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The Ernst Strüngmann Forum Founded on the tenets of scientific independence and the inquisitive nature of the human mind, the Ernst Strüngmann Forum is dedicated to the continual expansion of knowledge. Through its innovative communication process, the Ernst Strüngmann Forum provides a creative environment within which experts scrutinize high-priority issues from multiple vantage points. This process begins with the identification of themes. By nature, a theme constitutes a problem area that transcends classic disciplinary boundaries. It is of high-priority interest and requires concentrated, multidisciplinary input to address the issues involved. Proposals are received from leading scientists active in their field and are selected by an independent Scientific Advisory Board. Once approved, a steering committee is convened to refine the scientific parameters of the proposal and select the participants. Approximately one year later, a focal meeting is held to which circa forty experts are invited. Preliminary discussion on this theme began in 2008, when Gerd Gigerenzer brought the problem of literacy in health care and its impact on the health care system to our attention. In October, 2008, the steering committee—comprised of Gerd Gigerenzer, Muir Gray, Günter Ollenschläger, Lisa Schwartz, and Steven Woloshin—met to identify the key issues for debate and select the participants for the focal meeting, which was held in Frankfurt am Main, Germany, from October 25–30, 2009. The activities and discourse surrounding a Forum begin well before participants arrive in Frankfurt and conclude with the publication of this volume. Throughout each stage, focused dialog is the means by which issues are examined anew. This often requires relinquishing long-established ideas and overcoming disciplinary idiosyncrasies which might otherwise inhibit joint examination . However, when this is accomplished, a unique synergism results and new insights emerge. This volume conveys the synergy that arose from a group of diverse experts , each of whom assumed an active role in the process, and is comprised of two types of contributions. The first provides background information on key aspects of the overall theme. These chapters have been extensively reviewed and revised to reflect current understanding. The second (Chapters 8, 12, 13, and 19) summarizes the extensive discussions that transpired. These chapters should not be viewed as consensus documents nor are they proceedings; instead , they transfer the essence of the multifaceted discussions, expose the open questions that remain, and highlight directions for future work. An endeavor of this kind creates its own unique dynamics and puts demands on everyone who participates. Each invitee contributed not only their time and congenial personality, but a willingness to probe beyond that which is evident, and I wish to extend my sincere gratitude to all. A special word of thanks goes viii The Ernst Strüngmann Forum to the steering committee, the authors of the background papers, the reviewers of the papers, and the moderators of the individual working groups (Johann Steurer, Ingrid Mühlhauser, Hilda Bastian, and Heather Buchan). To draft a report during the Forum and bring it to its final form in the months thereafter is no simple matter, and for their efforts, we are especially grateful to Gerd Antes, Markus Feufel, Talya Miron-Shatz, Norbert Donner-Banzhoff, and Ralph Hertwig. Most importantly, I wish to extend my appreciation to Gerd Gigerenzer, whose tireless efforts throughout the entire process proved to be invaluable. A communication process of this nature relies on institutional stability and an environment that encourages free thought. The generous support of the Ernst Strüngmann Foundation, established by Dr. Andreas and Dr. Thomas Strüngmann in honor of their father, enables the Ernst Strüngmann Forum to conduct its work in the service of science. In addition, the following valuable partnerships are gratefully acknowledged: the Scientific Advisory Board, which ensures the scientific independence of the Forum; the Deutsche Forschungsgemeinschaft (German Science Foundation), which provided financial support for this theme; and the Frankfurt Institute for Advanced Studies, which shares its vibrant intellectual setting with the Forum. Long-held views are never easy to put aside. Yet when this is achieved, when the edges of the unknown begin to appear and gaps in knowledge are able to be identified, the act of formulating strategies to fill these becomes a most invigorating exercise. But this is hardly the end, for if people are to achieve health literacy and if current health care systems are to evolve into patient-centered entities, multiple efforts on many levels are needed. It...

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