Phrasing and Word Choice.

Public health writing requires a certain level of nuanced writing. There are two main aspects that make public health writing unique: conditional language and casual vs. academic/professional tone. While it may seem nitpicky, terminology is very important to convey an urgent and honest but not alarmist tone.

Conditional Language

The strength of scientific proof is often based on statistical analysis, and the relationship between evidence and hypotheses. How the evidence is interpreted is dependent on many factors from study design to assumptions and beliefs of the investigators and the audience.  Our data and findings may suggest strong correlations or even a causal direction, but it is usually not possible to state definitively that x causes y.

Therefore, as with most scientific writing, there is nothing that we can absolutely prove in public health; our data and findings suggest strong correlations or causations, but we cannot say that X proves Y.  Moreover, using certain language can cause unnecessary alarm for communities that may not have a solid understanding of scientific data.

It is often more appropriate to use conditional language to make it clear that the evidence is revealing correlations or (in the case of a randomized controlled trial) suggesting a causal mechanism, but that other explanations are possible. To emphasize a point, you should consider using conditional language, such as the following (1):

• May
• Could
• Might
• Potential
• Probable
• Likely
• Estimated
• Data suggest
• Research indicates
• Evidence supports the idea that
• The evidence suggests a relationship between…

You should avoid using the following terms:

• Proves
• Will (certainly)
• Causes

Using conditional language should not be confused with always be neutral and not taking a position. Public health writing should be objectively critical and make claims when supported by reasoning and evidence. We will discuss this further in other sections. However, no matter the strength of the association, you should always leave room for the possibility of being incorrect. For example, you should say “Drinking sugar-sweetened beverages may lead to increased rates of obesity” rather than “Researchers have proven that sugar-sweetened drinks cause to obesity.”

Casual vs. Academic/Professional Tone

While you may use a casual tone in colloquial conversation, you should employ a more academic/professional tone in your public health writing. Below are some common examples of casual tone replaced by an academic/professional tone:

General Tips for Writing

In addition to uncertain and academic/professional language, there are a few other aspects of public health writing worth noting.

• Brevity. Be brief and to the point.
• Avoid the first-person unless instructed to use it. Some instructors may approve of using the first-person point-of-view, but you may risk appearing too informal. For most forms of public health writing, including reports, “I” statements are inappropriate for the strong scientific or professional tone. Furthermore, expressions of opinion such as “I think that…” or “in my opinion…” should not be included. Let the evidence, literature, or arguments speak for themselves.
  • Note: Some instructors approve of the first-person point-of-view, such as “In this paper, I will discuss…” By removing the first-person viewpoint, you risk using the passive voice (see below). For example, switching “I analyzed” may require you to use “Data were analyzed.” You should consult your instructor to determine which point-of-view to use in your assignment.
  • Needs Improvement: “In this paper, I will discuss the following barriers to health….”
  • Improved: “This paper addresses the following barriers to health…”
  • Needs Improvement: “I think that…”
  • Improved: “The evidence illustrates that…”
• Avoid contractions. It is best to avoid using contractions in academic/professional writing. You should generally use the expanded form.
  • Needs Improvement: “The community doesn’t have access to healthy food options.”
  • Improved: “The community does not have access to healthy food options.”
• Use active over passive voice. Write in the active voice and use the passive voice sparingly (2). For an in-depth review of active vs. passive voice and appropriate use of the passive voice, visit these links:
  • Needs Improvement: “Refugees are provided medical attention by the U.N.”
  • Improved: “The U.N. provides medical attention to the refugees.”
  • More resources:
    • Active/Passive Voice Video
    • Active and Passive Voice from Purdue OWL
    • Active Voice Versus Passive Voice from Grammar Girl
• Avoid clichés, idioms, and purple prose. Clichés often convey a casual tone at the expense of succinct academic writing (3). Replace clichés with direct language.
  • Needs improvement: “jumped on the bandwagon”
  • Improved: “followed the cultural trend”
  • Needs Improvement: “Problems plaguing the community”
  • Improved: “Problems affecting the community”
  • Needs Improvement: “deadly/disastrous consequences”
  • Improved: “consequences”
• Avoid quotes. You should avoiding quoting when citing other works. The general convention is to quote only when the language is too complex or unique so that you cannot paraphrase it.
  • Needs improvement: Savedoff and Hussman point out, “susceptibility to corruption is a systemic feature of health systems,” (Savedoff & Hussman, 2005), in part because of large amounts of public money and the sheer number of people involved in operating and regulating a health system (4).
  • Improved: Health systems are susceptible to corruption in part because of the large amounts of public money and numbers of people involved in operating and regulating health systems (Savedoff & Hussman, 2005) (4).
• Consider reading level. According to the CDC, one-third of US adults have trouble reading health information(5), highlighting the importance of adapting materials to the reading level of the audience.
  • You can turn on reading level information on Microsoft Word rather than downloading external software. Simply enable the following: File > Options > Proofing > When correcting spelling and grammar in Word > Show readability statistics. These results show reading level.
  • If the reading level is too high, consider using simpler words, reducing jargon, and implementing shorter sentences. Visit Plain Language for more information on altering the reading level.

Additional Resources

For more information on strong language and word choice, visit the following resources:

• Simply Put: A Guide for Creating Easy-to-Understand Materials from the CDC
• Common Expressions in Academic Writing – Online Writing Lab
• Common Mistakes and Tricky Choices

 References

1. Rothman E. Writing a successful public health letter to the editor. 2015 Mar; Boston University School of Public Health.
2. Levy B, Gaufin J. Mastering public health: Essential skills for effective practice. New York, New York: Oxford University Press, Inc.; 2012.
3. Taylor DB. Style Tips. Writ Health Sci Compr Guide [Internet]. 2007 Sep 1 [cited 2015 Apr 1];1(1). Available from: http://hswriting.library.utoronto.ca/index.php/hswriting/article/view/3337
4. Transparency International. Global corruption report 2006. London; Ann Arbor, MI; Berlin: Pluto Press ; Transparency International; 2006.
5. Simply Put: A guide for creating easy-to-understand materials [Internet]. Centers for Disease Control and Prevention; 2009 [cited 2015 Jun 19]. Available from: http://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf