key: cord-0020470-dnpg2uzh
authors: Lenstra, PhD, MLIS, Noah; Flaherty, PhD, MLS, MS, Mary Grace
title: Closing the Gap:: Public Libraries and Public Health
date: 2020-09-28
journal: Dela J Public Health
DOI: 10.32481/djph.2020.09.013
sha: f812513e8ac58bb307261250bee8f9fbc9663076
doc_id: 20470
cord_uid: dnpg2uzh

nan

In June 2018, Beth St. Jean, Associate Professor in the University of Maryland's College of Information Studies, and an affiliate faculty member of the Horowitz Center for Health Literacy, released a Call for Papers for a special issue on the topic of "Health Justice" in the International Journal of Information, Diversity, & Inclusion (IJIDI). 1 The response received was overwhelming. The peer-reviewed journal ended up publishing two special issues in Summer 2019, featuring articles written by Library and Information Science (LIS) scholars on such topics as: "Scenarios of Health Engagement Experiences and Health Justice in Rural Libraries," "Health Insurance Literacy and Health Disparities in the United States," "The Lived Experience of Work and Career Among Individuals with Bipolar Disorder," and "Food Justice in the Public Library: Information, Resources, and Meals." 2 So successful was the call for papers, that St. Jean and her colleagues at Maryland decided to launch a second special issue, this time in the monograph series Advances in Librarianship on the "Roles and Responsibilities of Libraries in Increasing Consumer Health Literacy and Reducing Health Disparities." 3 The book comes out November 30, 2020. This recent history illustrates how interest in the topic of public health in our field of LIS has never been higher. This scholarly interest mirrors widespread interest in health promotion in the public library profession. Nonetheless, cross-sectoral collaborations between libraries and public health are not as robust as they could be. This essay aims to explore some of the promising avenues for future collaborative work, as well as to highlight some of the major public healthpublic library trends already underway. Our focus here is on public libraries, although there are also gaps that need to be closed between public health and other sectors of librarianship, including academic, school, and medical libraries.

In January, 2020 the Iowa Department of Public Health launched Harnessing the Power of Iowa's Libraries through a pilot in two counties: Linn and Dallas, one urban, one rural. In its press release, the health department states "Many libraries already understand the importance of healthy lifestyles. For instance, the Cedar Rapids Public Library has installed walking treadmill desks. The funding will allow libraries to build off existing health promotion efforts, in addition to expanding their offerings in partnership with their local public health agency." 4 What makes the language and approach of the Iowa Department of Public Health worth emulating is that it recognizes the following facts about public libraries:

1. Even before the public health department got involved, public libraries had already been working towards promoting public health and healthy lifestyles.

2. The project starts small, based on the fact that public libraries are idiosyncratically local institutions, and thus change, of necessity, begins at the grassroots.

This approach of the Iowa Department of Public Health also grasps two fundamental attributes of public libraries. Public libraries are:

Public spaces open to all community members, and as such can serve as an excellent community hub and as a place to help build local social capital; and 2) Run by public librarians, who tend to be trusted community members with known expertise in bringing together information and connecting it to community needs.

We see the mobilization of these two dimensions of public libraries in public health responses to the current COVID-19 Pandemic. Public libraries as public spaces were mobilized in cities like Toronto, where local media reported on "How the Toronto Public Library turned its branches into food banks." 5 After closing to the public, branches became hubs for receiving, packing, sorting, and distributing food to those in need. Similar efforts occurred in San Francisco, where "food bank officials say that ultra-organized librarians created a more efficient way to pack the food bags and even to maximize the number of bags per bin to meet delivery trucks' capacity." 6 Public librarians themselves were also mobilized in response to COVID-19 by cities harnessing librarians' ability to quickly and efficiently collect, collate, organize, and disseminate information. In Raleigh, North Carolina, public librarians became contact tracers. 7 In Rochester, Minnesota, public librarians staff a COVID-19 hotline anyone can call. 8 In good times and bad, harnessing public libraries for public health reveals: 1) Librarians frequently have the ability to launch and sustain local experiments. One such example is in Farmville, North Carolina where the public library was able to quickly start checking out pedometers, do health assessments, and even become the town's wellness coordinator 9 ; 2) Innovation begins at the grassroots and spreads upward. In fact, after public libraries closed to the public during COVD-19, librarians across North America started spontaneously creating chalk-and paint-based obstacle courses on their sidewalks to promote some fun, safe, family physical activity outdoors. 10 Given the grassroots nature of public library efforts to promote public health, knowledge of this tendency at the state and national level remains somewhat underdeveloped, despite the fact that public libraries have promoted health since their inception in the mid-19th century. 11 When Flaherty worked with public health professors on the article entitled "Public libraries: A community-level resource to advance population health" published in the Journal of Community Health, 12 it was apparent that knowledge of public libraries as partners in public health promotion remains underdeveloped in the field of public health. This finding was affirmed by Lenstra's participation on the advisory board of the American Heart Association's Voices for Healthy Kids' Activating Rural America initiative, in which during board meetings other members expressed surprise that public libraries were doing so much to promote healthy child development.

Nevertheless, despite some difficulties understanding overall missions, public library and public health professionals increasingly work together at local, state, and even at national levels, as the example of Healthy Ireland at Your Library in the European Union illustrates. 13

Given all that public libraries already do to promote public health, why are partnerships not more robust? Part of the challenge of fostering and sustaining partnerships relates to the very different systems in which these professionals operate. The field of public health is more organized nationally, with a strong infrastructure for communication. In contrast, although approximately 96% of the US population lives within a public library service area, 14 the nearly 10,000 public library administrative entities across the nation are run largely independently from each other. Nearly 90% of library funding comes from municipal or county funding sources, and there are no national standards one has to meet to become a public library. There are three main types of public libraries across the country: a General-Purpose Government library, in which the library is a sub-unit of municipal or county government (64%); a Library District, in which the library is an independent taxing district (19%); and a Nonprofit-Organization (NPO), in which the library is run like a 501(C)3 (15%). 15 Public libraries can also be part of tribal governments or school districts. In short, this is a national infrastructure with high levels of local autonomy and variation from place to place.

Uniting this vast infrastructure are the professional and continuing education providers to which librarians go to build and sustain their capabilities. Similar to public health, the Master's degree (in this case the M.LIS) is the primary credential and terminal degree. However, as with the variation in public library governance, there are differing requirements for education of library managers and directors; over half of all public libraries in the U.S. are headed by non-MLIS level directors. 16 The faculty who teach in LIS programs increasingly study and teach about public health. Some programs offer courses on "Health Literacy and Public Libraries," 17 while others have, with federal funding, sought to develop new approaches to preparing librarians to work with public health professionals. The University of Missouri is developing a program in which LIS students take courses both in LIS and in public health before deploying this knowledge as public librarians in small towns and rural communities. 18 At the University of Tennessee, faculty worked on a federally funded project focused on supporting public libraries as health partners in Central Appalachia. 19 One sign of the integration of this topic into the LIS curriculum is the arrival of its first textbook, published with the American Library Association Promoting Individual and Community Health at the Library in 2018. 20 After public librarians finish their degrees, they often seek continuing education. Here again, we see a growing focus on public health. In 2013, the national non-profit OCLC/WebJunction, "the learning place for libraries," received funding from the U.S. Institute of Museum and Library Services (IMLS) to develop Health Happens in Libraries. 21 The project initially focused on preparing public librarians to help patrons navigate the Affordable Care Act. Over time its focus widened to promote other facets of public health, including physical activity, nutrition, mental health, and more. One product of the initiative was the "Library Heroes Make Health Happen" infographic, which highlights the many and varied ways libraries support healthy living. 22 America's largest professional association of public librarians, the Public Library Association, part of the American Library Association, also supports this trend. A study commissioned by the American Library Association found substantially more voters said in 2018 they think public libraries should provide "activities and entertainment not found elsewhere" in a community (48% versus 38%), and many of these activities center around public health. 23 The American Library Association's 2020 annual report states, "Libraries provide a diverse array of health literacy and awareness services for their communities. Some libraries take healthy lifestyle services even further by offering walking, hiking, bicycling, or running programs that take place outside the library building. Nearly 23% of public libraries host fitness or yoga classes." 24 Programs involving or associated with walking promotion, in particular, have become especially common. 25 There are also signs that the field of public health increasingly attends to public libraries. The 2019 conference of the APHA featured numerous sessions and papers on public libraries, many of them associated with the Healthy Library Initiative 26 at the University of Pennsylvania, including "Occupational hazards in public libraries," "Four public health emergency preparedness partnership projects with the Free Library of Philadelphia," "Health information needs assessment of public library patrons and staff: A public health partnership," "Integrated health and social service delivery at the Free Library of Philadelphia," "Community Based Health: Evaluation of Public Library Stress Reduction Offerings," "Improving the nation's health: The role of librarians in an activist boot camp," and two sessions on public libraries and the opioid crisis: "Public libraries address the opioid crisis" and "Public health and public libraries: Partners in addressing the opioid crisis." 27 Researchers across the country, both in LIS 33 and in public health 34 also quickly grasped that public libraries were on the frontlines of the opioid crisis. Interestingly, however, public health partnerships around this crisis appear to be driven more by librarians than by public health professionals. The federally-funded report Public Libraries Respond to the Opioid Crisis with Their Communities found that "In almost all cases, the library initiated the partnership and outreach. To develop these partnerships, some libraries relied on personal relationships they had from previous work and others used the credibility of the library institution." 35 Public librarians led the charge, out of necessity, with the field of public health slower to realize what was happening. Public librarians have also been on the frontlines of crises related to homelessness and housing insecurity, 36 and have responded by working to bring social workers into their libraries to help with these social issues. 37 Due to the nature of public service and the mission of open access to all community members, public librarians often encounter social problems early on, and respond to them as best they can, given available resources.

A third factor shaping increasing public health partnerships has been the growth of the idea of public libraries as venues for programs and classes. LIS scholar Lili Luo found that during one year the San Jose Public Library offered 76 health programs, including oral health education classes, yoga, summer lunches, blood drives, and tutorials to sign up for health insurance. 38 Public libraries increasingly work with partners and entities like the USDA's Cooperative Extension to offer hands-on cooking and nutrition programming. 39 The fourth trend driving these collaborations is increased interest in the public library as a physical space embedded in the built environment. Sociologist Eric Klinenberg calls public libraries Palaces for the People, and these palaces are increasingly being designed in ways to maximize public health outcomes. 40 In Boise, Idaho, the city released a report entitled Boise Library Campus Health Impact Assessment: Library Site Visit & The 7 Dimensions of Health focused on how library renovations could support public health. 41 More recently, architect Traci Lesneski released the report Sensory Library Design: Responding to a Pandemic's Impact on Built Environments, focused on the public health dimensions of library re-openings. 42 The report includes the suggestion that libraries offer as many of their programs outside to promote social distancing, and indeed during the COVID-19 pandemic in summer 2020 we see public libraries offer everything from storytime to Yoga and Zumba classes in local parks and library parking lots.

These four trends converge with the fact that during 2018, the fourth most read article in the newsletter of the American Public Health Association was "Libraries, public health work together on community health: Settings serve as community hubs." 43 Nevertheless, despite increasing attention to the fact that public libraries 1) contribute to local cultures of health, 2) nimbly respond to disasters and crises, 3) increasingly offer health classes, and 4) constitute part of the community's health-enhancing built environment, our general understanding of how best to, as the Iowa Department of Public Health calls it, Harness the Power of Public Libraries, remains in its infancy.

On that note, this article concludes with a call to action. To ponder the myriad ways public health professionals and public libraries can work together, let's consider the 32 sections of the American Public Health Association 44 to identify where partnerships are already robust, and where additional work is needed. One section of the APHA focuses on Public Health Social Work. Here, we have seen over the last decade an explosive growth in social work-public library partnerships. When the Kansas City Public Library hired its first Health and Wellness Librarian, they hired social worker Amanda Landayan. 45 In hundreds of public libraries across the country, students completing their MSW degrees now have the option of fulfilling internship requirements by working as social workers in public libraries. 46 The American Library Association now has a Social Worker Task Force, 47 composed primarily of social workers who work full-time in public libraries. Research on this trend has been published both in the LIS and Social Worker research literatures, 37 and has been featured both at the conferences of the Public Library Association and at the Council on Social Work Education conferences. There is similar potential for collaboration in many other sections of the APHA, perhaps most notably in the Public Health Nursing section. Public health nurses already provide services in some public libraries, notably the Pima County Public Library in Tucson, Arizona. 48 There are also obvious opportunities for Community Health Workers.

There are many opportunities around topical sections of the APHA as well. Those interested in Food and Nutrition could look to libraries as partners in efforts to increase, as the Free Library of Philadelphia puts it, culinary literacy. 49 The roles of libraries in promoting food security has also been explored in a series of articles in Public Health Nutrition on the State Library of California's Lunch at the Library initiative. 50 Those interested in other topical sections could also find many opportunities for partnerships. Based on our knowledge of contemporary public library initiatives, we could easily point those interested in the following APHA sections to work already underway in public libraries across the country around the following topics: In today's information rich environments, citizens do not necessarily turn first to medical providers when faced with illness. Flaherty found in her study of information practices of those with a newly discovered meat allergy that people often learn about their condition from someone other than their primary care physicians. 51 Based on these shifts in information gathering and sharing, we can study public libraries as venues for not only the dissemination of timely public health information on emerging health issues, but also as venues for the collection of public health information. This work is already underway in the context of the 2020 Census, in which the U.S. Census Bureau has worked closely with American public libraries to ensure citizens have information about the census, 52 and the technological means to complete it. Similar efforts have begun to emerge through the National Institutes of Health's All of Us initiative. 53 As these national and local partnerships emerge and flourish, we also need to keep emphasizing the importance of evaluation. So often in public libraries, the focus is on doing. Librarians are people who get things done. Nonetheless, given the idiosyncratically local nature of public librarianship, more often than not after one initiative ends, there is no time to evaluate it before moving on to the next one. The field of public health could assist public librarians by better supporting efforts to evaluate the impacts of past, present, and future health promotion efforts.

Technical assistance in evaluation could in turn begin to fill the need of building an evidence base for the effectiveness of working with public librarians to promote public health. Establishing such an evidence base could, in turn, facilitate the integration of public librarianship into both the MPH curricula and the public health research funding apparatus. Much remains to be done, but we are already on the way to closing the gap between public libraries and public health.

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IDPH project pairs public health and libraries

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When librarians become disaster workers

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Member sections

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More to offer than books: Stakeholder perceptions of a public library-based meal programme

Diagnosis of life-threatening alpha-gal food allergy appears to be patient driven

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Delaware Academy of Medicine / Delaware Public Health Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License