How might health equity show up in health communication? Dr. Renata Schiavo, Editor-in-Chief of the Journal of Communication in Healthcare and Senior Lecturer at Columbia University, tells us her approach. There’s also a twist: turns out, focusing on health equity in communication can also save time in advancing health and social outcomes.
Many health professionals are concerned about health equity, including those who care about health communication. Dr. Renata Schiavo, the Editor-in-Chief of the Journal of Communication in Healthcare, has a health equity approach to communication that’s very much in synch with what we do here at HCP. It can help whether you communicate with patients, clients, or the public. And as a bonus, it’ll save you time. This is 10 Minutes to Better Patient Communication from Health Communication Partners. I’m Dr. Anne Marie Liebel, live via Skype with Dr Renata Schiavo from Columbia University. Dr. Schiavo, welcome to the show.
Thank you for inviting me.
So Dr. Schiavo is a Senior Lecturer at the Department of Sociomedical Sciences at Columbia’s Mailman School of Public Health. She’s the Editor-in-Chief of the peer-reviewed Journal of Communication in Healthcare: Strategies, Media and Engagement in Global Health. And is also the Founder and President, and on the Board of Directors, of the Health Equity Initiative, which is a member-driven, nonprofit membership organization. Dr. Schiavo can you tell us a little bit about the Health Equity initiative that you founded?
Thank you Anne Marie. My passion has been always with working with under-served, marginalized, vulnerable populations, both in the US and other countries. So Health Equity Initiative is founded on the principle that we need so many different people–so many different sectors, so many different communities–to get engaged in addressing the social determinants of health. And so we focus on championing transformative change to advance health equity. We support knowledge, we engage community leaders, and build capacity to address the barriers that prevent people from living a healthy and productive life. Health Equity Initiative advocates for improving condition(s) and achieving equity in health for all.
Thank you for that. That’s, that’s a remarkable reach that the organization has. And you’re already hinting at some of where I’m going with my next question, because you’re someone who works on health equity in and beyond the health sector at multiple levels. So: what is a problem that is really front of mind for you, that you are trying to address, that’s related to health communication?
So…in this moment and also throughout my career, we have been reminded about the impact of social discrimination. whether it’s racism or other forms of discrimination, just like against the LGBTQI Community, or against people from low-income settings, or immigrants, or others. So, I think that both COVID-19 and the recent episodes of police brutality against the Black community have demonstrated the importance of addressing social discrimination in our communities as a key determinant of a lot of health and social inequities we see. And I feel that communication, with its focus on building bridges, creating partnerships, empowering people, has a key role in addressing social discrimination.
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Thank you for that. And I’m wondering in the multiple leadership roles that you hold, how are you doing some of this work? How are you doing some of this bridge building? What does that, does that look like in your career? What does that mean to you now?
My main concern is that lots of the work we do…in health communication continues to be a bit top-down. And we really need to bring in the voice of communities, and use participatory and human-centered design solution(s) to approach so many of these inequities that our communities experience. So it’s important to listen to their…their concerns and their issues, their needs, their priorities and develop solutions with them. And so this is an approach that is by far more common in economically developing nations such as the countries where I worked. I worked in Rwanda, Angola and Brazil. And so community consultation, community dialogue, tends to be approaches that are more used in a lot of those countries. And also here in the US we are seeing a lot of, you know, increased interest in community dialogue and engagement. So there’s a lot to learn from these experiences from developing countries, and the importance of coming together as a community, and really raising the voice of community leaders.
So it sounds like you’re using some of your experiences in Rwanda, Angola, Brazil and and seeing some traction here for the community-driven approaches in the US. How does that emerge, or does that emerge in your work with the Journal of Communication in Healthcare?
So I think that there are different ways that through the Journal that we are trying to basically advocate for these themes to be integrated in health communication. One of them is through editorials, both by myself and other members of our editorial board. And the other one is through calls for papers that highlight the importance of a community-driven approaches to communication. And also other initiatives that may bring in the voices of patients and community leaders within the materials we receive and publish.
Sometimes people may feel there is a lot of time invested in participatory planning processes. But actually, the time that we may save up front we waste at the end, because the solution we may design may not be meeting the needs and priorities of our communities.”
What are you learning from going about this community- driven approach? What are you learning looking back at your career right now that might be helpful in this moment?
So first of all, it is possible to do this. that’s one important ‘lessons learned.’ And in fact, you mentioned before the Health Equity Initiative–we worked with the Office of Minority Health Resource Center, the HHS Office of Minority Health, on a consultative process with community leaders, with local academia, with local community centers and a variety of other stakeholders to develop Task Forces for infant mortality prevention here in the United States, in cities where there are high rates of infant mortality. There are some reluctance to do that. Because sometimes people may feel that there is a lot of time invested in participatory planning processes. But actually, the time that we may save up front we waste at the end, because the solution we may design may not be meeting the needs and priorities of our communities. And also, if we design a communication intervention with communities, we also recognize the expert in their needs and priorities. And so one of the main themes in my work has been that we need to recognize the expert in everyone. And while we may be, y’know, trained in Public Health or we may be trained in health communication, the communities are really the expert in their needs and priorities. And also this reduces the chance for any kind of bias and discrimination that we may bring in an intervention that had been designed without the input from community leaders in the communities that they are intended for.
Such a powerful set of statements too: what happens when you begin with the communities that you are trying to serve? You save time because you haven’t made an intervention that is irrelevant to them because they have been informing it all along. You help eliminate bias because it’s their values and their languages that are informing the processes. And you you build a different kind of relationship when you treat people as experts in their own situations and in their own lives. thank you for that! thank you for all of that. what do you see as your next steps as leader, a researcher, an editor-in-chief, a citizen?
I feel that things are starting to move in the right direction. So there is a lot of interest in community engagement, in community mobilization. We have seen the recent protests being an example of community mobilization. but it’s also important that people start releasing some power, and sit down on equal footing with community members. and really start recognizing this expert in everyone! This is a lesson that I learned very early in my career. As a young practitioner in Angola, I was basically working on malaria prevention in refugee camps. And I had, in one of these (meetings), encountered a young mother approaching me. And she just came to thank me for being there but she also said, ‘Look What you are talking about, malaria prevention, in this moment is not important to me. What I’m concerned about is where my children are going to sleep tonight, whether they are going to have food, and that fact my husband just recently died.’ And this was a very important moment in my career, in which I learned about the importance of attending first to the needs and priority of the communities we we serve. So I think that this is an important moment for the Health Equity and racial equity movement. A moment in which we need to put health and social justice at the forefront of everything we do. A moment in which we have to make every action and policy count toward heath equity. And making sure that the community voices are heard, and that they are incorporated in our communications, in our policy, in our intervention(s).
Wow! Thank you for that. thank you for the Angola Story too. And and for the emphasis on these, on the kind of coming together the institutionalizing, the formalizing, the codifying of these practices that have been going on in different places around the world for for decades now–but let’s go ahead and make that mainstream. Let’s go ahead and really focus on seeing the expertise that’s in the communities, and engaging that in every step of the process. Thank you Dr. Schiavo for being on the show and sharing this with us.
Thank you very much.
This has been Ten Minutes to Better Patient Communication from Health Communication Partners. I’m Dr. Anne Marie Liebel, live via Skype with Dr. Renata Schiavo