Are you sometimes confused by written medical instructions? Now, imagine what it would be like if you were sick, scared and had only third grade reading skills. Your doctor tells you, "You've got to follow these instructions exactly, or you could die."

About 200 recent studies have shown the reading difficulty of most health related materials FAR exceeds the average reading abilities of the American adult. One of the biggest silent health problems today is the gap between health materials and reading skills.

In the United States, the average reading level is eighth grade. In 1992, the Educational Testing Service determined that half U.S. adults read at between first and eight grade level. That is about 148 million people. It gets worse. One quarter of Americans read BELOW FOURTH GRADE level, meaning 74 million people would struggle with even the simplest, most well written health materials.

Does it matter? Do you remember the anthrax scare, when someone was putting deadly white powder into our mail system?

During that terrorist scare, the U.S. post office mailed millions of post cards to Americans. The post cards told people how to protect themselves from the deadly infection. They gave instructions on how to handle and report suspicious mail. These post cards were written at between ninth and eleventh grade reading level.

More than half the people who got that mailing could not read it well enough to protect themselves and others. Does it matter? Do 148 million people matter? Will it matter the next time the terrorists strike?

Do you remember the mailing the Surgeon General sent out explaining how to avoid contracting HIV? He made every effort to see that it was written in clear, simple language. He got criticism for just how plain talking it was in places. A later evaluation of that document showed that it was written at between seventh and ninth grade level. Half the people receiving it read at a level BELOW what was required to read it. No wonder the infection keeps spreading.

Think about it. For millions of people, the problem is not just the tiny print on prescription bottles. The problem is the words themselves. What does "take on an empty stomach" mean exactly? When should you "take four times a day"? Perhaps your doctor explained to you at the office. Do you remember what the doctor said a week later?

Have you ever read the instructions for testing and assessing blood sugar levels? Have you ever tried to fill out a Medicare form? Do you struggle with letters from your health insurance provider?

Only 45% of asthmatics with literacy problems knew that they should stay away from things they are allergic to even if they WERE taking asthma medication. 89% of the people reading at high school level were clear about the same information. It's not a matter of intelligence. It's a matter of a missing skill which well-educated health providers presume is present in their readers when they sit down to write.

There are two parts to the problem: the writer and the reader. Recently, the public health community has begun efforts to raise awareness. They are alerting the medical providers to the impact of health literacy issues. Some fledgling efforts are underway to provide clearer, simpler materials for the public. People are finding alternatives to reading for presenting the same information.

There is a long way to go. Sign up now with your local literacy program as a volunteer.

Drop in on your elderly neighbor and help her learn to read the specialized health material so critical in her life. (You may want to ask her about her life first, to save embarrassment when you learn you're talking to a retired English teacher). Start with all those ridiculously obscure materials her doctor sent home with her about glaucoma. You can go on to that Medicare form she needs to send in tomorrow.

Do you want to know what eighth grade reading level is? You just read 700 words of it. 74 million Americans reading at below fourth grade level could have found it too hard for them to understand.

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