Health information is too complicated, experts warn

Posted on 07 December 2012

New research into health literacy levels across England has shown that health information is too complex and that 43% of people aged between 16 and 65 years are unable to effectively understand and use everyday health information.  The figure rises to 61% when the information also requires maths skills.1   There are 34.1 million adults in England aged 16 – 65 years2; this means that between 15 – 21 million people of working age across the country may not be able to understand and use the information they need to look after their health.

Previous research from 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, coronary heart disease and asthma.3,4 This new research from London South Bank University suggests that this may also be true for our population across England.  Two thirds of people, 67%, who said they were in poor health, had low health literacy skills, whereas only 36% of people in good health had low literacy levels.1

A member of the research team, Dr Joanne Protheroe, Senior Lecturer in General Practice, Keele University, and GP in NHS Manchester, said: “Where health materials require reading skills, a significantly higher proportion of people in the North of England are unable to use the material effectively, compared to those in the South of England (excluding London). For example, 46% of the working age population in the North East of England would have difficulty with written material, rising to 64% if also require numeracy skills, compared to 35% and 54% in the South East of England1.”

This difference of 10% represents 3.2 million people of adult working age2. The priority now needs to be to improve the way in which health information is developed, delivered and communicated to ensure all patients accessing the health service anywhere in England can equally benefit from the services available.

Professor Gill Rowlands, Professor of Health Disparities, at London South Bank University who led the research team explained: “Health literacy skills are needed to understand and use information in ways that promote and safeguard good health. We know from research in the US and other countries that poor skills levels such as these have a huge impact and can lead to poor health.3,4  This is a preventable problem, which puts an increasing pressure on an already stretched health service. Our priority now is to look at addressing the challenges uncovered in the research and to develop solutions to ensure health information is more easily understood.”

This is the first study to examine health literacy levels across England and to explore the likely impact on the population in everyday situations.  It was conducted by an international team of experts in medicine, public safety and education led by Professor Gill Rowlands.  They collected a wide ranging sample of health materials commonly used to promote and protect health, manage illness or navigate services – such as health screening posters, labels on medicines, letters from GPs, and road safety information.  All sample materials were rated for difficulty to determine what reading and maths skills people need to adequately understand and act on the information within the materials. The difficulty levels of the documents were then compared to the literacy (reading) and numeracy (maths) skills of the English working age population. This information was collected in the Government’s 2011 national skills survey (The Skills for Life Survey) based on interviews with over 7,000 people from a cross-section of the nation’s population and assessed literacy and numeracy skills.5

Examples of materials sampled and ratings: 1


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


15 million

Instructions for
fitting a child’s car seat

Readability: 14-16

Maths: 7-9 years


15 million

Instructions for using
a bowel cancer screening kit

Readability: 11-14

Maths: 11-14 years


17 million

Calculating the Body
Mass Index Chart

Readability: 14-16

Maths: 14-16 years


27 million


The researchers presented their initial findings at a parliamentary briefing at the House of Commons in front of an audience of MPs, academics and healthcare organisations committed to supporting improvements in health and health inequalities. The Rt Hon Simon Hughes MP Deputy Leader of the Liberal Democrats hosted this event and commented on the importance of this new study: “It is great to see London South Bank University carrying out this hugely important research. I hope that those involved in producing health information take note of the findings. We must improve the way health information is communicated to make sure all patients using the NHS can gain the maximum benefit from the services available.”

The research team will be continuing the analysis of the data generated to further examine and explore where the greatest needs are in the population, for example regional variations in health literacy levels were uncovered, which showed that people in London and the North of England are particularly disadvantaged. Today a group of experts in the field is meeting at a policy roundtable event at London South Bank University to hear more about this new data and to consider strategies to address how the situation can be improved; ranging from short-term changes that can be made to the way the NHS provides information to longer-term educational reforms.

MSD (known as Merck in the US and Canada), the company who sponsored this research, has been advocating health literacy as an unmet health need for over 10 years.  It has supported a number of recent initiatives including the Health Literacy Award in Ireland, the Swiss Health Literacy Survey in Switzerland and the European Health Literacy Survey conducted by the University of Maastricht in 2011. Deepak Khanna, Managing Director, MSD UK commented: “This new research gives us greater insight to help us work towards improving accessibility to health information in its many forms. The ability to understand and act on information is vital if patients are to become active participants in decisions about their health”.


Notes to editors:

Health Literacy: Health Literacy is the term applied to the cognitive and social skills which enable people to access, understand and use information in ways which promote and maintain good health. Health Literacy means more than being able to read pamphlets and successfully make appointments. By improving people's access to health information and their capacity to use it effectively, health literacy is critical to empowerment.6

Research Team:

The research team was led by Professor Gill Rowlands an academic GP.  She is Professor of Health Disparities in the Faculty of Health and Social Care at London South Bank University.  Her research focus is on Health Inequalities and she is the first UK Department of Health GP Health Literacy Champion.  Professor Rowlands established, and now chairs the Health Literacy Group UK, a group committed to raising awareness of health literacy and developing the evidence-base in the UK.  The team also included Dr Rima Rudd, faculty member of the Harvard School of Public Health, US, and an international expert in health literacy. She is also Senior Lecturer on Society, Human Development and Health at the Harvard School of Public Health. Dr Joanne Protheroe, a Senior Lecturer in General Practice, Keele University and a GP in Manchester. Her research is focussed on the needs of socio-economically disadvantaged patients and the need for interventions to improve patient self-management in long-term conditions.  Lastly, John Winkley and Marty Richardson from AlphaPlus, one of the UK’s leading educational consultancies, were also involved in the research.


1. Evaluating Health Literacy Skills in England.  Data on file, London South Bank University. December 2012.
2. Population Estimates for England. - last viewed 19/11/12.
3. Berkman N D, Sheridan S L, Donahue K E, Halpern D J, Viera A, Crotty K,  Viswanathan M, (2011). Health literacy interventions and outcomes: An updated systematic review. Evidence Report/Technology Assessment No. 199. Rockville, MD: Agency for Healthcare Research and Quality.
4. Mancuso CA, Rincon M: Impact of health literacy on longitudinal asthma outcomes. J Gen Intern Med 2006, 21(8):813-817.
5. Department of Business Innovation and Skills Report - last viewed 19.11.12
6. WHO.  - last viewed 19.11.12