body.

You follow the patient histories of many patients, including Diego, in the book. Why was it important for you to put a human face on childhood adversity and toxic stress?

Because I think that probably our biggest obstacle is myth and misinformation. It’s this idea that childhood adversity is a story we think we know. Many people think, “Well, I know a guy who grew up in a terrible situation and now he’s the CEO of a company.” People have this conception that if you don’t have any behavioral problems it means you’ve left all your childhood adversity behind and it doesn’t have an impact on you. The science does not show that. What the science shows us is that childhood adversity changes our bodies in ways that are lifelong. It doesn’t have to be this awful “woe is me” situation, but people do need to understand if they’re at increased risk for health conditions.

Can you talk a little about what are these long term effects childhood adversity on people’s health?

When I first read the Adverse Childhood Experiences study, what was so striking to me—aside from how incredibly common childhood adversity is—is the fact that what we’re talking about is increased risks for things like heart disease, cancer, chronic lung disease, and Alzheimer’s. What’s amazing to me is that if a person has a very high dose of adverse childhood experiences, their risk of heart disease is the equivalent of eating thirty-three strips of bacon a day. We know that eating bacon is bad for your heart and it increases your risk of heart disease, but what we didn’t know is that having a very high number of adverse childhood experiences increases your risk of heart disease even more that eating a ton of bacon. So when I saw that connection to chronic disease, that was just really powerful.

The other area that I focused on was the science behind how early adversity causes these long-term changes in our brains and bodies. When we understand how these changes happen, for me that’s the hopeful part, because we can use the science to interrupt their progression. When it comes to toxic stress, the fundamental mechanism is our fight or flight response. It’s the release of stress hormones, including adrenaline and cortisol, that have all of these effects on our bodies that are designed to save our lives. It affects the way our brain functions, it raises our blood pressure, and increases our heart rate. All of that is really good if you are in a forest and you need to get away from a bear. The problem is when this process is activated too often, it goes from being life-saving to health-damaging. We see this in children since they are especially sensitive to repeated activation of the stress response because their brains and bodies are still developing. So when kids are exposed to high doses of adversity, it actually changes their developmental trajectory. It changes the way their brains, their hormonal systems, and even their DNA functions for the life course.

You mentioned the Adverse Childhood Experience (ACE) study and in the book you talk a lot about ACE scores. Can you explain what the ACE score is?

The ACE score comes from this groundbreaking study that was done by the Centers for Disease Control and Prevention and Kaiser Permanente, the health care group. In that study they asked 17,500 people about their adverse childhood experiences. They asked about ten categories, including physical, emotional, and sexual abuse; physical and emotional neglect; growing up in a household where a parent was mentally ill or substance dependent; growing up where there was parental separation or divorce; and growing up where there was parental incarceration or domestic violence. For every yes a person answered, they would get a point on their ACE score. When you totaled up that number, that’s your ACE score.

One part of the book that I thought was striking was how you remove any shame around having a high ACE score and instead treat it as piece of information.  If someone has a high ACE score, what can they do?

Well that’s what for me is so important, there’s a lot that people can do. It starts with recognizing that their ACE score might mean they have an overactive stress response. Just recognizing when their stress response is kicking in and whether it’s healthy or not is really important. What I talk about in the book is there are six interventions that there’s strong evidence reduce stress hormones, reduce inflammation, and enhance neuroplasticity, which is the ability of brain cells to connect to each other.

All of these work to heal the impacts of an overactive stress response. They include things like meditation; getting regular sleep and having good sleep hygiene; good nutrition, particularly a high-lean-protein, low-fats, low-sugar diet; getting at least an hour of exercise a day; good old fashioned mental health care; and healthy relationships.

I think healthy relationships is a really critical piece because we as human beings have the ability to not just trigger each other’s stress response but also buffer each other’s stress response. My point in the book, and I don’t think that I can overstate it, is having these networks in your life, having “the village,” doesn’t just feel good, it can actually improve your health and possibly save your life.

Even though there’s a lot of scientific research in the book, you present it in a very accessible manner. For you, who is the ideal reader of this book?

Everyone. I think that there’s no one who doesn’t need this book. For me, understanding that early adversity changes our bodies in this way is a little like understanding that microbes cause infections. There’s no one who doesn’t need to know that, because we all need to wash our hands, right? We should all cough into our elbows. This is really a matter of public health.

It doesn’t matter if you have kids or you don’t have kids. If you’re an adult, you once were a kid. And particularly for anyone who comes into contact with young people, who works with young people, who makes policies about young people, who comes in contact with or makes policies for parents of young people, it’s necessary. I think that the whole point of a public health movement is that every single one of us has a role to play in solving this crisis.

What role can librarians play?

I was at the Philadelphia Free Library last night for my book kick-off event and it was just such a powerful reminder that libraries are these hubs of civic engagement. They’re these places where families come, where people connect into the world of books and literature, and where people come for resources. So my hope is that librarians will be part of being on the front lines of shouting from the rooftops to talk about this work and and connect families to this resource and this information.

The post Every Single One of Us has a Role to Play in Solving this Crisis: Dr. Nadine Burke Harris on Childhood Adversity first appeared on Public Libraries Online.

It’s January, a time when everyone seems to be motivated to improve their health and start making healthier choices. Your library can make a healthy resolution, too! It’s always a good time for librarians to consider new programs and ways to improve health information services … but where do you start? How do you choose the right materials, and which programs will draw the most participants? To help answer these questions, it’s critical to understand your population — not only the regular library users, but also the community at large.

Observing and working with patrons on a daily basis will give clues about the demographics in your town or city, and you might see some trends in the types of questions people ask. Perhaps the community has a high percentage of seniors, a refugee or minority population, or a high incidence of a significant health issue.

But simple observation doesn’t provide a full picture. It’s easy to find basic data or detailed reports that will fill in all the missing information and help to guide your plan.

Start with basic demographics

For a quick overview of your county, try the County Health Rankings and Roadmaps site from the Robert Wood Johnson Foundation. Start by looking at basic demographics and health issues in the community. In the section titled “Explore Health Rankings,” search for your county, view the demographics, and browse the different health indicators. The site allows users to compare counties, and see how the county ranks in comparison to others.

Explore specifics about your community’s health

After reviewing the basics, you can access detailed community health needs assessments for your city or county. Known as CHNAs, these reports provide a wealth of information about the specific community. In addition to demographics and languages, the reports always include the most pressing health issues in the community and how the organization authoring the report plans to address the issue.

By seeing the whole picture, the library can design programming targeted to the identified health needs, which helps to draw in people from the entire community. The data can be used in collection development decisions or to support grant proposals and other related activities. In addition, the reports are excellent resources for learning about local health-related organizations. Use current CHNAs to help build your local organization directory for the reference desk or to find local experts who might speak at the library for a health program.

To find a CHNA report for your city or county, try a Google search as in this example: community health needs assessment Sacramento. You will see reports from local hospitals, county agencies and other organizations. Choose one, look at the table of contents, and then browse the sections of interest to help you understand health status of your own community. In particular, find the section of the top health needs or issues and the organization’s plan to address the issues. See what ideas are sparked by what you learn!

Turning knowledge into action

Once you’ve learned more about your community’s health needs, consider what the library can do to help community members improve their health. If there is a need for multilingual language materials, check out MedlinePlus.gov from the National Library of Medicine, the health website that every library staff should know from the National Library of Medicine. The site is in English and Spanish, and some information is available in over 45 other languages. Browse innovative health programming ideas on the American Library Association’s Programming Librarian website; choose “Health and Wellness” in the Topic pull-down menu.

By taking the time to learn about the health status and needs in the community, libraries can turn information into action to improve the health and wellbeing of the entire community.

The post Health Resolution: Getting to Know Your Community to Improve Health Information Services first appeared on Public Libraries Online.

Whether they’re searching the Internet, watching television, or browsing social media, Americans are bombarded with information related to their health, but the messages they’re receiving may not be understandable, reliable, or even credible. Faced with confusing medical terminology, conflicting reports, and a constantly changing healthcare system, people are looking to their local public libraries for guidance. That’s why the National Network of Libraries of Medicine (NNLM) is partnering with the Public Library Association (PLA): to help libraries meet the challenges of keeping up with evidence-based health resources and producing successful health programming.

Announcing Promoting Healthy Communities

PLA and NNLM are thrilled to announce Promoting Healthy Communities, a new nationwide initiative that will increase public library workers’ health knowledge and skills related to reliable health information resources, as well as support programs related to health and wellness. Throughout the nine-month initiative, PLA and NNLM will:

· Assess health information needs among public librarians in order to improve existing educational opportunities and develop new ones designed to meet the unique needs of public libraries.

· Share free resources, information about successful library programs, and professional development opportunities by holding training programs and webinars, publishing articles and podcasts.

· Unveil a new website (coming in early 2018) for public librarians that gives them easy access to training, tools and resources for consumer health information, health literacy programming and more.

Join Us In Person

The Promoting Healthy Communities initiative will include two in-person learning opportunities.

· “Public Libraries Supporting the Health and Wellness of Your Community,” Sunday, Feb. 11, at the 2018 ALA Midwinter Meeting in Denver. At this “unconference” event, attendees will be invited to connect with their fellow librarians to discuss the health-related topics that are most relevant to their needs. The session is open to all Midwinter Meeting registrants. Learn more and register for the Midwinter Meeting.

· “Stand Up for Health: Health and Wellness Services for Your Community,” Tuesday, March 20, 2018, at the PLA 2018 Conference in Philadelphia. This one-day preconference will review core competencies of providing health and wellness services; coach participants through understanding their communities’ needs; and explore how to create fun and informative health-related programming for different age groups and special populations. Pre-registration is required, and up to fifty $500 stipends are available. Learn more about the stipend opportunity.

Other Ways to Connect

Public librarians can find their regional office and access its resources at https://nnlm.gov/regions.

NNLM offers a wealth of resources that public libraries can use to engage their communities on specific health topics, such as:

· health outreach, nutrition and food labels, and health insurance;

· funding opportunities and awards available to public libraries; and

· microlearning videos to inform library staff about NNLM resources.

Finally, as Health Literacy Month (October) draws to a close, take advantage of the free Health Literacy Toolkit created by NNLM and the American Library Association (ALA). The toolkit includes customizable tools to raise awareness of how libraries support health literacy in their communities, including key messages, program ideas and downloadable marketing materials.

We look forward to connecting with you in the months to come.

This project has been funded in whole or in part with Federal funds from the Department of Health and Human Services, National Institutes of Health, National Library of Medicine, under Grant Number 1UG4LM012346-01 with the University of Iowa.

The post Promoting Healthy Communities: Connecting Public Libraries with Health Information first appeared on Public Libraries Online.