HC Past, Pres, Ethics

 History of health communication

o How long has health communication been around?
 Depends on what we mean, how we define it; Emerged as an area of
study in the late 1960s
 Health communication became a subdiscipline of communication,
according to the International Communication Association (ICA) in 1975
 Health communication traditionally has been divided into two areas:
 Healthcare delivery
 Health promotion
 Nature of Communication
o Transactional model of communication
 People collaborate to construct meaning in a process of ongoing
reciprocal influence
 Relational approach
 Proposes that meaning is interpreted at both a content and a
relational level
o Ex: “I’m pregnant”
 Health Care Models
o Biomedical
 Based on the premise that bad health is a physical phenomenon that can
be explained, identified, and treated physically
o Biopsychosocial
 Takes into account people’s physical conditions (biology), their thoughts
and beliefs (psychology), and their social norms and expectations
o

o Sociocultural
 Health reflects a complex array of factors involving personal choice, social
dynamics, and culture
  i.e.: health is partially dependent upon wealth/poverty, prejudice,
access to health services and information, living conditions, etc.


o these models and approaches to healthcare affect how people are treated and
how we communicate about health
 The Public Health Approach
o Holistic; Prevention is a priority
o Upstream and downstream influences on health
o Current range of communication modalities means more patient empowerment
 Population changes affecting health
o Aging
 By 2050, the % of people 60+ will be twice what it was in 2015
o Racial and cultural diversity
 People of Hispanic, Asian, and Native American descent together are
expected to be the majority of the population within 25 years
 Health Care Systems
o Universal coverage
 All citizens receive healthcare
o Single-payer
 one source pays the bills for all essential health care (Medicare)
o Multi-payer
 Health insurance is provided by a variety of sources, usually including
both private companies and government programs
o Affordable Care Act (2010): initiated universal coverage int e U.S. for the first
time
 20 million previously uninsured gained coverage by 2016
 In 2017, Trump reduced individual mandate fine to $0; that year, about
700,000 returned to being uninsured; varies by state
 Framing: ACA vs. Obamacare
DEI & Culture
 Why do people suffer and/or thrive disproportionately in terms of health?
o Genetics/biology
o Behaviors/lifestyle
  Ex: smoking, drug use, eating habits, exercise, risk-seeking choices)
o Differences in socioeconomic status (SES): education, income, employment level,
etc.
 Also known as the social determinants of health
 Intersectionality theory
o No one is simply male or female, rich or poor, black or white, heterosexual or
homosexual, etc.
o Instead, individuals are influenced by how these identities (and others) intersect
within larger environments
 Health literacy
o Ability to access health information, to understand it, and to apply it in ways that
promote good health
o In order to be health literate, people must:
 Understand the language in which information is conveyed
 Have access to reliable and relevant information
 Be interested in health-related information
 Have the social skills to discuss health matters with others
 Have adequate hearing and/or vision to access the information
 Understand how to apply the information
 Be wiling and able to put health information to effective use
 Narrowing the information gap
o Text4baby
 Health literacy: words that can baffle
o Adverse- bad
o Ailment- sickness, illness, problem with your health
o Benign- will not cause harm, is not cancer
o Cognitive- learning, thinking
o Excessive- too much
o Progressive- gets worse
 Suggestion for health communicators
o 1. Watch your language (use words that someone with less than a high school
education could understand)
o 2. Use multiple formats (ex: diagrams, pictures, infographics, videos in addition
to words and numbers)
o 3. Pre-test and evaluate messages for effectiveness and culture appropriateness
o 4. Focus on action (with specific, easy-to-follow steps)
 Suggestions for patients
o 1. Be explicit about your feelings
o 2. Ask 3 key questions (AMA)
 What is my main problem?
 What do in need to do?
 Why is It important for me to do this?
o 3. Admit if you don’t understand
 Gender Identity & sexual orientation
o Queer Theory: challenges the notion of static identities and rigid social
categories
o The idea that binary labels such as “man” and “woman” underrepresent the
multitude and complexities of gender identities that people actually experience
 How/why might gender matter in terms of health communication
o Choice of pronouns; other gendered language, assumptions, images, etc.
o Paperwork, demographic questions on surveys
o Suggestions:
 Don’t forget about/ignore these issues
 Avoid judgement; be as inclusive as possible
 Race and ethnicity
o Different care and outcomes among various race/ethnicities may result from the
following:
 High risk, yet lack of information in some cases (knowledge gap)
 Limited access (to good care) in some cases
 Patient-caregiver communication
 Distrust (Tuskegee Experiment)
o Ethnic Concordance: Perception of cultural similarities between oneself and
another
o When patients and care providers are of similar ethnicities, patients tend to say
more, trust more, and remember more about the visit
 Other Considerations RE: DEI
o Ageism
 Discrimination based on a person’s age
 E-quality theory of aging- older adults benefit as both teachers and
learners when they “use, contribute to, influence, and express
themselves” in electronic environments
o Disabilities
o Stigma
 Social rejection in which a person is treated differently, sometimes as
though they are dishonorable, or ignored altogether
 Cultural considerations
o Culture- set of beliefs, rules, or practices shared by a group of people
o Examples of cultural characteristics
 Individualist vs collectivist culture
 Paternalism (strong authority figure –like parent—often male) vs.
Maternalism (female perspective rules)
o Ethnocentrism- attitude that one’s own culture is better than others
 Communication accommodation theory
o People tend to mirror each other’s communication styles to display liking and
respect
 Convergence- partners use similar gestures, tone of voice, vocab, etc.
 Divergence- acting differently from the other person (shouting vs.
whispering)
 Implies social distance
 may be conscious or unconscious (result of asserting uniqueness,
pursuing different goals, not understanding or not liking each
other)
 overaccommodation- exaggerated response to perceived need