Thinking of health communication as a transfer of information is certainly popular. In this episode, I’ll ask you to take a step back from that, and be willing to think differently about the nature of health communication.
You may be used to thinking of communication as a transfer of information. Well, if you want to reduce health disparities, I’m gonna ask you to step back from that, and be willing to think about communication differently.
Hi everybody. I’m Dr. Anne Marie Liebel. This is “10 Minutes to Better Patient Communication” from Health Communication Partners, an independent health-equity focused education and communication consultancy. If your organization needs expert help with any topic in this series, visit healthcommunicationpartners.com and click on contact.
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Now, I’ve podcasted before about that fact that health equity means different things to different people. But no matter what it means to you, one of the overarching goals of promoting health equity is to reduce health disparities. the many, many, well-documented health disparities In the U.S.. like people in Black, Latinx, and Native communities have died and been hospitalized at 2 (or more) times the rate of the White population from COVID. Or that maternal and post-partum deaths in the US are much higher in Black and Brown pregnant people. According to the CDC, Black women are three times more likely to die from a pregnancy-related cause than White women.
Or like the fact that the entire LGBTQ community has been identified as a “health disparity population,” by the National Institute on Minority Health and Health Disparities, largely due to their difficulty in finding accessible, unbiased care. This is according to a Kaiser Family Foundation report. Thank you to GLMA.org for that report, links in the show notes.
And there’s nothing natural about many of these disparities. That is to say, they’re manmade in many ways. We have 20+ years of data that health disparities are partly due to people’s unequal access to care, and unequal treatment once they get there. That includes communication in multiple ways at individual and systems levels. Since I started Health Communication Partners, and this series, I’ve looked at the role that communication can play in health disparities. And there are many. If you’ve listened to this series, you know that one of my areas of focus is looking at health professionals’ ordinary, everyday comunication for hidden obstacles. What slips by without notice, that contributes to inequalities. Now that’s interpersonal communication, one place to look.
I’m gonna give you a list of examples from an AJPH study that summarizes some different forms that unconscious actions and attitudes can emerge in the care setting, and I want you to listen for how many of them have to do with communication::
“Subtle biases may be expressed in several ways: approaching patients with a dominant and condescending tone that decreases the likelihood that patients will feel heard and valued by their providers, failing to provide interpreters when needed, doing more or less thorough diagnostic work, recommending different treatment options for patients based on assumptions about their treatment adherence capabilities, and granting special privileges, such as allowing some families to visit patients after hours while limiting visitation for other families.”
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Did you notice how many of those are related to communication? Communication is one of the subtle ways that well-meaning health care workers can provide unequal treatment without noticing. This is because our everyday words and actions kind of escape our notice. You know this if you listen to this show. More and more people were recognizing this even before COVID.
Now COVID highlighted how public health communication, like just like interpersonal communication, seemed to be working better for some audiences than for others. So like I said in a recent episode, public health communication as a field is also trying to respond to its collective wake-up call about the need for more equitable communication. In that episode, I advised reflexivity in the face of these messy, complex problems.
I have been reflecting on them myself, and here’s one thing I know for sure: communication is social. Yeah, it happens in our heads, but ultimately it happens between people in particular social contexts. But it’s not often that our methods and tools for communication reflect this, in the research base anyhow. Until they do, until we center the social aspects of communication, we’re limited in what we can do with communication research, practice, and policy.
All right, what am I talking about? What do I mean, “communication is social?” Well, whole books have been written about this. I going to turn to one, by linguist Norman Fairclough, called Language and Power (1989, 2015). Fairclough reminds us that “language is a part of society, and not somehow external to it.” He says, “linguistic phenomena are social in the sense that whenever people speak or listen or write or read, they do so in ways which are determined socially and have social effects.“ (p. 23)
I’ll make this concrete with an example. Over the past several years, I have been able to interact with many people who are aware of and concerned about how they communicate when it comes to health. Health professionals, patients, administrators, educators, researchers, activists. And the conversations differ by group. The terminology differs by group. The focus of the conversations differs by group. The knowledge, assumptions, and motivations differ by group. In short, people’s ways of thinking and talking about health, wellness, and health care are connected to their social groups.
We know communication is social. and yet, as a recent article in The Lancet points out, “The social is all too often overlooked in health-care systems.” I’ll add that it’s too often overlooked in communication research. Instead, I’ve noticed the dominance of individualistic approaches in communication research in the health sector. Often this comes across in studies that artificially separate language from its social context. We can’t research communication the same way we research brain cells.
Now, I don’t think anyone is intentionally ignoring the social aspects of communication. On the contrary, many practitioners and researchers I’ve talked to are eager to embrace social approaches to communication.
So what’s the problem? I see one problem is that social approaches to communication aren’t supported in traditional communication theory. Therefore, most of the research approaches and tools based in traditional communication theory aresimply not designed to prioritize investigation of social aspects of communication. This is problematic! Yes, traditional communication theory is what we’ve inherited, but no, it’s not entirely up to the task.
Plainly put, inequitable communication constitutes a barrier to care. Reducing this barrier would be a benefit to many outcomes, patient satisfaction, patient experience, patient safety and quality. There are ways to center the social in order to connect communication directly to equity. So you can be better equipped to provide equitable care. So you can connect with all patients in order to reduce barriers to care and reduce health disparities. That’s why I started Health Communication Partners.
We help people and organizations in health and digital health to advance equity by improving their communication with diverse groups. and we do this by centering the social, using the best research in the world on social perspectives on communication. I’ve spent years sharing tools and resources from the language and literacy world that center the social, or use social approaches to communication, and connecting to the research base in healh communication.
This is because I care about helping you communicate equitably as part of your job.
Everything we do centers the social aspects of communication. So if you want to have social appraoches, you’re in luck! Because you’re listening to this show. You could also visit health communication partners.com, click on the podcast, check out our health communication hub. And stay tuned for a big announcement. Because we’re about to bring you social approaches to communication in a whole new way.
This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music by Joe Liebel. I’m Dr. Anne Marie Liebel.