Friday, January 30, 2015

“Measles Elimination” – an important public health concept that gets lost in the FOG of Words

People should get vaccinated against contagious diseases for their own safety AND because vaccination is a critical way to eliminate that disease from a population. These two facts are central to public health messaging.
 The first message is sort of simple “Get Vaccinated." (Not saying that people’s responses to calls to vaccinate are not fraught.)

Today I’m focusing on the second function of the vaccination message- to foster the public’s understanding of disease elimination. Uncannily, health writers, especially when they're writing definitions, seem to fall into a haze of complex and circular Epi concepts and language, not shared by the general public. 

The Fog of Words   

(accessed 1/30/15)
Q: What does "measles elimination" mean?
A: Measles elimination is defined as the absence of continuous disease transmission for 12 months or more in a specific geographic area. In such areas, there may still be measles cases, but they are from infected people who bring the disease into the area.
A Health Literacy Load Analysis – (what the message assumes the reader knows)
·                                 “continuous disease transmission” – both read it and understand it.
                      above has a critical timeframe ( 12 months).

Q Public
So let’s just say I’m one of the millions in the US (actually at least 50 % of adults) who reads at 8th grade level or lower and who doesn’t have a solid foundation in health concepts.   I stumble across “the absence of continuous disease transmission”.
(To further fog things up, the link the reader sees takes you to
A JAMA Pediatrics  article with a reading level and science literacy level of post HS/college)

Here’s what I likely come up with trying to read and understand this definition.
  • ·      A person is “absent” from the area where the disease is.
  • ·      Or I skip over the one word I know, “absence” and start with “continue”.  So something about continuing the disease.  Maybe people can continue to get measles for 12 months.

This definition bypasses the easier to read active verb form.  Instead, it turns the verb into a noun-deactivates it (nominalizes it) è”the transmission of measles.”

We know that active forms of verbs and sentences are generally easier to read.
If we unpack the complex sentence above we get 3 active ones: 
The disease is transmitted.
The disease is transmitted continuously.
The disease transmission must stop for 12 months.

You could write the definition like this:
Q: What does "measles elimination" mean?

A: Measles elimination is when people living in the same geographic area stop spreading (transmitting) the disease from one person to another for at least 12 months. There is not more measles in the area. Measles may start again if an infected person brings the disease into    the area.   

Any other ideas?  

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