Literature for Life: Teaching Health Literacy with Picture Books and Novels

by Chris Liska Carger, Sally Conklin, and Francine Falk-Ross

No curriculum content is more crucial for life—literally—than that of health education. Alcohol, tobacco, and other drug use, low levels of physical fitness, poor nutrition, injuries, stress, and mental illness (all on the rise in our nation's youth) can impede learning and reduce quality of life. The American Medical Association has designated school health education as the most important factor in future improvements in our nation's health-even more valuable than biomedical breakthroughs. Health education in schools is essential to enable students to apply health-related knowledge in their own lives successfully and meaningfully.

Traditionally, attempts at health education have emphasized memorization of science-based facts and societal prescripts. Research (not to mention the current health of American youth) tells us that this approach has not been particularly successful. This reactive approach is best replaced by a proactive one based on the strengths, talents, and resiliency that children possess. The American School Health Association, the Association for the Advancement of Health Education, and the American Cancer Society worked jointly to generate National Health Education Standards that encourage what they term health literacy. These standards provide flexible, conceptually anchored parameters within which educators may find a meaningful health education curriculum.

The seven health standards (see sidebar) blend well with critical literacy principles and reader-response teaching techniques. The power of a good novel, well-written poetry, or creative biography could reach an adolescent struggling with critical health-impacting decisions more effectively than a textbook. With novels in particular, it is harder for students to distance themselves from health issues and behaviors exemplified through a compelling story and well-developed characters. Holt's When Zachary Beaver Came to Town, the moving story of a community's reaction to an obese orphan, conveys the devastating effects of poor nutrition and a sedentary lifestyle more powerfully than could any edict about proper nutrition and exercise. Pedro and Me deals with the complex issues precipitated by author Winick's fellow MTV's The Real World cast member Pedro's battle with HIV/AIDS in an accessible graphic art format. Even White's classic fantasy novel The Trumpet of the Swan can provide concrete examples of goal setting and applying a decision-making process to a health issue as Louie struggles to adapt to being mute. Readers clearly see the consequences of not addressing health issues when the title character in Gantos' Joey Pigza Loses Control stops taking medication for his attention deficit disorder. Even books that may not appear to address health issues (such as DiCamillo's Because of Winn-Dixie) integrate health literacy characteristics into the plot. Small group discussions of responses to books like these with authentic questioning and interpretation will help students to personalize facts and use them to develop health beliefs that consider the interconnected physical, mental, emotional, and societal dimensions of their decisions. Nonfiction health and science reading materials can also be made available in learning centers to link to fiction selections.

The goal of health literacy is to train children to become critical thinkers; responsible, productive citizens; self-directed learners; and effective communicators. The following reading suggestions may help all teachers-not just those specifically trained in health-to encourage these assets.

Books for Younger Readers

Browne, Anthony. Piggybook. 1986. 32p. Dragonfly, paper, $7.99 (0-679-80837-X).
K-Gr. 2. Mrs. Piggott is sick and tired of doing all the laundry, all the cooking, and working full-time, while her husband and two sons don't lift a finger. She leaves for a few days, and, in her absence, the three actually become pigs as their home turns into a colossal mess. Only when everyone learns to pitch in and help do they resume human form. Personal hygiene and the importance of a clean and healthy home environment are literally illustrated in this amusing story.

Carle, Eric. The Very Hungry Caterpillar. 1969; reissued 2000. 32p. Philomel, $15.99 (0-399-23641-4); board book, $9.99 (0-399-22690-7).
Preschool-Gr. 1. It's never too early for children to think about health-enhancing nutrition, and this classic story of a caterpillar who eats his way to a stomachache is a perfect vehicle for discussion. The message of striving to realize one's potential can easily be linked to the caterpillar's metamorphosis. For an engaging picture book about the food pyramid, see Loreen Leedy's The Edible Pyramid: Good Eating Every Day (Holiday, 1994).

Cisneros, Sandra. Hairs/Pelitos. Illus. by Terry Ybañez. 1994. 32p. Dragonfly, paper, $6.99 (0-679-89007-6).
K-Gr. 2. A vignette from Cisneros' The House on Mango Street, this picture book celebrates diversity within a family. The bilingual text is complemented by Ybañez's cheery, simple drawings, and the affection the narrator has for family members is apparent as she lovingly describes their various hair textures and other characteristics. This book can facilitate discussions on physical diversity in families, communities, and beyond.

dePaola, Tomie. Now One Foot, Now the Other. 1981. 48p. Putnam, $15.99 (0-399-20774-0); Puffin, paper, $7.99 (0-399-22400-9).
K-Gr. 2. When everyone else has given up on Bob, a stroke victim, his five-year-old grandson Bobby realizes through a game that Grandpa does recognize him and is able to comprehend his surroundings. With unwavering hope and dedication, Bobby reteaches Bob how to walk, feed himself, and tell stories-all things his beloved grandfather once taught him. Through effective interpersonal communication, the two generations devise strategies that enable Bob to cope with his affliction and enjoy a highly functional life.

Martinez, Alejandro Cruz. The Woman Who Outshone the Sun / La Mujer que Brillaba aún más que el Sol. Illus. by Fernando Olivera. 1987. 32p. Children's Book Press, $15.95 (0-89239-043-3); paper, $7.95 (0-89239-112-X).
Gr. 1-3. The story of the "wonderful yet so strange" Lucía may cause children to think about the consequences of mean-spirited gossip. When villagers cruelly drive the lovely Lucía out of town, her beloved river leaves with her. This bilingual tale is excellent for discussing the importance of emotional well-being and a community's role in supporting the diversity and individualism of its members.

Polacco, Patricia. Thank You, Mr. Falker. 1998. 40p. Philomel, $16.99 (0-399-23166-8).
Gr. 4-6. Through poignant prose and emotionally expressive illustrations, Polacco presents a girl eager to read but unable to figure out the jumbled mess she sees on the page. After she suffers the teasing of classmates, her fifth-grade teacher, Mr. Falker, discovers her problem and helps her overcome it. Health themes include relationships with grandparents, dealing with death, overcoming adversity, and advocating for personal health needs, including mental and emotional needs.

Seuss, Dr. Hunches in Bunches. 1982. 48p. Random, $14.95 (0-394-85502-7).
K-Gr. 3. When many choices exist, selecting only one can be difficult. The message to readers in this rhyming, easy-to-read book is "Get it done! Only you can make your mind up!" Teaching decision-making skills works well when a humorous example is used to illustrate the steps of defining the problem, weighing alternatives, and finally making a choice. In this case, "six hot dogs for lunch" may not be the best hunger hunch answer! Explore other alternatives, and perhaps follow up the discussion with a nutritious snack for the whole class.

Sís, Peter. Madlenka. 2000. 48p. Farrar/Frances Foster, $17 (0-374-39969-7).
K-Gr. 2. Little grabs the attention of primary schoolchildren as quickly as the topic of loose teeth. Madlenka spreads the good news that her tooth is loose to several friendly merchants. With fine detail that begs interaction, Sís takes readers around a New York City block and, in doing so, around the world. (For more loose tooth titles, see the article "Primary Smiles" in the April/May 2002 issue of Book Links.)

Young, Ed. Seven Blind Mice. 1992. 40p. Philomel, $17.99 (0-399-22261-8); Puffin, paper, $6.99 (0-698-11895-2).
Preschool-Gr. 2. Young's effective use of cut-paper collage on black background will delight children, in this retelling of an Indian fable in which seven blind mice try to describe an elephant. One mouse finally aggregates the clues and correctly identifies the mysterious object. The lesson about analyzing and synthesizing parts into a whole makes this picture book a good springboard for investigating more complex health issues in other readings.

Books for Older Readers

Conly, Jane Leslie. Crazy Lady! 1993. 192p. HarperTrophy, paper, $5.99 (0-06-440571-0).
Gr. 3-6. Facing the prospect of failing English class and repeating seventh grade, Vernon finds a tutor in the eccentric, alcoholic Maxine Flooter, a neighborhood woman known as the "crazy lady." Despite the ridicule he fears from his friends, he gets to know Maxine and her mentally retarded son, Ronald, eventually helping Ronald participate in the Special Olympics. Vernon's relationship with Maxine and her son, as well as the personal family and learning problems he copes with, highlight issues such as the identification of community resources and working cooperatively to promote health.

Cormier, Robert. Tunes for Bears to Dance to. 1992. 112p. Laurel-Leaf, paper, $4.99 (0-440-21903-5).
Gr. 5-8. In post-World War II Massachusetts, Henry takes a job working in a grocery store to help his family. At the same time, he befriends a Holocaust survivor in his community who is carving a wooden replica of his destroyed home. When Henry's employer threatens to fire him unless he destroys his friend's beloved village, he must weigh his options carefully. This novel offers several examples of decision-making dilemmas, including response to peer pressure, understanding racism, consideration of home and family responsibilities, and respect for property.

DeFelice, Cynthia. Devil's Bridge. 1992. 96p. HarperTrophy, paper, $4.95 (0-380-72117-1).
Gr. 4-6. Ben's recently deceased father was Martha Vineyard's Striped Bass Derby champion for years. After he hears a local man plotting to beat his father's record using an illegally caught fish, Ben must make some difficult decisions related to competition and honesty. The influential advice and support of peers, family, and community members as Ben struggles to demonstrate his independence and self-worth are important models for young students' decision-making.

DiCamillo, Kate. Because of Winn-Dixie. 2000. 192p. Candlewick, $15.99 (0-7636-0776-2); paper, $5.99 (0-7636-1605-2).
Gr. 3-5. Despite her odd name and being new in a small Florida town, India Opal Bulonni manages to improve interpersonal communication with her father, who, along with Opal, is devastated by his wife's abandonment of the family. Opal also gathers a unique assortment of friends, ranging from a scraggly stray dog to a reclusive African American woman. Opal encourages young readers to march to the beat of their own drummers, communicate across race, gender, and age barriers, practice conflict resolution, and value diversity in friendships.

Gantos, Jack. Joey Pigza Loses Control. 2000. 208p. Farrar, $16 (0-374-39989-1); HarperTrophy, paper, $5.95 (0-06-441022-6).
Gr. 4-7. This sequel to Joey Pigza Swallowed the Key (Farrar, 1998) gives readers a heartfelt glimpse into the world of an attention deficit disordered (ADD) child. In this book we see the consequences of the poor health-related decisions both Joey and his father make, not to mention the severe impact that an ongoing smoking habit has had on his grandmother's lifestyle. As Joey spirals out of control by going off his medication, children dealing with this condition themselves or those with ADD classmates can clearly see the importance of appropriately controlling its devastating effects.

Giff, Patricia Reilly. All the Way Home. 2001. 176p. Delacorte, $15.95 (0-385-32209-7).
Gr. 3-5. Mariel, a polio victim living in post-Depression Brooklyn, wonders about the identity of her birth mother. Brick, a struggling upstate New York student, worries about tough times due to a fire in his family's apple orchard. The two meet and share their love for the Brooklyn Dodgers and their understanding of each other's plights. Both characters offer many admirable traits as they deal with physical, emotional, and educational challenges in the pursuit of healthy lives for themselves and their loved ones.

Holt, Kimberly Willis. When Zachary Beaver Came to Town. 1999. 240p. Holt, $16.95 (0-8050- 6116-9); Yearling, paper, $5.50 (0-440-22904-9).
Gr. 4-6. "Nothing ever happens in Antler, Texas," declares Toby Wilson, until a 600-pound boy in a trailer pulls into his sleepy town. Toby and his friend Cal move from curiosity regarding the new boy in town to compassionate friendship as they begin to comprehend what life is like for this orphaned and immobile young man. Health connections abound as readers see concrete ways in which lifestyle affects health, and the importance of effective interpersonal communication. Holt's writing is filled with memorable, moving images.

Jiménez, Francisco. The Circuit. 1999. 144p. Houghton, $15 (0-395-97902-1).
Gr. 5-up. This episodic semi-autobiographical novel by a former migrant worker gives readers many examples of perseverance in the face of physical, emotional, and educational challenges. The protagonist's family's struggle with the illness of its baby also offers the opportunity to discuss traditional and nontraditional health care and cultural beliefs. Panchito's story continues in the sequel Breaking Through (Houghton, 2001).

Kanefield, Teri. Rivka's Way. 2001. 144p. Front Street/Cricket, $15.95 (0-8126-2870-5).
Gr. 4-6. It is 1778, and Rivka, who suffers from mysterious stomachaches that her doctor father is unable to diagnose, longs to see the bustling city outside the walls of Prague's cramped Jewish quarter, where she has spent all her 15 years. Disobeying her parents and risking the shame of her community, Rivka secretly explores the city; once she acts on her desire, the stomachaches disappear. Rivka's adventure provides an opportunity for students to discuss the consequences of taking risks and the importance of interpersonal communication for building positive, healthy attitudes and critical-thinking skills.

Koss, Amy Goldman. The Girls. 2000. 128p. Dial, $16.99 (0-8037-2494-2); Puffin, paper, $4.99 (0-14-230033-0).
Gr. 5-8. The five middle-school friends referred to in the title ride the emotional roller coaster known as adolescence. Sometimes honesty, trust, and empathy prevail; yet, with typical youthful insecurity, real feelings are seldom fully revealed. A range of mental and emotional health issues, including phobias, is sensitively handled. This realistic and engaging book provides a powerful example of how interpersonal communication skills enhance mental health.

Naylor, Phyllis Reynolds. Alice in Lace. 1996. 144p. Simon & Schuster/Atheneum, $17 (0-689-80358-3); Aladdin, paper, $4.99 (0-689-80594-7).
Gr. 7-9. When Alice's health class studies critical choices, she and her friends are faced with a range of hypothetical situations that test their ability to investigate real-life issues. An underlying theme is the tension between planning ahead and being unable to predict unexpected events. In this fictional account the parents, older siblings, teachers, and administrators all fill the roles of supportive adults.

Paulsen, Gary. Hatchet. 1987. 208p. Simon & Schuster, $16 (0-02-770130-1); Pulse, paper, $5.99 (0-689-82699-0).
Gr. 5-8. When the pilot of the small plane transporting 13-year-old Brian Robeson to Canada dies mid-flight, the young teen manages to land the plane on an isolated island. Stranded with only a hatchet to help him survive the challenges of everyday living, Brian must make crucial decisions in choosing food, shelter, and priorities for action. The narrative provides suspenseful reading and useful information for young adolescents about problem solving, independence, and purposeful action in dangerous situations.

Russo, Marisabina. House of Sports. 2002. 192p. HarperCollins/Greenwillow, $15.95 (0-06-623803-X).
Gr. 5-8. For Jim Malone, a seventh-grader and an avid basketball player, changes are occurring all around him. His grandmother has a stroke; his dog, once playful and energetic, is now too old and sick to move without help; and his basketball team now has a female member. As Jim tries to accept these changes, he learns more about his friends, family, and himself. This moving story of Jim's emotional growth highlights issues of health and illness, death and loss, and sacrifice in a sensitive and spiritual manner.

Van Draanen, Wendelin. Sammy Keyes and the Curse of Moustache Mary. 2000. 144p. Knopf, $14.95 (0-375-80265-7); Yearling, paper, $4.99 (0-440-41643-4).
Gr. 7-9. Sleuth Sammy Keyes, along with her three friends, assist Lucinda, the 90-year-old granddaughter of Moustache Mary, an early California pioneer, in locating the hidden sack of gold coins Mary wrote about in her diary. This engaging mystery involves age-old themes of friendship and feuding, alongside the perennial teen temptations of drugs and alcohol. With its clear message, this is a perfect book for discussing staying healthy despite peer pressure.

Warner, Sally. How to Be a Real Person (in Just One Day). 2001. 112p. Knopf, $15.95 (0-375-80434-X).
Gr. 5-8. How can a sixth-grader care for her mentally ill mother all by herself? Kara tries to find comfort in her favorite book and a friendship with a classmate, until a caring and perceptive teacher contacts Kara's father and exposes her secret. Many children deal with family circumstances they are reluctant to share. This sensitively written book provides an avenue for a class to explore the steps needed to be an advocate for personal and family health.

White, E. B. The Trumpet of the Swan. Illus. by Fred Marcellino. 1970; reissued 2000. 272p. HarperCollins, $16.95 (0-06-028935-X); HarperTrophy, paper, $6.50 (0-06-440867-1).
Gr. 2-4. Louis, a young male trumpeter swan, has no voice. Since trumpeter swans attract mates with their resonant voices, his parents worry about his future. But Louis determinedly makes his way in the world and finds strategies to overcome his disability. He even succeeds in courting his beloved Serena by playing a trumpet. Louis is a great example of perseverance and adaptation when facing a potentially disabling condition.

White, Ruth. Belle Prater's Boy. 1996. 208p. Farrar, $17 (0-374-30668-0); Yearling, paper, $5.50 (0-440-41672-9).
Gr. 3-5. Cousins Woodrow Prater and "Gypsy" Arbutus Leemaster both find the strength to face a tragic event during their sixth-grade year in Coal Station, Virginia. In addition, Gypsy learns that physical appearances are not all that matters as she grows to appreciate and love her offbeat cousin. Facing problems, managing stress, and adjusting to loss are all touched on in this beautifully told story.

Wilhelm, Doug. Raising the Shades. 2001. 192p. Farrar, $16 (0-374-36178-9).
Gr. 4-7. As 13-year-old Casey struggles to deal with his father's alcoholism, he becomes increasingly isolated and angry. Though the ending is a bit too neat and tidy, Wilhelm's novel realistically shows how devastating the disease can be for family members. Also see Colby Rodowsky's Hannah in Between (Farrar, 1994).

Winick, Judd. Pedro and Me: Friendship, Loss, and What I Learned. 2000. 192p. Holt, paper, $15 (0-8050-6403-6).
Gr. 8-up. In graphic art form, Winick helps readers see the compassionate and caring man who became his friend, not just someone afflicted with AIDS. The text contains explicit sexual information regarding AIDS prevention for young adults. It also provides a tangible example of the consequences of choices and will help young adults to identify responsible and harmful behaviors. Winick's simple and forthright story breaks down negative stereotypes about those afflicted with AIDS.

Zinnen, Linda. The Truth about Rats, Rules, and Seventh Grade. 2001. 160p. HarperCollins, $14.95 (0-06-028999-3).
Gr. 5-8. A studious seventh-grade girl named Larch lives with her widowed mother in a mobile home park. The mystery of how her father died is entangled with a community history project, a newspaper delivery job, and the special talents of a rat terrier. Communication-especially about a topic as sensitive as a parent's death-is the health focus. Another fine novel exploring this theme is Sis Deans' Racing the Past (Holt, 2001).

Web Connections

• Body and Mind, at http://www.bam.gov, is the kids' page maintained by the Centers for Disease Control and Prevention. With the slogan "Your questions answered--no questions asked," the site seeks to provide health information to kids who might not take their concerns elsewhere. Along with fitness tips, profiles of disease detectives, and health quizzes and games, there is a Teacher's Corner, with preassessment questions to determine what students already know, as well as activity ideas.
• Produced in conjunction with the Epidemic! The World of Infectious Disease exhibit at the American Museum of Natural History, Infection Detection Protection, http://www.amnh.org/nationalcenter/infection, features interactive games, quizzes, and stories about microbes, infections, and disease detectives.
• KidsHealth for Kids, at http://www.kidshealth.org/kid/index.html, features informative articles that provide tips on staying healthy, everyday illnesses and injuries, kids' health problems, and more. A dictionary of medical terms is also included.

Chris Liska Carger and Francine Falk-Ross are faculty members in Northern Illinois University's Department of Literacy Education. Sally Conklin is a faculty member in Northern Illinois University's Counseling, Adult and Health Education Department. Special thanks go to librarian Cleo Pappas, formerly of the Lisle Public Library in Lisle, Illinois, for her help with this article.