Public Libraries as Key Partners for Advancing Health Equity

Public libraries have an extensive population reach in the United States, with public library services available to the vast majority of the US population. A Public Library Service survey conducted in 2016 found that nearly 311 million people in the United States, or 96% of the US population, lived in a public library service area, the geographic area for which a public library offers services.¹ In many cases, the accessibility of public libraries extends to an online presence that can be accessed remotely, such as 400 million e-books that are available to US library patrons annually.¹ Further, US public libraries are used by a broad segment of the population. In fact, it was estimated that 171 million registered users, or 52% of the US population, visited public libraries more than 1.35 billion times over the course of one year.¹

Lower-income Americans, Hispanics, and African Americans are more likely to affirm that public libraries positively affect their lives and communities than are other Americans.² US public libraries and public library staff have provided safe spaces and intensive support for people experiencing mental illness and substance abuse, homelessness, immigration challenges, and trauma.³

Even in disenfranchised communities, such as many in the segregated neighborhoods of Chicago, Illinois, amid area gun violence, deep poverty, and isolation, libraries offer a safe space, and librarians are well trusted to support information access across racial/ethnic and other diversity divides. Some Chicago area libraries have added social workers to their staff and tailored their programs to meet local community needs, such as homelessness and applying for public aid programs. During the COVID-19 pandemic, public librarians, such as those the Chicago Public Library (CPL) employs, have continued serving the community in a variety of ways, including providing traditional library services such as making e-books available, disseminating COVID-19 resources, and connecting those in need with food.

In essence, public libraries are emerging in key roles for improving the health of underserved communities. We describe a budding academic–library research partnership formed between Northwestern University and the CPL to equip the city with resources and tools to reach diverse populations who seek health and wellness information, including information and resources about clinical trials and preventive services. We put forth this example to encourage similar partnerships with public libraries to address identified community needs.

WHY PUBLIC LIBRARIES?

US public libraries often serve as social centers by providing programming, hosting events, and meeting specific needs of patrons such as job seekers and students.⁴ For example, US public libraries have a long history of offering assistance to patrons searching for employment opportunities, preparing for exams, and applying to school. In recent years, they have increasingly provided patrons help in connecting with agencies providing social and mental health services.⁴ Many US public libraries also support basic literacy programming.⁴

The Pew Research Center’s studies of US public libraries conducted from 2011 through 2016 included survey results showing that trust in librarians is high because of their demonstrated ability to curate and share reliable knowledge.⁴ The notion of public libraries as trusted spaces has also been affirmed in a study of first-generation Mexican immigrants who participated in classes in six US public libraries. The study found that participation in library programs increased trust of the library, the librarians, and other library users in this study population.⁵

HEALTH FOR ALL

In 2018, researchers at Northwestern University Feinberg School of Medicine approached CPL leadership to pitch a collaborative research project that would bridge medical researchers, health science librarians, and public librarians to develop digital tools for increasing awareness of and participation in clinical trials research among people from health disparity populations. CPL has 81 locations serving 2.7 million residents in Chicago’s 77 community areas. Well-established CPL programs that improve the lives of diverse Chicago residents include programs in science, technology, engineering, and mathematics initiatives and digital literacy programs. However, few programs have directly touched on the health inequities experienced in many CPL neighborhoods—hence this opportunity.

The Health for All study was originated and launched shortly after those initial meetings, with grant funding from the National Library of Medicine. A design-thinking approach was employed to ensure fit and responsiveness to the needs of CPL patrons and libraries. Researchers and librarians from the study’s Library Partnership Advisory Committee conducted needs assessments, focus groups, and usability testing, leading to a Health for All Web-based resource for library patrons to learn about clinical trials. Resources specifically addressed barriers identified by library patrons and librarians—such as distrust of clinical trials, researchers, and universities. The Health for All tool has been deployed across 10 CPL branches and is now being promoted across CPL as a digital resource; evaluation is ongoing. Qualitative research findings accrued thus far speak to the perceived value of the tool in engendering confidence in clinical research participation among diverse library patrons.

NAVIGATING WELLNESS

In recognition of the importance of disease and illness prevention to public health, the US Preventive Services Task Force (USPSTF) was formed in 1984 as an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services.⁶ Building on the infrastructure developed in Health for All, researchers and the Library Partnership Advisory Committee successfully applied for National Library of Medicine grant funding to scale the partnership efforts beyond clinical trials—and to health and wellness more broadly. Development of new wellness modules within Health for All—coined Navigating Wellness—is under way, with the goals of working closely with public librarians to encourage medically underserved library patrons to seek out USPSTF preventive services recommendations directly and equipping them with tailored information and community resources that will allow them to find, navigate, and connect with primary care providers and discuss preventive services with them.

OPPORTUNITIES WITH PUBLIC LIBRARIES

According to the Pew Research Center, 42% of patrons report using libraries’ digital resources to search for health information.² Based on the extensive population reach and inclusivity of public libraries as well as their longstanding status as trusted spaces, it has been posited that public libraries may serve as an opportune space for health-promoting services. In fact, a trial implemented in urban neighborhoods selected to reach diverse, underserved communities found that participatory research in the public library system offers a scalable approach to reduce cancer health disparities.⁷

The Health for All public library–academic partnership we describe is an example of how public libraries can serve as a safe space to support health disparity populations in dismantling the information divides that perpetuate health inequities. Public libraries such as Health for All’s CPLs can work together with medical researchers to forge trust and deliver health information to advance health equity. At this time, the COVID-19 pandemic is having a disproportionate adverse impact on health disparities populations in the United States, which may be further exacerbated if these populations forego or face barriers to participating in COVID-19 trials or utilizing COVID-19 vaccines or therapies that may be forthcoming. Thus, initiatives at public libraries such as Health for All and Navigating Wellness are now more important than ever.