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Health literacy isn’t the problem we think it is

Writer: Rachel
Rachel
Oct 2
4 min read

In the UK, 7.1 million adults read and write at or below the level of a nine-year-old and 43% of adults do not understand written health information – figures cited by NHS England’s Library and Knowledge Services team (PIF online). When you add stress, illness, digital barriers, and the complexity of our NHS system, even “simple” information can become unusable.


Health literacy isn’t just about understanding leaflets – it’s also about whether people can navigate appointment systems, make informed choices, and feel confident in the care and treatment they receive.


Health literacy depends on clear, accessible communication.


Health literacy month


October is Health Literacy Month. Helen Osborne created this in 1999 as a global awareness campaign to highlight the growing evidence that people were excluded from care because information was not accessible. What started in the US has become a worldwide movement (Healthliteracy.com).


Health Literacy Month gives organisations, including the NHS, a moment to pause and ask a simple question:

“Are we communicating in ways that people can actually understand?”.


Our perspective


With 35+ years’ experience in the public sector between, Alexia and Rachel have plenty first-hand knowledge of the negative consequences that occur when people can’t access or understand the healthcare they need.


The COVID-19 pandemic brought this in to the fore of everyone’s minds when it become clear that the groups whose communication needs weren’t being met were experiencing the worse outcomes – such as those with autism and/or learning disabilities and those who do not speak English as a first language. (OHID / NHS England) This was a tragic time that shone a light on the importance of accessibility – yet it feels like this was momentarily fleeting and the NHS has struggled to keep the pace of change that is essential.


We don’t actually like Health Literacy Month


That being said, we’re not sure we like the title Health Literacy Month. It positions the problem as something that sits with the individual and their literacy level. Framing it this way misses the point in our opinion.


The real issue isn’t whether people are “literate enough”. It’s about whether professionals and organisations are communicating clearly enough and meeting people’s very reasonable communication needs.


Health information and communications should be designed by default for the fact people will be experiencing stress, illness, time pressure, language barriers, cognitive load and digital exclusion.


If people can’t understand or act on information they’re given, if people can’t access services because they aren’t set up to meet their communication needs – that isn’t a failure of their literacy: it’s a failure of the system.


So what can professionals do?


If you agree with us that responsibility sits with professionals and organisations, not with a person’s literacy level, then the next question is:

“What can we do differently?”


Clear, accessible communication isn’t complicated. It’s a set of actions that may take a little extra time at first, but quickly become everyday practice.


When these habits become routine, the impact is immediate: people understand more, feel more confident, and can act on the information they’re given.


And that leads to more trust, better relationships, and better outcomes.


Design for real-world conditions


Start by designing communication for the reality people are living in. If you work in the NHS, assume people are stressed, worried, not feeling their best. Write with a reading age of 9-11, using one idea per sentence, and structuring your information so the most important point comes first. Back to some basics.


Build on this by learning how to make accessible documents. This means they will work fully with screen readers and other assistive technologies. Access some training (like us!), implement and start checking your documents with screen readers before you publish them.


You can’t do good engagement work if you’re bad at accessibility


This speaks to something deeper for us and we’ve written about it before.


You can’t do good engagement work if you’re bad at accessibility. If your documents, forms, letters, surveys, or digital platforms aren’t usable, then the people you most need to hear from simply won’t be able to take part. Accessibility isn’t a technical bolt‑on; it’s the foundation of trust, participation, and safety. When communication is inaccessible, engagement becomes selective. You only hear from the people who can push through the barriers.


What does good practice look like


Now we’ve established that the responsibility for health literacy, or rather, clear communication, sits with professionals. Here’s what it looks like in practice:

  • Build accessibility in from the start, not as a last‑minute fix.

  • Use structure properly: headings, styles, spacing, and logical flow.

  • Write for real people, not internal audiences or policy teams.

  • Test your content with a screen reader to understand how it behaves.

  • Offer information in multiple formats (Easy Read, BSL, translations, audio).

  • Remove cognitive load wherever possible: shorter sentences, clearer actions, less noise.

  • Make accessibility a team habit, not a specialist skill.

  • Treat accessibility as part of safeguarding, because it is.

Accessible communication isn’t a specialist discipline. It’s a professional responsibility and one of the most powerful ways to reduce inequalities in the NHS.


How Open Voice Lab can help


This is exactly why Open Voice Lab exists. Our vision is simple: to help public services create communication and engagement that people can actually use. We support organisations to build the skills, habits and confidence needed to make accessibility the default.


We offer practical, hands‑on training that helps teams improve quickly. Our Accessible Word, PDFs and Forms training gives people the tools to create documents that work for everyone, including those using assistive technology. And our newest course — Ditch the AI: Writing Skills for Engagement Professionals — is designed for teams who have never been formally trained in writing. It teaches the core skills of clarity, structure and plain language, starting from the basics and building upwards.


Whether you’re improving letters, redesigning forms, writing public‑facing content or strengthening engagement, we can help your organisation communicate in ways that work for more people, more of the time.


Accessible communication isn’t just good practice. It’s part of delivering safe, equitable care and we can help you get it right - get in touch.


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