Achieving Even Plainer Plain Language: 3 Steps for Public Health Professionals

Plain language is more than just simplifying words—it’s about making sure your message lands. The National Institutes of Health (NIH) describes it as language that improves understanding. It should always be professional and accurate, yet never condescending. Public health professionals are trained in this concept, and federal agencies are mandated to use it by the Plain Writing Act, but there is still work to be done in making public health information truly accessible to everyone. 

Consider this: The average reading level in the U.S. is a sixth-grade reading level.  This fact highlights a crucial need for communicators to choose their words carefully to ensure health messages are actionable. Yet, public health communications are often dense with jargon. 

This reliance on jargon is understandable; as public health professionals, we spend years learning concepts such as health equity, social determinants of health, community capacity, public health surveillance, structural racism, and intersectionality, to name a few. However, these are not words and concepts that members of the general public use in their day-to-day lives. What’s more, some of these words and concepts have been misconstrued or even politicized. Plain language is a necessary tool to make these critical concepts easily understandable to the average person.

A Process to Achieve Plain Language

To transform technical communication into plain language, you can use a three-step process.

1. Define. We live and breathe these terms in public health, so we can have a hard time breaking the concepts down into relatable examples. A good first step is to define what the terms mean.
2. Simplify. To practice using plain language, simplify the definitions of the concepts. Break the jargon down into the most basic words and concepts you can think of (while maintaining accuracy). 
3. Segment. Different audiences may prioritize different aspects of each concept. If you have a specific audience, look for research on their beliefs and attitudes, as well as any specific disparities that might affect that group, and list those out. This way, messaging can be customized to that audience. using that plain language to create messages that are specific, relevant, and actionable for that particular group.​​

​Let's break down how to apply this process to common public health terms.

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Example #1: Social Determinants of Health

NOT THIS:
​The social determinants of health, such as socioeconomic status, social context, and neighborhood environment, significantly impact individual and community health outcomes. These factors can exacerbate health disparities.

WHY?
​The original sentence is full of jargon: "socioeconomic status," "social context," "neighborhood environment," "health outcomes," and "health disparities" aren't terms most people use regularly.

HOW?
Step 1: Define. Social determinants of health encompass several domains, including socioeconomic status, social context, neighborhood environment, health outcomes, and health disparities. Let's define those five terms:

• Socioeconomic status: “A multidimensional construct comprising multiple factors, such as income, education, employment status, and other factors."
• Social context: “Includes key issues such as cohesion within a community, civic participation, discrimination, conditions in the workplace, and incarceration."
• Neighborhood environment: “Includes key issues such as quality of housing, access to transportation, and neighborhood crime and violence.”
• Health outcomes: “Measurable change in symptoms, overall health, ability to function, quality of life, or survival outcomes from interventions.” 
• Health disparities: “A health difference that adversely affects disadvantaged populations in comparison to a reference population, based on one or more health outcomes. All populations with health disparities are socially disadvantaged due in part to being subject to racist or discriminatory acts and are underserved in health care."​

​Step 2: Simplify. Let's break down those five terms:

• Socioeconomic status: How much money you make; if you graduated high school, attained a GED, completed some college, or completed a college degree; if you are unemployed; what kind of job you have.
• Social context: If you feel like you belong or fit in with your community, how well neighbors get along, how well neighbors care for each other, if you take part in making your community better, being treated differently because you are different than others in your community, having safe work sites, being in jail or prison. 
• Neighborhood environment: Having safe neighborhoods and safe housing; having easy ways to get to work, school, stores, or the doctor; having safe roads to drive on and sidewalks to walk on; being close to nature. 
• Health outcomes: How good or bad you feel, how well your body works, or how long you might live after changing something related to your health, such as switching medicines, starting exercise, or changing what you eat. 
• Health disparities: Some groups of people are less healthy than others because they lack access to the same resources or are treated differently or unfairly.

Step 3: Segment. In this example, the general public is the audience, so we personalize by adding "you" and "your."

THIS:
​How much money you make, where you live, and access to transportation can all have a big impact on your health. For example, people who live in poor neighborhoods that are unsafe may not have access to healthy foods, bus stops, or safe outdoor spaces to exercise, which can lead to health problems like heart disease and diabetes.​

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Example #2: Health Equity/Equity

NOT THIS:
Our hospital is committed to health equity through equitable systemic transformations of care delivery mechanisms by addressing social determinants of health.

WHY?
​“Health equity” and “social determinants of health” are jargon. “Equitable systemic transformations” and “care delivery mechanisms” are technical terms. This example also isn’t specific about what will be addressed. 

HOW?
Step 1: Define. 

• Health equity: “Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health.”
• Social determinants of health: “Conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. These [social determinants of health] are grouped into 5 domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context."
• Care delivery mechanisms: “Encompasses a complex network of healthcare providers, institutions, and resources working together to deliver patient care.” 
• Systemic transformations: “An intentional process designed to alter the status quo by shifting the function or structure of an identified system with purposeful interventions…Systems change aims to bring about lasting change by altering underlying structures and supporting mechanisms which make the system operate in a particular way. These can include policies, routines, relationships, resources, power structures and values.”

Step 2: Simplify. 

• Health equity: Everyone has the support they need to be as healthy as they can be. 
• Social determinants of health: Factors about an individual's surroundings—where they are born, live, learn, work, play, worship, and age—that affect their ability to be as healthy as possible. These factors are put into 5 groups: income and work, education, housing and neighborhoods, and community involvement. 
• Care delivery mechanisms: How multiple people and organizations connect and work together to provide patient care. 
• Systemic transformations: Intentionally changing how factors like policies, resources, and power are used together to benefit the people who need them most. 

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Step 3: Segment. The original sentence sounds like a hospital discussing goals with vested partners and perhaps patients. Because this is a hospital, they would be focusing on areas of health equity and social determinants of health that they can directly influence. They are not likely to be building a park to increase green space, but they could do things like build a new clinic or send a mobile unit to an underserved area. They could increase the number of providers or interpreters they have. 

THIS:
Our hospital is working to provide support to the community so everyone can get what they need to be as healthy as possible. We are doing this by providing rides to appointments, offering basic health checks in our mobile health unit throughout the community three days a week, and starting a diaper distribution center for community members who need it. 

Key Takeaway

Many organizations provide guides for plain language, but the most important thing is to remember to segment your audience and choose words that connect directly to their lives.

By: Melissa Goetz