Half the population can't understand simple health advice

More than half the adult population can't understand routine health instructions given out by doctors and nurses and written  on medicines and posters.

Around 43% of people were not at the literacy levels to fully understand written words on cancer screening kits, doctors' letters, or child cycle helmets.

Add in some maths and the figure rises to a staggering 61%, the first survey to look into the problem in England  has found.

More than three out of four - 78% - cannot understand the most common measure of obesity, a Body Mass Index (BMI) chart which ranks obesity levels on measures of height and weight.

The study of 16-65 years olds in England was presented to MPs in the House of Commons last week.

Professor Gill Rowlands, who led the research, told me there was a "mis-match" between the level health information was pitched at and the literacy and numeracy abilities of the population.

She told me: "I was staggered. I am a GP in an inner city practice so one of the reasons for me doing this was to find what people were understanding. I was just staggered by the extent of the problem.

"I spend quite a bit of my time with people bringing in material to show me or letters they have received from hospitals and saying to me what does it say?

"There is one bit of caution in that the percentage of people who could not understand it does not mean they could not understand or use it at all because people do  ask a family or friends if they don't understand.

"So people do have coping strategies but there is no doubt if it is tricky for people to understand some people don't bother,  other people are too embarrassed to ask, and others will have to spend far longer on it than they would otherwise have to."

Examples of materials sampled and ratings: 1

Material	Level of difficulty of health material	% unable to effectively understand the information	Number of English adults 16-65 years unable to effectively understand the information
Instructions to calculate a child’s dose of paracetamol	Readability: 14-16 years (GCSE C or above) Maths: 5-7 years	43%	15 million
Instructions for fitting a child’s car seat	Readability: 14-16 years Maths: 7-9 years	43%	15 million
Instructions for using a bowel cancer screening kit	Readability: 11-14 years Maths: 11-14 years	49%	17 million
Calculating the Body Mass Index Chart	Readability: 14-16 years Maths: 14-16 years	78%	27 million

"We sampled across a range of activities so there was stuff about promoting good diet and exercise, there was stuff about preventing illness, having flu jabs and taking part in cancer screening. What to do if you get sick - how to manage an illness and there was also a section on public safety - things like how to fit a child's  car seat and how to fit a cycle helmet. It took a really wide range of material."

The team rated the difficulty of the material, the readability and the maths difficulty, against the English Skills Qualification Framework .

Then they looked at the literacy and numeracy skills of England's population from last years national skills survey which was run by  the Department  of Business and Skills and got people to do literacy and numeracy tests.

Professor Rowlands, of London South Bank University, said: "We measured like with like. We said: This is the difficulty of the material what proportion of the English population have got the skills to be able to understand and use them. 

"And that is where we found this gap. We found some of the health material just had text in it, just written information, and for that 43% of the population nationally were not at that level.

"And if you bring in any kind of maths - which is obviously quite common in health - then the proportion of people who could not really understand it goes up to 61%.

"Another example was bowel cancer screening and again 41% would not be able to completely understand those instructions.

"One of the things which really struck me was that it was an across the board issue whatever angle you looked at most of the material that was coming out was at a level that was above the level of the skills of the people that needed to use it."

Some may say the study is a damning indictment of modern education. Professor Rowlands thinks health information could be brought into English and Maths teaching. But the easier short-term solution is to make health and safety instructions much simpler and easier to understand.

"The problem is the mis-match between the complexity of the health materials and the skills of the people who need to use them. So the two approaches should be to reduce the complexity of the materials or to support people to develop more skills.

"It is simply quicker to get the health service to write their information more clearly. But in parallel we have got to support the development of literacy and numeracy in order that people can use them for health.

"There is important work to be done to look at people over 65 which hasn't been surveyed yet. When I look at some of my older patients they are on several different drugs they have different colours and they have to be taken at different times of day it can be very complicated.

"The other group which has an issue is the lower income groups. They could do with closer access and support to be able to get access to health information and then evaluate it - see if it is right for them - and go and find someone to talk to about it.

Previous research in the US has shown that people with low health literacy levels have poorer health, are less likely to engage in cancer screening programmes and are less likely to be able to manage illnesses such as diabetes, heart problems and asthma.

This research suggests the same may be true in England. More than two thirds of people, 67%, who said they were in poor health also had poor health literacy levels while only 36% of those in good health had similar low literacy levels.

The research was sponsored by MSD, known as Merck in the US and Canada, which has been pushing low health literacy as an unmet health need for ten years. Researchers will now look more closely at inner London and northern England, where the problem is worst.