just
so the recording captures everything I'm
in a real quick do the intro again
welcome my name is Sarah Levin-Lederer
and I'm an Education and Outreach
Coordinator for the National Network of
Libraries of Medicine New England region
I'm going to start by very quickly
introducing NLM and NNLM our host then
turn it over to Meredith Li-Vollmer and
then there will be time for questions at
the end please put the questions in the
chat box because we do have a very large
group today
make sure your chat settings are set to
all participants so everyone can see
your comments and questions there is a
live captioning link in the chat box if
you need it this session is being
recorded and will be made available on
the NNLM YouTube page
The
National Library of Medicine is the
world's largest biomedical library and
it maintains and makes available a vast
print collection and produces electronic
information resources on a wide range of
topics, searched billions of
times each year by millions of people
around the globe and these resources are
in the form of general information for
the public through things like MedlinePlus
 and PubMed as well as more
more specialized databases
as well
it also supports and conducts research
development and training in biomedical
informatics and health information
technology
okay there are some people in the
chatbox saying they can't hear me are are
there people who can hear me sorry we're
fine
we can we can hear you just fine let's
sort up the troubleshooting guide that
you linked to
the National Network of Libraries of Medicine
is an eight region six thousand
member the national network of libraries
of medicine is an eighth Region six thousand member coalition that provides and
promotes access to health information in
communities across the United States the
mission of the NNLM is to advance the
progress of medicine and improve the
public health by providing all US health
professionals with equal access to
biomedical information and improving the
public's access to information to enable
them to make informed decisions about
their health
NNLM supports all libraries and also
works with health professionals public
health community and faith-based
organizations through providing access
to quality health information delivering
training on NLM and other reliable
health information resources and
partnering with local regional and
national organizations to further the
mission to improve the public's access
to biomedical information these
partnerships also include funding
opportunities
I would encourage all of you to contact
your regional medical library and see
what resources and services are
available to you membership is free and
our RMLs provide training in person and
online like this one and a variety of
other services that are useful to those
who conduct health outreach so with that
said I would like to introduce
Meredith Li-Vollmer who is a communication
specialist at public health Seattle and
King County and clinical assistant
professor in health services at the
University of Washington School of
Public Health she has served in national
capacities in that public health field
for organizations including the National
Academies the National Association
Association for county and city health
officials and the Center for biosecurity
Meredith is also a cartoonist and a
board member for short run comics and
art her comics have been published in
The Stranger Illustrated pen in the
American Journal of Public Health and
she has spoken on Public Health comics
at San Diego comic-con Emerald City
Comicon and the comics and medicine
conference she received her doctorate
in communication from the University of
Washington and take it away
hi good morning
it's good morning here in Seattle
I know it's afternoon for you all I'm
really excited to be here this is one of
my favorite topics I'm going to try and
cram a lot in and so I recognize some of
you from the graphic medicine community
so it's great to see you joining and for
some of you I hope to get you involved
and so I want to start by I want to talk
about graphic public health specifically
but I think before I talk about graphic
public health I need to talk a little
bit about graphic medicine because there
is so much exciting work happening
within the field of graphic medicine I
understand that a lot of folks here this
has been a series and so many of you may
be already familiar with graphic
medicine but for those of you who aren't
here I've got a photo that shows
some of the great work that's happening
in graphic medicine this is just a tiny
fraction of it and you can see that
through our graphic novels there are
scenes there are all kinds of
publications here a lot of the ones that
I'm showing are related to people's
personal experiences within healthcare
and I will show you here's a close up
from the book marbles by Ellen Forney
who is a fellow Seattleite who has
written extensively about her experience
with bipolar disorder and has really did
some wonderful comics related to that
and so graphic medicine at its most
basic definition is the intersection of
comics and healthcare is the one that's
was widely used and so it's a it's also
a growing community of people who are
sharing ideas and sharing stories that
relate to comics in healthcare and it's
very exciting because it has created a
space to talk about illness and
treatment and the experience of patients
here you see in Ellen Forney's comics
that really gives a lot of voice to
individuals who are going through these
experiences and it's a very active and
passionate community for those of you
who have not yet joined in and it's also
a place where a lot of providers have
been involved so here you see a some
works that are done by taking turns for
instance is done by a nurse MK Czerwiec
who talks about her experiences
early on in the AIDS epidemic working at
one of the first HIV/AIDS care units you
have things that are created more like
zines you have a zine here like a
barrier lifted the top surgery caregiver
support zine that providers are creating
for supporting one another there's a lot
of health education going on and even
some historical work here you see Woman
Rebel about the Margaret Sanger story
that's done by the cartoonist Peter Bagge
and then there's a large comics and
medicine conference you see the program
for that that is held internationally
every year and it's the best conference
I ever go to I highly recommend
so much is happening in this field and
you'll notice that so far what I've
talked about really falls within
healthcare that graphic medicine really
has focused a lot on healthcare
interactions disease illness treatment
talking about the medical system
interactions between providers and
patients and it's really wonderful work
and really exciting work and at the same
time the focus has primarily been
on the medical world and there have been
a number of comic so that I'll talk
about that are more focused on public
health and there's definitely overlap
between public health and medicine right
so you have there are some health
departments like mine that have some
clinical services there are different
definitely issues that public health and
the medical world both work on disease
prevention being one of them
but I think it's important to note that
there there are real distinctions
between the medical world and the public
health world and when I joined public
health I came in through the back door I
was a communications person and one of
the first things I learned is that
people here don't really orient our work
as healthcare and that we work in
population health and so the term
graphic medicine in some ways doesn't
speak to folks who work in public health
who don't identify themselves as working
in the world of medicine and one
interesting example of that is when we
hosted the comics and medicine
conference here in Seattle it was held
at our Central Library which is just a
few blocks away from where I work which
is the central headquarters of our
health department and I put posters all
over our department advertising this
wonderful conference and we made it free
we had some great events that were held
during lunchtime and I was really hoping
to see a big turnout and really only two
people from my department out of a
department of 1,500 people attended the
conference and I was really disappointed
but I am beginning to think that that
maybe they were thinking was much more
of a medical conference and so they
didn't feel it was as relevant and I've
just recently given a presentation
similar to this one called graphic
public health which was attended by over
a hundred people in public health many of
them from my department so I think that
thinking about it in graphic public
health may have more appeal to people
who work in this field and I think that
there is a lot of exciting potential to
talk about population health so these
are things like in addition to disease
prevention looking at the value of
public health interventions to improve
community health looking at
environmental health issues thinking
about the ways in which we can help
people comprehend and appreciate the
ways in which health issues affect
themselves how they affect their
communities how they affect our society
as a whole and so here you see an
example from the cartoonist Whit Taylor
who has really done some wonderful work
in the field of graphic public health
she did this for thenib.com which is
online current affairs kind of comics
journalism site and she did a comic
strip dealing with how we're not ready
for pandemics which is a topic that
comes up a lot in public health and so
she has chosen to use the comics medium
to show these emerging pathogens as this
bubbling brew that's ready to spill over
and she looks at what are some of the
key reasons why we're beginning to see
the rise of these very dangerous
pathogens coming in and I think it's an
example here of how in comics we can
talk about the contexts in which public
health happens we can talk about the
history of some public health issues and
so there's a lot of exciting opportunity
in this field for public health and one
of the things that I find a lot of
promise in that we're just beginning to
see some really great comics coming out
are comics that can explain the systems
and structures that affect health
and this is a big area within public
health large focus of our work here at
our health department is on addressing
health disparities and addressing the
social determinants of health and as a
communication specialist I can say that
these are difficult issues to
communicate about they tend to get wonky
very quickly the conversations tend to
be on this very high level they can
often involve discussions of issues that
can be uncomfortable for people so
institutional oppressions like racism
often come into the picture and so
getting people on board interested in
these topics when they're not already in
the public health field can be
challenging and I think that there's
some real potential here for comics to
humanize some of these policy issues and
really show how individuals are affected
by these systems and structures and what
that means to our health so I've got
here this is a very recent comic strip
that was posted on the nib why am I
scared to ride a bike and so I've just
shown a couple of panels here and so you
can see that in this comic strip it
talks about in the context of this
person having fears of safety as a
cyclist talking about how the problem is
related to how our streets are developed
they're not developed to keep cyclists
safe and so she talks about ways in
which biking could be made safer
in the way that cities are designed and
that is straight up a public health
issue and you'll notice here that this
isn't something that maybe would fall
within health care right this is dealing
with the design of cities city planning
but it's definitely a public health
issue and I think that this is what a
really fantastic example of a comic that
I don't know to what degree this
cartoonist thought about this as public
health comic but I definitely do and I
think there's some really wonderful ways
in which we can engage people with
stories about individuals and how systems
impact individuals in a way that shows
the big picture and you don't have to be
a great artist necessarily to tell some
great stories about this and I think
this is for me again as a public health
communicator really intriguing because
as communicators we know that we need to
reframe public health issues so that
they don't blame individuals and their
individual health choices for a lot of
public health problems so for instance
the obesity crisis we need to move
beyond blaming individuals for the food
that they buy because we know that there
are a lot of other systemic problems
that influence what people buy whether
it's the access to good nutritional food
within their neighborhoods or the
prevalence of really cheap fast food in
low-income neighborhoods there's a lot
of other institutional factors that go
into play and I think that through
comics we may be able to tell intriguing
individual stories because people always
want to hear about real people but in a
way that points at some of the systemic
problems so here I am showing something
that I saw at the comics and medicine
conference when it was here in Seattle
and this these were done by Dr. Anita Ravi
who is a doctor who established a
clinic for victims of human trafficking
and she showed these post-it notes that
she had created which effectively become
like a comic strip in which she was
processing some of the experiences that
had happened at her clinic and so in
this particular strip she's showing how
there was this client who always came on
time with her children and that's not
always common in her practice and so she
really was impressed with what an effort
that this mother made to make it to all
of her appointments on time and so you
see her praising that the patient for
never missing an appointment and then in
the final panel
it shows what this mom had to go through
in order to make it to that appointment
on time and
that is that she had to find people who
would be willing to swipe her and her
child through the subway because they
couldn't afford the subway fare and so
it took a long time she had to set out
three hours in advance in order to be
able to get to find people who would be
willing to swipe them through on the
subway and so for this doctor it was a
sort of a lightning bolt moment where
she realized that transportation and the
cost of transportation which we know is
a social determinants of health was a
real issue for her patients and that she
needed to figure out a
different kind of system in this case
providing her patients with subway fare
tickets in advance in order to meet
their health needs and I just was really
moved by this very simple form of comics
that I thought so clearly Illustrated a
systemic health issue so I want to talk
about some of the ways in which I've
been using comics here at our health
department in Seattle and why I think
they work well for health literacy and I
think all pretty much all the work I do
falls somewhere under the category of
health literacy and so I'm going to talk
about some of those examples that I've
been working on and why I think they
work and so I think the most salient
feature of comics is the image and
because it is so image based you can
really pack in a ton of information
before you even add any words so here
you can see this is from a comic strip
we did dealing with norovirus and I
think it pretty vividly illustrates what
people might experience if they have
norovirus and so it's very economical
because just at a glance you know
something about what symptoms and signs
to expect from this particular virus and
in our department we sometimes use
pictograms we sometimes use infographics
and I think that those can be very
useful in health information as well but
what I like about comics is with the
illustration you can add a great deal of
specificity
in the image but comics of course is not
just the image and I think the words
play a really important function so
graphic public health is not like other
forms of comics where there really is a
goal behind telling public health
information or really sharing some key
messages and so adding the words can
really add clarity to what you're
talking about so here if you just looked
at the three panels you would see oh
this shows something about sneezing and
coughing and touching a doorknob but
once you add the text in about how flu
spreads and you add a little bit of
explanation you can see oh this is
really about germ transmission which is
typically a difficult it can be a very
wordy piece of text if you're trying to
explain about germ transmission but here
we can use just very minimal text and
with the images and we can get the
basics of how flu spreads in the simple
comic strip and I think the other thing
that comes into play here is the
sequential nature of comics right so
that you can see oh you know the sneeze
and the cough happens first and then when
it gets on your hand as in the cough and
you touch the doorknob that's how this
germ can spread and so I think sequence
carries a lot of meaning and can be very
useful because we can use sequence to
discuss outcomes and that's a really
important part of health communication
so here this is taken from a comic strip
that we did these the illustrator for
both of these was David Lasky who is the
artist who I've worked with very often
over the last 10 to 12 years and here
this was a comic strip of trying to talk
about the reasons why people should stay
home when they have the flu and so in
this first panel you can see we were we
were asked by the school district to
come up with a communication tool to
help this was during the H1N1 flu
pandemic and they were finding that
there was a lot of sick kids coming
to school and so was there something
else we could
to to communicate about why it's
important to stay home and so we decided
to put some emphasis not so much on
staying home to get well but on how
staying home helps protect other people
in our community so we illustrated those
people and showed through the illustration that many people who are at
higher risk look healthy and then you
can see the power of the sequence
happening in two different ways so then
the next panel says if you go to school
or other gatherings when you are still
spreading the virus you will put others
at risk and you have the person who's
coughing so he's out in the community
with the flu and then you have the
pregnant woman and a young child
entering their frame and you can see
that she's heading right into the
direction of where those germs are being
spread so within that individual panel
you have some of the power sequence
happening but you also can connect her
to the earlier panel so that you know
she's a high risk individual so I think
that this makes it different than other
forms of illustration that we use in
public health because we can use that
sequence to show what kinds of health
outcomes can happen here I'm showing
another example from the cartoonist
Whit Taylor this time working with the
illustrator Chris Kindred and they did a
comic strip that was published on the
nib about the Tuskegee Experiment which
was a major public health historical
moment unfortunately one that had a lot
of bad outcomes and led to a lot of
distrust that we see among a community
towards the public health system and so
this explains that and shows the good
reasons why they would be mistrustful
and so through a comic strip she was
able to tell this story and show exactly
how does this happen how are people
manipulated in this public health
setting and so you have I think the
dialogue panel in the middle here really
shows how conversations may have had
between people who are involved in the
experiment
and community members who were connected
to this experiment and so you can start
to see how this kind of manipulation
might have happened at a very subtle
level so you have the providers saying
to a family member who is one of the
people that they were experimenting on
the provider saying while he rests would
you mind if I had an extra moment of
your time
why of course nurse rivers he all right
I'm sure of it I just wanted to let you
know of a new gift that our program
provides in case and so talking about
these burial stipends that were used to
get people to agree to be part of this
experiment I'm excited about one of
these new comic strips that we've done
in the past year related to climate
change in health because I feel like
this an example of how we can frame
issues as public health concerns that
were not considered public health issues
previously and so we've chose to do a
comic strip called climate changes
health that I wrote and Mita Mahato
did the art work for and we were really
trying to help people who may have
already had a lot of fatigue related to
climate change who may no longer care
much about greenhouse gas emissions
because it seems something abstract and
not relevant to their daily life and
really show them no climate change
really is having an impact on you right
now where we live by showing them the
kinds of health outcomes that are
happening here in western Washington as
a result of climate change
and I chose Mita as the artist because
she does these really beautiful cut paper
illustrations and I thought that they
were visually arresting enough so that
people who might have already tuned out
on a lot of climate change issues might
be drawn visually to looking at them
when we post them to social media or
when we make them available as little
mini comic books and so what we're
hoping is that people will pay attention
to climate change in this context and
rethink
how they view the kinds of behaviors
they are using that might contribute to
climate change we really wanted this to
get out to some of the more affluent
members of our communities who have more
resources to be able to change their
behaviors and also probably contribute
more to climate change so we are hoping
to make this comic strip available in a
lot of places like the Pacific Science
Center which is a science museum where
more affluent families might encounter
this little comic book comics work
really wonderfully for social marketing
and for those who are unfamiliar with
social marketing social marketing use is
basically adapting techniques that are
used advertising
to try and get people to interested and
to have more demand and desire for
public health related behaviors or
services and you really like advertisers
really focus on target audiences and so
here using a brand new comic strip these
are a couple panels for one about why
it's important to test children for lead
and we're just starting to roll this out
as a campaign and so I'll talk a little
bit more about it so I think comics work
really well for social marketing because
you can adapt them to reach specific
audiences to make them more appealing
and to help you reach those kinds of
social marketing goals so here we really
want to get the word out to parents that
young children should be tested for lead
particularly if they live in older homes
or if they live in particular
neighborhoods where we know that there's
been lead contamination in the soil or if
they have kinds of household items that
are high in lead and so the trick was
that I think lead poisoning is not an
appealing topic that it's a scary topic
because it's scary I think people can
often avoid looking at materials related
to scare
topics because they just want to avoid
the issue they may feel powerless
particularly a lot of the families that
are most impacted by lead poisoning are
ones that are lower-income areas
they're communities of color, they're
immigrant groups so how do you get
parents to even look at materials
related to lead poisoning so I picked
Amy Camber as the artist here because
Amy has this wonderful gentle style it's
a very clean look and we worked on
picking a palette that would look like
the color of kids blocks so that it was
really signal to parents this is
information for young children and by
having these really charming children it
makes it easier to look at information
that's about a scary topic and I think
that this adaptability of style really
means that you can reach very specific
audiences so this one is taken from a
campaign called don't hang on to meds
which is really related to our opioid
addiction prevention work and here in
King County Washington we have medicine
return drop boxes in 100 locations
around our county and it's a place where
you can go and take your unused
medications and that's important because
we know that many times especially for
young people addictions can start from
people who take pills out of medicine
cabinets and it's something that that
happens and people aren't even aware
that others are taking their pills and
so in this campaign we knew that people
weren't aware about the Dropbox's we've
done the audience research we knew that
also people had a lot of reasons for
hanging onto meds they're expensive they
didn't want to have to go renew
prescriptions so they just kept them in
their medicine cabinets and so for this
campaign we wanted for there to be
awareness of these Dropbox's we wanted
them to know why it's important to
return your meds and we wanted to see
increase use of the drop boxes so I
worked with a cartoonist
named Tatiana Gill we based some
comic strips on actual stories from
people who had experiences with having
bad outcomes from keeping unused
medications in their home so here this
is a young woman who talks about how she
started stealing medications as a
thirteen year old and how nobody guessed
that she was doing this and so here we
put into the illustrations how she was
on a first-place debate team how she was
on us state champions soccer team to
show that this could really happened to
any kid and that I I think people may
tend to think that only certain kinds of
people are going to take pills and we're
really finding that it's a widespread
problem so then in the next panel we
show how her parents been locked up
their medications and then they take
their unused medications to the drop box
and we really show the drop boxes in our
area look like post office boxes and so
many people don't even know what they
are when they see them in pharmacies so
part of our campaign was to really
highlight what that drop box looks like
and so then once we have these comic
strips developed we can really use them
for a lot of different materials and
they can be very effective effective
marketing tools in that way so you can
see some different ways we've use them
there's an example of one we've done
about staying safe and heat but we have
translated into Chinese that appears in
one of the Chinese newspapers in our
area there's an example of our new lead
testing comic book as a mini comic book
I really like the use of these little
mini comics these little zines because
they're very appealing and something to
pick up and I we find that they
disappear much more quickly than
brochures because they're so tactile and
they're really kind of fun to look at a
little book we've also used them as
postcards and as posters and then social
media is a big way that we use a lot of
our comic strips it's very cheap and we
can really reach a lot of people with
the comic strips by using social media
here you see you see a picture
of something that we were able to do
with our don't hang on to mids campaign
but we were able to create these giant
posters that hang in our light rail
stations and if you look across the
posters it tells the whole comic strip
across the posters we were able to use
the image of the drop box on these
pillars that were inside the station so
it's another way in which we could use
comic strips for social marketing my
primary job at the Public Health
Department is in risk communication and
so risk communication means that I work
on some of the most urgent crisis kinds
of communication I work on a lot of
outbreak communications and anytime we
have severe weather other kinds of
emergencies there's always health
impacts so I do a lot of that
communication work so here you see a
large-format comic book that I did some
years ago with David Lasky we did a
series called Survivor Tales which told
real-life stories about people who've
been through disasters as a way of
showing people how to be resilient and
giving tips based on what real-life
survivors had been through so I'll talk
a little bit more about that in a second
but I want to start talking about why I
think comics work well for this kind of
communication work and we know that when
people are in stressful situations their
brains are flooded with stress hormones
they literally can't process information
very well and so as a risk communicator
I have to think about what can I do to
make information especially this kind of
critical health information more
accessible easier to understand when
people are having a hard time processing
information and I think comics work so
well because again it's that use of that
image with a brief amount of words that
can provide a lot of clarity in a very
economical way so here you see comics
that are related to what we would call
isolation and quarantine so there are
certain kinds of communicable diseases
that we need to make sure that people
stay home and don't unintentionally
infect other people by being out and
about one
have particular diseases so tuberculosis
is an example of that there are
sometimes situations where we had we
have people who have the potential to
develop a disease and we need them to
stay home so here this tells people what
is safe so in this case what is not safe
to do when they are under some sort of
quarantine and we had found that
particularly because we work with people
at a variety of levels of literacy both
for reading for English and for health
literacy that people don't always
understand if they're just told over the
phone or in an email what they can't do
when they're in a quarantine situation
but here the illustrations make it much
more clear what they can't do in the
case of a quarantine I think comics also
are very useful in the work I do because
I deal with some situations that could
happen and if they happen they are going
to be very challenging situations for
our community there could be some pretty
severe health consequences but they
aren't things that happen very often at
all and so how do you prepare people for
something that is so unfamiliar and so
this was actually the first comic book
that I did and I did it with David Lasky
no ordinary flu and it was about the
1918 flu pandemic and at that time you
know I was just beginning to read about
the use of comics but I hadn't tried it
myself but I was trying to engage people
on the possibilities of a severe
influenza pandemic and what that might
mean and people typically aren't
interested in something that seems so
remote and people didn't really have any
memory of anything like that we have
very few survivors almost no survivors
now of the 1918 pandemic and it was
something that people didn't really talk
about but I found that when I talked
about stories from the 1918 pandemic
people were fascinated because they
didn't know it has happened before and
they had no idea how severe it was
so I base a wrote a comic book based on
a family in 1918 and what they
experienced as a way of showing people
you know the severity of it and it made
it much more concrete but this is
something that had happened and not only
has it happened in the past but it's
something that could happen again and in
this comic I was able to show also by
talking about what had happened to a
family in 1918 and that what their
descendants were doing to prepare for a
pandemic that could happen now and I was
able to illustrate what it might look
like if we have a severe pandemic
because it would really change everyday
life in a way that it's hard to picture
unless you've actually experienced it so
here we literally picture it for them
and so we show that businesses might be
closed because a lot of people are sick
you might have to do what we call social
distancing which is spreading out within
a space so that people are not in close
contact with one another and not
potentially spreading a virus so you see
that with the cubicles that large public
events might have to be canceled and
most importantly that our health care
system could get overwhelmed because as
you know our ERs are full most of the
time on ordinary days but in a severe
pandemic the demand for health care is
going to be so high that difficult
difficult decisions will have to be made
about how we allocate healthcare in the
severe pandemic and we want people to be
prepared for that in the sense that it's
a possibility and we call this in the
risk communication field mental
rehearsal so that they've gone through
considering that this could happen and
so that they're better prepared to deal
with it in the event that it actually
does happen here is a page from that
first comic book that I showed from
Survivor Tales which that
particular one is a story about a flood
that happened here in Washington State
and we talked to a family in the rural
part of Western Washington who had a
severe flooding situation on their farm
and so through the comic book we were
able to tell their story about what
happened and what steps they had to take
most importantly we focused a lot on how
people helped one another through this
event and to show what community
resilience looks like and how we'll need
to support one another because it's a
very important emergency preparedness
message that we have as a health
department because we know that
government resources will be stretched
so thinly during disasters that people
need to be prepared to help one another
and then the mother in the story gives
advice to people based on her own
experience of what she recommends that
they have in place what they do to
prepare now so that if something like
this happens to them they'll be prepared
and I think by telling a narrative and
by telling a real-life story that that's
much more compelling to people emergency
preparedness is pretty much one of the
hardest topics to engage people on they
you know they are not interested people
don't take the preparedness steps
because it just is hard to imagine
that's going to happen they have other
priorities so we use this comic book to
try and make it more real and to have a
real person giving advice to others
another reason why I've often used
comics is because they really help meet
some communication challenges that we
have particularly with the diversity we
have in our community here in King
County Washington and one of the reasons
why comics works so well I think for
some of the communities we deal with we
have over 170 languages or spoken in our
county and it's impossible really for
our family resource department to
provide translations interpretations and
all those languages so if we can have
lower word counts it helps if we can use
those pictures right so that people can
understand some basic information with a
small number of words and they can glean
information from the illustration so
this is from our stay safe in the heat
comic in which we know that people in
lower-income housing and people who
already suffer from a lot of everyday
health disparity are also the ones that
we see in emergency rooms on hot days
and they tend to have things like
cardiac arrest
kidney failure and stroke
 as some of them main
outcomes that can happen on hot days for
certain people so we were trying to
provide information about what people
could do and what puts them at risk and
here you can see that you have a lower
word count and you can use the
illustration to get that information
across and because you have a lower word
count it also makes it cheaper to
translate so when we had grant money to
do no ordinary flu we were able to
translate it into 22 languages most of
our comics are translated into at least
six languages and we're able to do that
even though we don't have a lot of
resources because the word count is low
one of the things I like best about this
in terms of communicating with our
diverse populations is that if we do
audience research up front we can
incorporate aspects of our communities
within the comic strips so here in the
stay safe and heat comic strip we're
able to show cultural practices that we
know happen in our community to help
people stay cool to stay hydrated and I
also think that people are much more
inclined to look at our materials when
they can see themselves reflected in
them so I think that's a really powerful
aspect of comics that's really different
than say using just infographics or
pictograms and lastly I want to touch
upon how I think comics can really work
for advocacy and activism and some of
the ways in which I've been using that
both in my personal life and at work and
here you see a panel from a collection
called Sketches Outside the Margins
which were patients stories told from a
giant pop-up clinic
we have here in Seattle that provides
free medical dental and vision care once
a year at a big arena here in Seattle
and I've been the communications lead
for this clinic for a number of years
and I was working with the clinic
director on how can we make people more
aware of these individual patients
stories about why people have to access
a giant pop-up clinic because the point
is we don't want to keep running the
clinic we want the healthcare system to
be fixed so that people can get the
health care they need all the time and
so we enlisted a group of cartoonists to
help us capture stories from the clinic
from patients and volunteers to help
people understand what are some of the
gaps in our healthcare system so that
people have to resort to charity care to
get the care that they need and so I
think that the comics really helped tell
the human story that was happening at
the clinic where when people hear about
healthcare access it seems like a very
abstract policy issue but here we can
tell it as a human story so here we have
the story of Dave who had been waiting
for seven hours to get care at this
clinic with his family and he says I'm
37 years old I work for a small business
they can't afford dental insurance my
tooth is fractured and keeps getting
worse it's impacted and caved in I make
too much to get low-income assistance
but too little to afford care without
this clinic dental is myself and a
pair of plyers
I've done it before not fun and so here
you know through Dave story you you get
a picture of all the different kinds of
people who have to access this free
clinic to get health care but it's not
just who people assume it is you know
definitely there are patients who are
living homeless and there are a lot of
immigrant patients who don't qualify for
healthcare and or for health insurance
but you also have people who are
employed but there are a lot of gaps in
our system such that people are
underinsured they can't afford their
premiums there's a lot of different
reasons why people can't get the
coverage that they need so that they
can't afford the care that they need I
think comics also encourage empathy
knowing that you know we try to elevate
voices that often aren't at the policy
table of people who are impacted by by
by the health policies that leave them out
so here this is one that I did and
I was talking to this family that runs a
house cleaning business there were two
sisters and kids and in this comic strip
I felt it was a great that they told a
great public health story because you
can see that the dad talks in the
fourth panel and he says
immigrants work hard for this country
it's important that we can get health
services too in this country if you're
dying everything is done for you they
don't want you to die but if you're sick
they charge you it's very costly why
can't they focus on helping people not
get sick and that is a really important
public health message I want to in fact
this family asked me to make sure that I
included something about how immigrants
work hard for this country because they
felt like their voice was often left out
I tried to make this family relatable by
showing the kids and how squirmy they
were and having to wait so long to get
this health care at this clinic I put a
you know the dad was wearing a Seattle
Seahawks cap and here in our reason you
know that makes them very relatable
so to help people have more empathy for
some of the families and residents of
our County that are affected by a lack
of access to health care so I worked
hard to create some visibility for this
project because we really wanted the
people who have power to make decisions
to see these comics so here you see an
example of how they were shown at a
medical conference and how attendees of
the medical conference were encouraged
to react by posting post-it notes about
their own stories that they had heard or
what they thought about the comic strips
that they read we made sure that all of
our elected officials in this region got
copies of the
anthology that came out of this it's in
the reading library in the waiting room
for the University of Washington
Provost's we got it in the hands of all
the hundred organizations that came
together to produce the clinic a lot of
whom are healthcare systems and medical
associations we got it published in
local publications so really this is a
way in which we were trying to bring
those patient voices to the forefront as
a way of talking about healthcare access
I think there are a lot of really
interesting story possibilities for
talking about public policy again this
comes from the bike safety comic strip
that was very recently published on
the nib here this cartoonist includes both
data about who is biking and the
differences in gender and also her own
personal narrative about how she started
to feel scared and what that means
because I think having that emotional
contact content and having that personal
story engages people helps build empathy
and I think can really be used for
getting interesting conversations going
about health policy so we've done comics
really to gun violence we've done some
related to health coverage and I'd
really love to see more like that also I
would love to tell more stories about
what happens in our health department
this is one that I did that talks about
how thinly stretched our communicable
disease investigation team is and how
hard they're working and I know time is
limited here so I'm not going to go
deeply into it but only to say that you
know these are tricky stories to tell
because there are a lot of telling about
the need for public health funding can
be hard when you're trying to engage
taxpayers who already feel like they're
already giving a lot of money so how do
you really show that we're doing good
work we're doing good service and yet
we're stretched thin by all the disease
outbreaks that are happening that we
would want to be able to do more work
about
disease prevention but we have all these
competing outbreaks happening and we
don't have enough staff to deal with
them and so here in the last couple of
frames our medical epidemiologist is saying
I don't know what we'll do if anything
else comes our way and one of her staff
says Meagan we've got four new cases in
the school well back to work
and so this is my start to try and tell
our own story because I think people
don't really know enough about what
Public Health Department's do and why we
need resources and I think there's a lot
of other stories in the public health
world that we could tell and I'm hoping
others will be interested in which
brings me to some tips for making
graphic public health and I'm working on
a book right now that I hope will be
published in the next year that will
have a lot more of these tips but going
through them you know at a quick level
and I encourage folks who have an
interest in making graphic public health
to really read comics and to look at the
ways in which particularly the words and
images are used to convey information
and to how do you move the story along
with dialogue how does your eye flow
through a comic strip and what makes it
easier or harder to understand I think
there are some lower cost alternatives
to illustration fotonovelas are
something that are used a lot in
spanish-speaking communities and so this
is an example of one that was done both
in English and in Spanish in which you
use photographs again you have to be
really careful in your selection of
photographs but if you don't have
access to illustration it's a way that
you could do it an interesting thing
that our State Department of Health has
done is they've commissioned an artist
again David Lasky to develop a whole
series of illustrations there's 300
panels that he's drawn that we can mix
and match to try and convey health
information so that I think has been an
innovative use of comics by our State
Department of Health and then I think
it's really important that as with any
other public health communication that
you really think about key messages and
target audiences what you're trying to
achieve because this is not just casual
comics we're really trying to convey and
information
we're trying to create awareness or
behavior change or knowledge and so we
really need to be focused in and making
sure that they that those key messages
come out of the work that we do and
making sure that comics are the right
way I think almost always comics are a
good fit but sometimes they may not be
depending on what you're trying to
achieve and finally if there's any
possibility of testing your comic with
members of the community that you're
trying to reach that that will really
benefit the quality of your comics and
making sure that you're reaching the
goals that you want to reach if you're
producing comics yourself there are some
resources in particular graphicmedicine.org
if you aren't already paying
attention to that
you really should there's some fantastic
work going on there's a lot of really
interesting conversations there's also a
graphic medicine group on Facebook and
there are so many wonderful librarians
who I can't even keep up with all the
information that they're posting there's
a this week in graphic medicine part of
the graphicmedicine.org blog that is
really encapsulate a lot of the exciting
work that happens if you're interested
in how we've used comics in our health
department you can check out our blog
and then I really recommend thenib.com
and and you can always contact me in
particular I'm hoping to start
developing some sort of platform with
Whit Taylor who is a really wonderful
cartoonist that's specific to public
health comics and we'll announce that
through our through my Twitter account
and Facebook once we've got that set up
so please feel free to follow me if
you're interested in hearing more about
that
Thank You Meredith we
do have we had some questions in the
chat box so we'll see how many we can
get through in the next five minutes so
there was a question about the slides
being available we will make the slides
available when we make the recording
available
there was a question about use of comics
in the classroom and then I wanted to
broaden that out to copyright issues and
then also somebody asked about reference
standards how do you give credit to the
creators as well so what was the
specific question about use so I
haven't had a chance to look at all the
comments in the yeah in the chat just so
that you know any of the comics that
I've produced on behalf of the health
department that we are really happy to
share them we know that there are a lot
of folks out there who are less resourced
than we are in our department and so we
appreciate an attribution to Public
Health Seattle King County but we are
really happy to allow you to share them
in whatever ways you see fit and for
instance I'm happy to share that the
native files if you want to do your own
print runs of any of our comics we're
happy to do that so the question was
specifically are we allowed to use some
of these comics in our classroom
absolutely so I would contact the ones
that I showed that belong to other
people did for the nib for instance I
would contact those artists you can get
their contact information by going to
thenib.com but for any of the ones
that I showed from Public Health
Seattle King County you're absolutely welcome
to use them for classroom use there have
been a couple of questions about how do
you evaluate you mentioned that if you
can get in front of communities but what
did you do to evaluate your comics
yeah so we when we can we like to do a
audience testing of the comics and so
typically we will ask them what they
know about the subject before they read
the comic and then we do a post you know
questions about what they took away from
it we will ask them about whether it's
culturally appropriate yet if there's
anything that's not culturally
appropriate or not culturally relevant
we will often have them check our
translation if we do comics and
translation we want you know really
people to
to tell us what they thought the key
messages were to make sure that that's
coming across because often in these
comics we may not necessarily state the
key message directly in so many words we
might use a combination of the image and
the words to get the key message across
but we want to make sure that that's
understood after people have read the
comic sometimes I'll ask about
credibility whether they find
information presented through comics is
as credible as information that might
appear in a brochure for instance and
whether they would be likely to pick it
up and look at it if they saw it so I
have to say we haven't done extensive
evaluation because often we don't have
enough resources to do that and we're
just moving with all the other things
that we're doing in the health
department so if there's anybody who
would be interested in collaborating on
evaluation I am really open to that
a couple questions that I think I might be
able to smush together for our last one
how do you get started any tips for
starting or finding collaborators and
creators and are there any templates or
applications for people who might not be
cartoonists that are interested in
illustrating some of the communications
they're working on right so I think the
best thing to do is to join the graphic
medicine Facebook group because there
are so many people who are actively
participating who are artists
storytellers librarians clinicians
Public Health folks and that might be a
good place to find people who are also
interested in this field a particularly
artists who already work in this area
because not all artists are going to be
as adept at telling health stories I
think so I would highly recommend that I
you should also just check out
graphicmedicine.org
there's a lot of good resources there I
think finding artists another way is to
go to some of the sort of smaller comics
conventions here in Seattle we have the
short run comics and art festival
there's other ones in Portland and
Olympia in this region but if you can
find one where you have a lot of in
dependent artists working rather than
some of the big-name comic-book
companies for instance you might find
people who would be interested in in
doing art work for you if you use
graphic design firms I really suggest
that you check to make sure that any
illustrator that wants to affirm really
is experienced in telling stories
because there's a lot of great
illustrators who aren't necessarily
experienced storytellers through their
illustrations and they might not be the
best fit oh and I know that there are
comics making apps unfortunate I haven't
played around with those I don't you
know I think they they probably vary in
quality so that might be something to
put on the graphic medicine Facebook
group if you join that to find out what
people know about comic making match so
there have been a couple other questions
we have hit the 3:00 p.m. mark though so
if I send them to you maybe we can get
some answers in writing for those sure
yeah we'll do it that way so we can let
people go real quick thank you all for
attending a couple of housekeeping
things if you are interested in another
graphic medicine webinar from NNLM
midday at the Oasis is the monthly
webinar from the Pacific Southeast
region and there is a link to register
for the inclusive graphic medicine
communication collections and community
webinar coming up on August 21st if you
are getting MLA credit for this session
once you close the browser you will
be directed to an evaluation and then
you will get your code once you finish
the evaluation if you have any questions
about this session or other sessions or
about NLM or NNLM feel free to reach
out to me or to your local region so
thank you for joining us
