Like urban communities across the nation, Kansas City, Mo., has a public health problem. Gun violence is staggeringly high. In 2022, despite a nationwide drop in gun crime, Kansas City suffered its second-deadliest year since records have been kept. We rank in the bottom third of the United States’ urban centers in mental distress. Our rates of physical activity lower still. I see the city’s vital signs up close every day, not because I work in a hospital or health clinic, but because I work in a public library.
Setting aside warm memories from childhood trips to the library, chances are you’ve seen similar things. If you are like most, you still go to your neighborhood branch library — a lot. Despite a significant pandemic drop, there were more than 730 million visits to our nation’s public libraries in 2020. But if on your most recent visit you paid attention to your fellow patrons, you might have noticed considerable evidence of urban trauma.
In our public library system, we see people who are unhoused, unwell and considered unfit. Add the book club member, jobseeker, recent immigrant and after school teen. Those who enter our buildings are in search of something, whether that be information, connection, programming or simply respite.
Increasingly, this means that as you browse the stacks, you are as likely to meet a social worker as a children’s librarian. Library staff now offer a broad range of health-care services to our patrons, free, no questions asked.
As University of Pennsylvania health researcher Anna U. Morgan explains, libraries in America are an important part of the public health environment because they offer two foundational components of a successful health-care network — accessibility and trustworthiness. Your local public librarian can make a needed medical appointment, find a shelter bed for the evening, de-escalate a patron in distress or administer an emergency dose of Narcan. If this work leads to conflict, librarians are often asked to serve as security, policing unacceptable behaviors and restoring calm. Today’s public libraries are a lifeline (sometimes literally) for our society’s most exposed and vulnerable.
This labor is worthy of hearty applause, except that librarians should not be doing any of it. The most qualified librarian should never replace medical providers and social service experts. Yet necessity has transformed many library staff members into front line health workers. The noisy debates about book bans dominate national headlines, but it is the work that libraries provide in safety net health services that should get everyone’s attention, because the situation is becoming unsustainable.
THE SOLUTION is for U.S. health-care providers to form stronger partnerships with public libraries. Both libraries and the health industry share a common goal of building vibrant and resilient communities. Yet, when nearly one-fifth of our gross domestic product goes into health care and much of that investment is spent treating preventable ailments or prioritizing symptoms over causes, this is an inefficient system.
Better to recognize the crucial role of literacy as a structural determinant of health. Low rates of literacy do not manifest as easily as the visible evidence of sickness or disease, but we do know they are drivers of health inequity in this country.
Communities with poor literacy experience higher rates of hospitalizations, increased health-care costs and, most distressing, higher mortality.
Life expectancy varies in this country for a host of reasons, but basic literacy remains a significant factor. Low reading neighborhoods have higher rates of asthma, heart disease, obesity and diabetes. We also know that antismoking, weight loss and early cancer screening campaigns are more successful in communities that read. The opioid epidemic neatly overlays with rates of literacy. And improving literacy might not immediately address gun violence, but the connection between below-grade reading and violent crime suggests that an investment in literacy will improve outcomes.
LITERACY is an obvious core mission for America’s public libraries. And with support from the health-care sector, libraries could do even more. Libraries are well-positioned to be partners in making change, because we are already located in our nation’s most diverse communities, often the very same neighborhoods most in need of health services. At select branches, for example, the Kansas City Public Library feeds 600 kids a month (it’s almost double that in the summer). With additional resources, we could expand this program in number and quality, educating our patrons on the importance of healthy nutritional habits.
Partnerships with local health systems could also lead to expanded health programming for library patrons as well as much-needed specialized public health training for staff. Just as significant could be sponsorship of mental health intervention and support groups, improved access to government health benefit programs and urban housing resources.
Issues that were decades in the making are not solved quickly, so libraries and health networks must look toward a distant horizon. Our patrons know and trust their local librarians. Our nation’s public libraries are a valuable asset in tackling some of America’s thorniest problems. But we can’t do it alone.
About the author: John Herron is executive director of the Kansas City Public Library.
