Americans visit a public library over one and a half billion times each year, more than four million visits each day. In contrast, Americans visit a physician’s office just over 928 million times annually. What if library visits could be leveraged as opportunities to promote health? In Health Affairs, as part of the Culture of Health issue, colleagues and I from the Healthy Library Initiative analyze the ways in which the Free Library of Philadelphia, the city’s public library system, already promotes better health, and suggest what more it could do.

In Philadelphia, a city of one and a half million people, the Free Library has five and a half million visits annually. That provides untapped opportunities to reach Philadelphians, especially vulnerable individuals for whom libraries often serve as a haven. Our team conducted an analysis of current library programming and a needs assessment of community members and library staff. We found that libraries are already working to promote health, but there are opportunities to do more to harness their power and potential.

At their core, libraries are sites of literacy promotion and lifelong learning, and literacy is linked to better health outcomes from childhood, through adulthood, and into old age. A recent study also showed that reading more books was linked to better health.

People use public libraries as sources for health-related information that they may not be able to get from the health care system, perhaps due to lack of access, time, language barriers, or feeling intimidated while speaking to a health care provider. According to a recent survey, over 40 percent of the information that patrons search for online at the library is related to health. 

Public libraries are also addressing the social determinants of health (i.e., nutrition, employment, education), which is crucial to reducing health disparities. In Philadelphia, the Free Library offers programming that includes nutrition classes at the Culinary Literacy Center and workshops at its job and career information center. These services are utilized by half a million people.

Our analysis showed public librarians to be committed to public service, deeply trusted, and responsive to the needs of their patrons. Librarians report addressing almost any question asked of them – from assistance finding cookbooks about nutrition and interpreting official documents, to help setting up email accounts and writing resumes.  However, library staff are often stressed by the tremendous needs of their patrons and lament that they feel ill-equipped to deal with the challenges of working as front-line staff in vulnerable communities.  

What else is needed? A first step in harnessing the power of public libraries to address population health is increasing library capacity. While the library often serves as a haven for vulnerable individuals, the formal training of librarians is often inadequate. Our team worked to address this gap by developing a training curriculum for librarians to “recognize, engage and refer” vulnerable individuals to appropriate resources. The topics selected for the training – mental health and substance use, homelessness, immigration, and childhood and family trauma – were identified by library staff and community members as the most pressing health concerns in their communities.  

We delivered the training in South Philadelphia, and preliminary analysis shows that the case-based training modules significantly improved library staff knowledge, confidence and comfort in addressing the needs of these patrons. We plan to repeat the training in West Philadelphia in the next few months.

We must also work to build partnerships between public libraries, health systems, and public health agencies to encourage an interdisciplinary approach to patient care and well-being. An innovative model exists here in Philadelphia at the new Community Health and Literacy Center, which co-locates a health-focused library, adult and pediatric public and private medical clinics, and a city-sponsored recreation center.   

Finally, we should leverage the trusted role of librarians in their communities. Libraries and their staff are free and open to the public, rooted in the local neighborhood, and deeply trusted, making them a key partner in building a healthy community.  While doctors may understand little about their patients’ lives outside the consultation room, librarians are embedded in their communities, and know their patrons’ daily routines and challenges. Library staff are in an ideal position to serve as “sentinels” in their communities.  If we work with librarians to identify ever-changing health and community needs, we may be able to more rapidly address health concerns.