The Plain-Language Crisis

By William H. DuBay

Workers in finance, government, and health care are faced with new requirements to write documents in plain language. The problem is, few people in those fields know what plain language is or how to write it. Since the 1960s, consumer-advocacy groups have promoted documents that the public can read and understand. It has been a lofty goal that is rarely met.

In 1998, the Securities and Exchange Commission required all investment documents be written in plain English. Readability expert Mark Hochhauser in Business Week reported that the new, revised documents are still too difficult for the average investor. They require a college sophomore level of reading skill. This means only 30 percent of the adult reading public can read them.

We should remember that the reading level of the average adult in our country is the 7th grade. Because most people read comfortably two or more grades below their ability, experts recommend writing documents intended for the public at the 5th-grade level. The most popular novelists write at the 6th and 7th-grade levels.

Consumer Health Information

The journal Pediatrics last year reported that instructions for installing child safety seats in cars are written in language too difficult for the majority of adults. Vehicle collisions are a leading cause of death and injury of infants and children. About 80 percent of car-safety seats are installed or used improperly.

The lack of attention that health organizations give to the readability of their publications is overwhelming. The inability of people to understand health information annually costs the industry billions of dollars.

Average readers have great difficulty reading online or printed health information. Health-plan benefits (often 100 pages long) requires a 3rd-year of college reading ability. Even for advanced readers, trying to cope with so much difficult information can cause confusion, stress, and impaired judgment.

Legislation now requires health organizations to have ready consent forms in plain language for clinical trials. A study of 114 medical schools by Johns Hopkins researchers in February 2003 confirmed that consent forms use language far too difficult for most people to understand.

In May of 2002, the Inspector General's Office of the Department of Health and Human Services issued a similar report on "Clinical Trial Web Sites." Of the 110 clinical trials listed, only 29 discussed the trial benefits and none discussed the risks to human subjects.

Health-care organizations also face an April 23 deadline to comply with new "privacy rights" provision of the Heath Insurance Portability and Accountability Act (HIPAA). Mark Hochhauser, a consultant with the U.S. Department of Heath and Human Services, studied the privacy notices of 31 health organizations. He found they required a 2nd and 3rd-year college reading level. He said, "Average readers will find these notices hard to understand, especially the elderly and those whose primary language is not English."

Plain Language Requires Training

During the last century, publishers, educators, and the military conducted thousands of studies on how to make texts readable. The results of that research have yet to penetrate the schools of business, administration, law, and engineering. Students graduating from those schools are not trained in readability. They fail to realize that they have many options in preparing a text for a particular audience. They are often excellent readers who find difficult texts easy to read. They have no idea how difficult a text can be for others.

Last year at a clinical-trials conference, the FDA announced that they were changing the readability requirement of consent forms from the 8th to the 6th-grade level. When the speaker was asked how one achieves that level, he said he did not know.

Although a plain-language program is the smartest investment an organization can make, it takes training and method. As Jacques Barzun wrote, "Simple English is nobody's native tongue."