Libraries are uniquely positioned to address public health needs in underserved populations, according to findings from a study by researchers at the University of Pennsylvania and the Free Library of Philadelphia in this month's issue of Health Affairs. The research team then took these findings a step further, developing a pilot program to train library staff into "community health specialists."

After completing a needs assessment including interviews with 77 Philadelphia residents and 18 library staff, along with an analysis of ten of The Free Library of Philadelphia's largest programs, the researchers report that the library routinely helps patrons secure basic human needs that are fundamental to health, such as housing, food, employment, and health care. The findings highlight that libraries are changing with the times and are highly responsive to consumers' needs -- well beyond books.

In a city like Philadelphia, there is substantial opportunity for libraries to address population health issues. Philadelphia is the poorest of the Nation's ten largest cities, with nearly a third of residents living below the federal poverty level. Thirty-eight percent of low-income Philadelphians lack a high school diploma, setting them up for lifelong struggles that undermine health. The city's rates of hypertension (38.2 percent), obesity (33.3 percent), and diabetes (15.4 percent) are among the highest in large United States cities. "Public libraries are a critically needed and trusted lifeline for many vulnerable citizens," said Carolyn Cannuscio, ScD, director of research at the Center for Public Health Initiatives and an assistant professor in Family Medicine and Community Health at the Perelman School of Medicine. "Our analysis found that library staff already serve as catalysts in addressing the needs of many immigrants, people experiencing mental illness or homelessness, and others seeking assistance. And they have the capacity to do even more."

Of the Free Library's 5.8 million in-person visits in 2015, 500,000 included participation in specialized programs that addressed multiple health determinants, such as job skills and literacy. The study's data are unique to Philadelphia, but the authors suggest that similar programs could have a major public health impact if implemented in the nation's 9,000 public library systems that host 1.5 billion visits annually.

The needs assessment found that library staff reported feeling under-prepared and stressed by the profound health and social needs of many library patrons. This led to "The Healthy Library Initiative" partnership between Penn and Philadelphia's public library system, in which Penn advisors collaborated with librarians to integrate evidence-based public health programming in a library setting. The community health specialist pilot training addresses issues faced by children and families experiencing trauma, mental health and substance abuse, the health and social needs of immigrants, and homelessness. The training encourages library staff to recognize vulnerable patrons, communicate productively with them, and guide these patrons to appropriate community-based services.

Starting with library staff in the Community Health and Literacy Center that opened earlier this year, the team plans to further evaluate and expand the program in the Free Library of Philadelphia system and beyond, aided by funding from the National Library of Medicine.