Public Health Writing Program

Writing Clear, Direct, Succinct Prose Is Rarely Simple or Quick

Public health writing is deceptively difficult. At its best, it is simple, clear, and succinct. It gives the impression of having been effortless to write. But the opposite is usually true. A piece of writing that is concise, clear, and a pleasure to read is usually the final of many iterations, revised over time (and often with a certain amount of angst). Writing prose that others appreciate, willingly read, and learn from is deeply gratifying. But, just as often, writing can be a frustrating, lonely, tedious, time-consuming process.

You might be thinking, all writing is difficult, time-consuming, and frustrating, so public health writing is no different. That’s true. Writing demands focus, courage, discipline, humility, patience, and more time than you ever want to give it. The difference, as introduced in an earlier post, is that public health writing can be especially daunting because we are writing for a reader who is looking for information packaged in prose that is clear, concise, accurate, and engaging. We need to be vigilant about not wasting words and paying attention to how our message is landing.

Taking Care of  Your Bewildered Reader

Does the reader understand easily? Does she want to keep reading? Does she feel like the time she spends reading will be a worthwhile use of her time. The answer to these questions takes root in our sentences, how we structure them, and the words we use. Lazy or muddled language can have, as we have seen again and again with messaging about Covid prevention and vaccination, real-world consequences.

For me, this quote from E.B. White’s introduction to the fourth edition of The Elements of Style says it all. He is writing about William Strunk — White’s professor, colleague, and the original author of this timeless guide: “Will felt that the reader was in serious trouble most of the time, floundering in a swamp, and that it was the duty of anyone attempting to write English to drain this swamp quickly and get the reader up on dry ground, or at least throw them a rope. . . . I have tried to hold steadily in mind this belief of his, this concern for the bewildered reader.”

The other complication is that those of us who work in public health have no single genre, audience, language, or voice we can pinpoint as ours. Rather, we must be able to write many types of documents for many types of readers for a wide variety of purposes. The types of documents we write include: policy briefs, peer-reviewed journal articles, scripts for health campaigns, proposals for funding, protocols to get institutional review board clearance to start a research project, literature reviews, email, Tweets, Instagram posts.

This is by no means a comprehensive list. Every time I host a workshop on public health writing, I ask participants what type of writing they do most frequently in their classes or jobs. I hear about all the genre’s listed here, and I inevitably learn about one or two I’ve never heard of.

So how does one set about mastering the many different types of documents that fall under the umbrella of public health writing. My answer is simple (again belying the very real challenge):

• Learn by doing;
• Read the instructions — again, and again, and again;
• Ask questions — When in doubt about any aspects of the instructions talk to your professor, teaching assistant, supervisor, grant coordinator/program officer, the person most knowledgeable about the project you are working on;
• Talk to colleagues — ask if they have written the type of document you are working on, ask them for their writing tips, ask about their writing process;
• Use the internet to find descriptions, guidelines, and sample outlines then adapt as needed — The Purdue OWL (Online Writing Lab) has extensive resources for professional and technical writers that are relevant to public health.
• Start early to give yourself time for revision
• Share your draft with peers, writing coaches, or even friends for feedback on clarity, readability, etc.

And here we are, back at deliberate practice.

Each type of document has some standard expectations about language and organization and, over the course of our careers, we get familiar with some of the basic formulas. But we are never on completely firm ground because reader expectations differ, sometimes dramatically. For instance, a policy brief can look very different depending on the subject matter, purpose, and audience expectations. You, the author, are always adapting outlines and formats typical to the genre.

Read Part 1:  Public Health Writing as Deliberate Practice

Read Part 2: Stretching Your Attention and Ability: Deliberate Practice 

To apply the concept of deliberate practice at a student level, I can offer my experience in learning how to write for my public health classes. All my academic training before I arrived in the MPH program at Boston University was in English literature. I wrote a book-length dissertation on the mid-twentieth-century author, Barbara Pym. And I wrote dozens of meandering 20-page papers interpreting the writing of other people. I had no idea what a literature review was (though it turned out my English lit papers were a type of literature review). I had to search for examples and online guidance to figure out what a policy brief was.

Aside from the email and newsletters I wrote for my program coordinator job in the Center for the Humanities at the University of New Hampshire, I had never consciously written with the goal of conveying useful information to a specific reader. But I had a vague idea it would be easy. Much easier than writing my dissertation, where I was never sure what I would put on the page until I sat down to write.

When I started my MPH classes, I quickly discovered just how much work I needed to do. I needed to learn to read the usually detailed instructions and keep consulting them. I needed to write an outline and stick to it, or revise it as the draft developed. I needed to convey correct information (not just creative interpretation), and I needed to do it in a way that was easy and pleasurable to read.

Knowing that someone would read what I wrote because they wanted to learn something, was completely new to me. I realize that sounds ridiculous, but it’s true. I had never done any formal writing with the goal of being useful. I quickly discovered just how difficult writing clear, concise, accurate, and engaging documents could be. So, every paper I wrote during my time as an MPH student was a form of deliberate practice. I didn’t have that language then or for a long time.

I joined the BUSPH faculty in 2005 as an assistant professor and “writing specialist” in the Department of Global Health. I was eager to take the job because I knew I had a lot of knowledge I could share about the writing process and revision. Even though I was often at sea with my own writing, I had been teaching undergraduate composition classes while working on my MA at Ohio University and my PhD at UNH. During those years, I was immersed in a world where we talked about composition theory and pedagogy all the time. I was trained to help students work their way through a multi-draft writing process. And I had empathy and patience when giving other people feedback on their writing. But the “writing specialist” part of my title always made me nervous.

Who is a writing specialist? Alice Walker, Stephen King, James McBride, Ta-Nehisi Coates, David Sedaris, Celeste Ng. Famous people who make their living by their pen. None of them walk around talking about how they have mastered writing. So who was I? An erstwhile English PhD pretending I knew how to write public health documents on critical, complex problems for readers who would use my work to inform and guide their actions. We all have our imposter-syndrome demons, and that was one of mine.

The concept of daily, deliberate writing practice – even for just 15 timed minutes a day – completely changed my relationship with writing and provides a daily bulwark against self-doubt.

My first challenge was committing to that 15 minutes at the keyboard Monday through Friday. It didn’t come easily, and I’m always resisting urges to skip, to focus on other things (like responding to the 30 emails that came in overnight). Once I developed a successful track record over the course of a year (even if I only wrote a sentence or two) I was able to attend to the mechanics of my writing style. I became more deliberate while revising (rarely while writing the first draft—more about that later). I created time and room to deliberate about words and flow. What a gift.

Writing strong, clear sentences where, as Strunk and White say, “every word tells” has been central to my daily deliberate practice for the last couple years. I tend to write long sentences containing multiple thoughts and many unnecessary words. I was always vaguely aware of this habit and thought of it as my natural style, the source of my voice and creativity. Then, when writing proposals and articles with colleagues, I started to notice that they often broke up my long sentences. They also excised words that contributed little to the meaning. I was fascinated by their ability to cut through my fog of words to the nugget of meaning with small edits and punctuation changes. I’ve gotten pretty good at doing the same for other writers. My challenge is to be able to do it for myself as I revise. It’s a path I know I will be on for the rest of my writing life.

As you develop your daily practice, you can decide what’s important to you. You can make sure all your subjects and verbs are strong, or read your work out loud as you write and revise to hear places where wording is awkward, unclear, or overly wordy. For me, these choices depend on where I am in the writing process and what kind of document I am writing.

Read Part 1: Public Health Writing as Deliberate Practice

So what differentiates deliberate practice from other types of practice? In a 2007 Harvard Review article called “The Making of an Expert,” K. Anders Ericsson, Michael J. Prietula, and Edward T. Cokely, explain: “When most people practice, they focus on the things they already know how to do. Deliberate practice is different. It entails considerable, specific, sustained efforts to do something you can’t do well — or even at all. Research across domains shows that it is only by working at what you can’t do that you turn into the expert you want to become.”

This quote may have you thinking that deliberate practice doesn’t apply to the writing you do for your public health classes or your job. That thought ran through my head too. I know how to write. I can form sentences and paragraphs and generally convey ideas in a way that other people understand. I write 40+ emails every day. Isn’t that practice enough?

Here’s how I answered the question for myself. When I write and respond to email, write comments on student papers, or text my friends, I am not writing for myself. I am engaging in daily life. My overwhelming inbox may challenge every aspect of daily professional life and my mental health (that’s another story). But it is the antithesis of something I do deliberately, to improve my clarity of thinking and expression, to revel in words and syntax. I may spend 45 minutes crafting a particular email because I want it to be kind, clear, nuanced, and concise. But that isn’t feeding my sense of myself as a writer. It just feeds the rapacious information machine of day-to-day professional life.

When it comes to engaging in deliberate practice to develop your public health writing skills, the idea of stretching your ability is key. This makes me think of my colleague, David Ozonoff (Professor Emeritus of Environmental Health at BUSPH), who has been doing mathematics for an hour every day for the last 30 years. He started working his way through a mathematics textbook to brush up on his skills. Then he kept going. He has never missed a day.

In the last few months, Professor Ozonoff has switched from doing math to writing a book about it. Now he devotes his daily hour to writing. He’s pushing his deliberate practice in a new direction. As a successful academic, he certainly knows how to write. He has scores of articles in peer-reviewed journals and he wrote daily blog posts for over four years (totaling some 3,400 posts). The difference now is that he is writing about mathematics in a way that is new for him and will advance the field.

Math every day for 30 years, 4,200 blog posts. Dave's example may seem overwhelming, impossible to match. But remember that he started small one day and he kept going. You don't need to write for an hour or write every day to engage in deliberate practice. Start with something small and realistic. Find a way to make it enjoyable. Build your practice as you go.

Read Part 3: How Public Health Students Can Develop a Deliberate Writing Practice

Public health writing can differ in many ways from other types of academic and professional writing. First, writing about population health can take many forms. While the phrase, “public health writing,” is convenient and useful, it is also imprecise. Public health writing encompasses many types of documents in which we adapt our language, voice, and style to meet the needs of our audience.

Audience and purpose are critical. Public health writers always need to keep their reader in mind, and that reader is often expecting you to provide information and analysis to fill a particular need. Your readers may want to know about the newest scientific evidence showing the connection between housing quality and asthma. They may want to know about the findings of a study you conducted. Or, they may be trying to decide on a particular course of action based on research showing which option is most likely to be effective. Our role as public health communicators is to gather, synthesize, and translate information. And just about any act of communication starts with writing.

Continuously trying to Improve our writing is one of the most important things we can do as public health professionals. This is true for all of us: students, professors, researchers, community activists, you name it.

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We're revamping the Public Health Writing Guide. Watch the Public Health Writing Blog for new sections.

Several years ago, the peer writing coaches here at Boston University School of Public Health created a Public Health Writing Guide, which you can download for free from the Population Health Exchange. I hope you will use it!

For some time, our team has been planning to update and expand the original guide. As we develop the new edition, we will post new or revised sections here on the Public Health Writing Blog. We welcome feedback and suggestions!

I’m sitting in the dark little apartment I’ve rented in the Palm Beach neighborhood of Aruba. It’s I:47 pm and there is nothing I want to do more than go to the beach. Sun, blue blue sky, jostling coconut tree fronds and the knowledge of the Caribbean a 10-minute walk away are infinitely distracting. I’m waging a constant battle in my head. You said you were going away for a week to write. You said you were taking your first vacation since August 2019 to rest your brain, your discipline, your creativity, and your soul. So which is it?

Four days in, I have hit the very obvious realization that the need to rest is winning out over the need to dive into my writing. When I booked this trip, I had a vision of getting up at 8:00 every morning, walking to Starbucks, writing for an hour or two, doing yoga, going to the beach for another hour or two. Then returning to, again, write for another hour or two. Leaving for dinner, taking a walk on the beach, coming back for a final 30 minutes of writing. That’s not what has happened. Not even close.

I sleep until 11:30 (because I’m up until 3:00 reading on my little patio and listening to strange night birds communicate with each other). The anxiety sets in immediately. I’m not going to have enough time to write. I get my latte and sit down for my usual 30 minutes of daily writing. But now my anxiety shifts because I start to realize I am wasting precious time in this beautiful place staring at my laptop screen. So I stop, go to the beach, swim, read The Witch Elm, drowse in the sun. But I’m still feeling vaguely uncomfortable. What about that small writing project I hoped to get back to? What about the cache of blog posts I planned to get a head start on?

This morning I reread Anne LaMott’s “Radio Station WFKD,” and imagined two radio stations speaking into each of my ears. I took a minute to listen to the dueling voices: Write more. Get to the beach. Do both. Don’t waste your time. Life is short. You’re finally away from email and the gloom of Boston. Write a lot and relax even more. Then I turned the volume down.

That’s the moment when the little voice whispering in my head said in a clear whisper, “hello, you don’t go to Aruba from Boston in dark cold January to sit in a shadowy air-conditioned room in front of your laptop.” Vacation is vacation. Write a little, sure, then put it away. And when you get home sign up for an actual writing retreat, with other people who are writing, where there will be structure, community, and accountability. Where the whole point will be to sit with your thoughts and fall into the flow of thinking and constructing sentences and paragraphs.

I’m packing the laptop now, not opening it again until I get to the airport. When I get home, I will look for a writing workshop to sign up for. In the meantime, I will keep at my daily, 30-minute writing sessions. Maybe I’ll even try to plan a vacation where the laptop stays home.