Vital Signs: Taking the Plain Writing Act personally

From what I heard at both the Texas Conference on Health Disparities on May 30-31 and the Tarrant County Health Literacy Symposium on June 6, a lot of people have a long way to go to comply with the Plain Writing Act of 2010. The goal of the Plain Writing Act is to improve effectiveness and accountability of federal agencies by promoting clear government communications that the public can understand and use. Plain writing means writing in language that the intended audience can readily understand and use because it is clear, concise, well organized and follows other best practices. It covers any document necessary to obtain any federal benefit or service, to provide information about any federal benefit or service, or to explain to the public how to comply with any requirement the federal government administers or enforces. Judging from all the complex and repetitive Medicare literature I received upon turning 65 this month, I believe some federal agencies have a long way to go. (I would say most of them, but that would be an assumption because I have not had to deal with most of them, thank goodness.) And judging from the fact that just to sign up for Medicaid and SNAP (food stamps) in Texas, you must wade through 26 pages of instructions and forms (in tiny print), I think it’s safe to say this state makes even greater demands on people who are largely health-illiterate, which is most of us. By way of contrast, Laurie Martin, a policy researcher with the RAND Corp., displayed the two-page application for a bank bailout through the TARP Capital Purchase Program alongside the 26 pages it takes to file for Medicaid in Texas, during her presentation at the Literacy Symposium in Arlington. The average payout for the completed Medicaid application is $57 per person per month or $228 per month for a family of four, Martin said. The average payout from the two-page TARP application is $271,148,777.91 – more than $135 million per page. The RAND Corp. says Texas Medicaid has “the biggest burden” with “the smallest payback” of any government program. RAND is a nonprofit firm dedicated to improving policy and decision-making through research and analysis. Martin’s presentation clearly demonstrated the burden of illiteracy when it comes to the complex subject of health care, which often depends on documents with lots of scientific jargon, tables and legal disclaimers. Most of us are at least somewhat illiterate when it comes to health care, Martin says. We don’t really know what congestive heart failure means or what a carcinoma is. We don’t understand the difference between steroids that athletes sometimes use to bulk up and add strength and steroids our doctors might prescribe to reduce swelling and inflammation. And we don’t know what to do about “poor glycemic control.” Timing is everything. Just when we most need to be literate and make informed decisions – when we are in pain or scared or confused about our own new diagnosis, or distraught about our children’s or elderly parents’ pain and suffering, or when we get bad news from our latest lab tests – we are most likely to be illiterate. “You can be well educated and not have health literacy when you are thrust into a situation that is foreign to you,” Martin told me during a break at the symposium. Only 12 percent of U.S. adults can read, understand and effectively use basic medical instructions and information, she said. When I suggested that the Internet must be helping a lot, she pointed out that much of the medical information online is outdated, erroneous or from disgruntled bloggers who have an ax to grind concerning their own health care. There is so much information online, that it is difficult to sort through and figure out just what is coming from the National Library of Medicine, the National Institutes of Health, the Mayo Clinic and other trusted sources, and what is coming from individuals who do not know any more about the subject than you do. To help with that problem, the University of North Texas Health Science Center in Fort Worth is offering a series of training sessions for area librarians, public health practitioners, professional associations and community-based organizations, Andi Spencer, the outreach librarian at UNTHSC, said at the symposium. More than half of all people who go to Tarrant County libraries to use computers are seeking health care information, Spencer said. “Building the Bridge to Health: Consumer Health Information at Your Library” is funded through a United Way “Live Well” grant. For more information, go to

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