Talking About Health; Why Health Communication Matters

What is the message in ‘Jamie Oliver’s food revolution’?

141_0767 April 7, 2010

In the past couple of weeks, I have been watching the TV show that sparked some discussion on this blog a couple of weeks ago. After watching it so far [and with plans to continue to do so], I wanted to take note of a couple of points in his message that may be getting lost.

First, I heard Jamie say, “It is not about weight. …Thin people can be unhealthy, too.” This is a message about our health that gets lost in the clutter of messages about weight loss, dieting, obesity, and the fixation on what the scales say. Another time that I heard a similar message in a popular TV show was one year when the first dancer to be voted off ‘Dancing with the stars’ was a model. When she was rehearsing and then performing, she did not have the physical strength to pull herself up from some of the positions her partner placed her in. She was beautiful but as her expert dance partner said, “She is deceptively unfit.” So, yes, it is NOT about the weight. If we could follow more of the fitness model and less of the weight model, a healthy weight would likely be one of the outcomes. This is one of the great messages being communicated by Michelle Obama… to the kids of the U.S., get out and get up and get moving. To the rest of as adults who set role models for our youth and for our friends and family and coworkers, ditto… I talk about this in my book ‘Talking about health’ when I tell my own experience with sitting at the computer for too many hours over too many years and developing bone spurs in my neck–literally a stiff neck. I talk about how our generation of computer workers is not unlike the old factory and production line works in that we are in one position for too long and literally get stiff [and a little fat from it, too]. My physical therapist told me, ‘Never sit at the computer for more than 30 minutes without getting up and taking a stretching break for at least 2 minutes.’ He told me to set a timer and I do–at home and at the office. Get moving and make it fun!

A second message from Jamie Oliver’s show that we should hear and act on has to do with the how over processed our foods have become. We have given the food industry a profit motivation to come up with products for us to purchase that say on them such things as ‘fat free’ or ‘no sugar added.’ A long list of ingredients then includes a lot of long words that none of us recognize because they have mostly been created in food laboratories. I was shocked when Jamie showed a class of youngsters various vegetables and the kids could not name a ‘tomato’ or a ‘potato.’ They knew what french fries are but not what a potato looks like. Wow! A shout-out to those writing the ABC picture books. We need to put some vegetables in one. Perhaps an entire picture book devoted to vegetables. And then, of course, it would be great if we followed up by eating some of these vegetables. On this blog a couple of weeks ago when the Jamie Oliver show was brought up by a participant, it was noted that the cost of fresh vegetables is high. The cost of frozen vegetables may be a good substitute. One of the partipants in that discussion said that she could buy a bag of mixed frozen vegetables in the store brand for $1 and feed her family of four with it. I suspect that the store advertises that product with an emphasis on the cost rather than the nutrition. We need more communication about how to use frozen affordable vegetables when fresh ones are not an option.

Third, following on the heels of our food being over processed is a message about our foods containing too much salt. Most of us know that the ‘dead sea’ doesn’t support any life because the water is too salty. Well, when we get too much salt, our health doesn’t do well. That is one of the challenges of buying frozen vegetables. We still have to look at the product to see if anything has been added. Not all frozen vegetables are created ‘equal.’ Some of them have salt added. So it is not just the long scientific chemical names to watch out for when looking at nutrition labels and the ingredients of products, we need to watch out for ‘sodium’–salt that has been slipped into the ingredients. We can change the way products come to us. We change them with the votes of our dollars–our food purchasing dollars…

What is Dr. Besser telling us when he says, “There is no ‘evidence’ that herbs work for a cold”?

March 30, 2010

Spring is in the air and hopefully, you are not suffering from a spring cold. Or allergies. This morning on, “Good Morning America,” Dr. Besser talked about health information and social media–offering cautions about ‘advice’ that might appear on Facebook or other outlets, or health information sent via tweets.

After offering the general advice to be careful about what we believe, he focused on an example relating to the use of an herb to fight a cold. He made the statement I used in the title for this post: “There is no evidence that herbs work for a cold.” O.K. What’s wrong with that statement?

From a health communication perspective, this kind of comment is made often. If Dr. Besser or another source of the comment is someone we trust and believe to be an expert, we may accept the comment without further thought. We are usually not expert in health. Not surprisingly, we look to experts in health to guide our understanding.

But here is the problem I have with such statements. They do nothing to help us become more competent in making decisions for ourselves about health information. Dr. Besser could explain that there is no evidence and also explain what he means by evidence. For him, evidence = scientific data. Those numbers are usually the result of carefully conducted clinical trials. Those carefully conducted clinical trials cost — well a lot of money. And relatively few dollars are spent on research to study complementary and alternative medical practices–such as the use of herbs to fight colds.

The traditional approaches to health in the U.S. are prescription and over-the-counter drugs, and surgery, and the use of medical devices–many device relate to surgery and others that boost some of our ability to manage our own health. There are many expensive funded studies to evaluate the effects of these approaches. Based on the results, evidence is published and then disseminated to guide our doctors’ knowledge and our care.

We should realize that the research by pharmaceutical companies sometimes looks at herbs and works to understand how they might work to help or harm human health. Finding that an herb works may lead the drug company to produce synthetic versions of the herb and conduct research to see how they work. After all, we and our doctors do not live in the era of Dr. Quinn, Medicine Woman and cannot go into nearby woods to pick herbs to make teas or other potions to heal us. Medicine generally needs products that can be sold in mass quantities.

So, what does a lack of evidence mean when it comes to Dr. Besser’s statement? It means that no scientific clinical trials have shown the use of the ‘natural’ herb to be effective in reducing the effects of a cold.

Dr. Besser’s statment is not considering that your friend, your neighbor, or a thousand friends and neighbors on a social media site have used the herb and tell their stories about how it worked for them. It is not addressing the fact that we often trust the stories of others as ‘evidence.’ But it is not the same kind of evidence as science would provide. That is something he did not say. From a health communication perspective, we want to know this to help us better understand health information.

He also did not say whether the herb being promoted for a cold is one that drug companies may have or may be studying in some form. From a health communication perspective, we also want to know this to help us better understand health information…

What can maps tell us about health?

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March 13, 2010

A map is a wonderful example of a visual health communication tool that tells us so much with so little text. The notion that “one picture is worth a thousand words” more than applies. Mike Mackert discusses a new resource, a map, on his health communication research blog [http://blog.healthcommunicationresearch.com/2010/03/new-interactive-tobacco-map.html]. If you click on his link to the overall map resource, you can use a slide bar on the right side to display which states have passed which laws and policies relating to tobacco and smoking. A great example of giving citizens and elected representatives points for comparison. From a communication perspective, several thoughts come to mind.

First, this is a great way to illustrate a role for visual literacy as part of health literacy. In terms of our understanding, when we have a visual image to tell us something, it saves us a step in our thinking and understanding. We don’t “think” in words. For example, when I say “snow,” you “think” an image — something likely related to your own experience with snow. You do not think “s”–“n”–“o”–“w” and try to get meaning from thinking and forming these letters in your head. When you see a picture of snow, there is an instant connection to your mental picture.

Second, this process I have just described assumes, of course, that you have experience with snow to draw on in forming a mental picture. I am reminded of a test that my daughter was given in order to start public school “early.’ Her birthday is September 14th. She thus missed the September 1 cutoff date. We requested that she be tested to start, as we felt that she was more than ready. The test validated our opinion. It also showed that she could not give a name to a picture of a “snow shovel.” She was born in Tucson, Arizona, and she had never seen snow let alone a snow shovel. So, she could not make a match in memory between the picture and a name or label for it.

So, third, any visual form used to communicate–and there are many in health communication, ranging from photos to bar graphs to pie charts to maps and more–depends on a user’s ability to connect experience and skill to an intended meaning. In the case of the map Dr. Mackert identifies, it aids the user who moves a mouse over the geography by having the names of different states ‘pop-up’ to help a user who may not remember the name or location of any given state. It offers a series of folder options across the top for a user to click on, so that there is not too much information presented in any one map. It does rely on a number of colors in the maps that are somewhat close on a color wheel and might be difficult for some users to distinguish. It also identifies two sources of the information at the bottom of the map that are not easily navigated to gain insights about the method used to gather the information. It is, however, what policymakers often seek to help them wade through all the mounds of information related to decision-making.

Maps can, therefore, tell us what is happening in one location as compared to another, giving us a location hypothesis or explanation for health and health care…

What is “public health” anyway?

copy-of-p3061598 March 1, 2010

As children begin to know about roles and jobs, some will say, “I want to be a doctor.” Their parents buy them a ‘doctor’ kit to play with, and they practice being a doctor. I never hear a child say, “I want to work in public health.” Why is that? What’s wrong with this picture?

Public health isn’t part of the usual high school curriculum, so we don’t get an introduction to what a career in public health might look like. When health education is taught in high school, the course doesn’t introduce students to the public health system. And so, not surprisingly, few of us know what public health is or what the public health system does.

Public health often treats health as a public good. A public good is something for which the benefits for one of us cannot be separated from the benfits for ‘all’ of us. When I get a flu shot, I am supposed to benefit by not getting the flu. But others benefit because they do not get exposed to the flu from me.

So monies spent to inspect restaurants or public pools benefit every member of the public who eats at the restaurants or uses the pools, not just one of them. Monies spent for newborn screening programs benefit all of us because we identify conditions at early stages when prevention or care may limit the harm, and all of us benefit by having a friend or neighbor who can be a healthier and more productive citizen.

School vaccines. Programs for reproductive health. Collection of data about births and deaths–vital statistics that can show patterns and be used to suggest how to improve birth outcomes and decrease deaths. Cancer registries. Programs to prevent disease and accidents. All of these and more are prt of public health’s efforts to promote the public good.

Is the public good “good” for me? Often it is. Sometimes, it may not be.

There are limits to what vaccines I want to be used as gatekeepers to my employment. But there are even more limits to what genetic tests I want to be used as gatekeepers to my free choice to pursue life paths. So the first step is to become aware of what public health means what public does. Then we can advance agendas relating to support for public health and guidelines about where to draw the line in the name of promoting the public’s health.

Should we ask our doctors about antibiotics?

138_07301 February 27, 2010

On the ABC evening news this past week, Dr. Besser advised the audience, “Do not ask your doctor for antibiotics.” He provided the evidence to support the claim that asking for antibiotics greatly increases the chances that a doctor will prescribe antibiotics to a patient. He went on to explain that antibiotics are designed to treat bacteria. They do not treat a virus.

I would reframe this conversation. From the doctor’s side, if a patient asks for antibiotics to treat a virus, this seems like a great opportunity for the doctor to explain, “Antibiotics do not work to treat a virus, and your cold is caused by a virus.”

The advantages of this approach include the chance to improve a patient’s health literacy. We can increase our own understanding about health if our doctors take the opportunity to use these teachable moments to ‘teach’ us.

Another advantage is that we feel able to ask a question about our treatment without concern that our doctor might prescribe something unncessary. One likely unintended of Dr. Besser’s advice to not ask for an antibiotic is that it may lead us to wonder, ‘how often would a doctor prescribe something to me just because I asked for it?’

The medical research supports the conclusion that in the U.S., direct-to-consumer advertising leads patients to ask for tests and prescriptions that increases the likelihood that a doctor will order the tests and/or prescribe the medication. So, like in the case of antibiotics, when a patient asks — a doctor is more likely to prescribe.

But is this always a bad thing? We have decades of research to support the conclusion that the time demands on a doctor and the ever growing body of research about available therapies for various conditions = less chance to consider all options in each situation. To participate in our care, we should ask about treatments we may know about. Just asking may prompt the doctor to consider a path that wasn’t the one being considered. Just because it is considered doesn’t mean it should be selected. Sometimes, however, the doctor might judge it to be a ‘good idea.’

If each time a patient asks a doctor for treatment that is not a good match to the health condition, a doctor feels compelled to prescribe the treatment, it will lead to further waste in the health care system. We know that a doctor is not likely to follow the path a patient suggests if the doctor believes it will be harmful…at least, in the short term. But with antiobiotics as a case to illustrate, we want our doctors to think about our well-being in the long term. And if our request doesn’t make sense, take a minute to tell us why it doesn’t.

This approach means that doctors and patients can keep talking, and that their communication might benefit health in the short term and the long term, and the cost of health care as well.

Do we want doctors to tell us if we have advanced cancer?

117_1755 February 18, 2010

In 2002, Hisako Kakai published an article in the journal, Health Communication, about preferences for disclosure of a cancer diagnosis. Dr. Kakai indicates that in Japan, a direct communication style is usually preferred when it comes to disclosing one’s personal diagnosis of cancer. In other words, people want to be told they have cancer. However, an indirect communication style with no disclosure, or an ambiguous disclosure to the patient was preferred for a family member. The article raises many interesting communication and ethical issues.

A serious diagnosis raises the question, ‘how do we deal with uncertainty?’ Communication plays a big role. It points to the reality that we often are not good with dealing with uncertainty. We frame uncertainty as ‘bad’ and let uncertainty overtake everything good that might be going on in our lives. This relates to how we communicate about a serious health condition. It also relates to how we communicate about the economy, about security, and about an endless number of issues that equal being — human.

The message communicated often to us is, ‘work hard and it will pay off’ — with payoff crossing a spectrum from health, relationships, and wealth. The message, ‘life is uncertain. Work hard at your relationships and school and work, and take satisfaction in the fact that you worked hard’ — is communicated less often, if at all. And it shows up in our inability to deal with uncertainty, our obsession with …reducing the uncertainty.

Should the goal in communicating be to reduce uncertainty? When it comes to our health, that may not always be the best aim. If we can learn to manage the uncertainty of a diagnosis, we may be better able to live our lifes as someone living with cancer or heart disease or diabetes. If we make the diagnosis a more integral part of our being and identity, we may communicate in ways that define us to others as being disabled rather than living with a disability, diabetic rather than managing life while living with diabetes, and so on.

Even more surprising, when we focus on managing our uncertainty as a part of life, we may even discover that there are times when we communicate to increase uncertainty. Instead of being certain that our future, our health, our well-being are uncertain and that is a bad thing, we can use uncertainty as a way to promote hope. In our own research, Ben Cairns and I found that this was particularly important for people who have newly experienced spinal cord injuries and their family members. ‘Will she walk again? Will he be able to do things for himself? Can she sit up on her own? Can he feed himself?’ Not knowing offers people living with the injury and their families and friends the hope that they might do these things again.

Communicating to increase uncertainty about a diagnosis thus gives some time to adapt to a diagnosis. And that may be the best and more ethical way to communicate about an advanced cancer diagnosis as well. Not telling so that a patient does not know a true diagnosis may seem to offer a way to manage a serious diagnosis and thus to reduce uncertainty. Telling and acknowledging that the diagnosis is serious, even very serious, but that predicting exactly when the end-of-life will happen is uncertain may give some time to adapt to the diagnosis and some hope that important things that have not been said can be…

…a lesson in Dr. Maureen Keeley’s award-winning book, Final Conversations that has been shown to be so important for those who know that they are dying and the loved ones they will leave behind.

Why should we keep track of our use of vitamins and other supplements and who should we tell?

February 11, 2010

119_1917a Taking vitamins is the number one way that U.S. citizens ‘complement’ the formal health care they receive. This is a finding that has been consistent for some years and the 2005 Institute of Medicine Report about use of complementary and alternative medicine [ http://www.iom.edu/Reports/2005/Complementary-and-Alternative-Medicine-in-the-United-States.aspx] considers this reality as well.

Many debates about using vitamins, minerals, and other supplements — including garlic or herbs or cinnamon or ginger — focus on getting us to eat ‘healthy’ rather than depending on vitamins to make up for a diet that may be lacking. Other debates focus on the cost of ‘unproven’ therapies.

Whatever the debate, keeping track of use increases our ability to report use to our doctors. Talking to our doctors about use may make the difference between a therapy working or not. Many prescribed medications have been found to interact with different vitamins and other supplements, spices, and/or herbs. Sometimes, we need more or less of a medication based on use. So keep track and talk about use to avoid harmful effects.

What is a “competent” health communicator?

119_1944a February 9, 2010

I received a ‘smileworthy’ email from my friend and colleague, Ed Maibach, on Monday. He had received word that one of the articles we co-authored had been named to the 50 most read articles in the Sage journal, the American Behavioral Scientist. In fact, the article is #5 on the list, as you can see if you visit http://abs.sagepub.com/reports/mfr1.dtl

The article’s title, “Competencies for the health communication specialist of the 21st century,” gives some idea why it has been one of the most read publications. The importance of this area both theoretically and in application has been widely recognized. This has contributed to a surge in adding health communication classes to undergraduate and graduate programs around the world. And in adding these programss, the debate continues about the focus of education and training.

As I looked back at the lessons learned to develop the article, I realize that many of these competencies are ones that we all need in order to successfully navigate the health information that might only be described as overwhelming in quantity and sometimes questionable in quality. One of the competencies that health communication specialists may choose as a focus focuses on gaining access to and using various electronic databases. As we’ve discussed on this site before, we all need to harness the skills to do this. One of the most important issues remains the ability to identify the sources of these messages in order to consider the validity of their claims.

The emphasis in the article reflects the importance of understanding the role of both media and interpersonal communication on our health habits. To continue the conversation from yesterday, we too often do not seek formal health care because our family or friends don’t support doing so. And we frequently substitute care from our support networks for formal health care. In fact, one of the roles that many faith-based organizations assume relates to providing support to members sruggling with illness or recovering from events that limit their well-being. This may include injuries on the job or the death of a loved one.

Perhaps one of the most surprising and least considered areas of health communication competence relates to impression management. This, too, flows from the knowledge generated from research and practice in interpersonal communication. I reflect on my own hesitation to reveal my failure to behave in ways that I know I should. I want others to form a positive impression of me and to like me. And it carries over into health realms. Besides wanting to present our own best image, we often–with little thought–help others project their own best image. So we may fail to ask our doctor about something we thought we would be talking about in our appointment because we are thinking that to do so might seem to imply that we are ‘criticizing’ our doctor.

Other competencies related to the 21st health communication specialist that we identified more than 15 years ago that all of us will benefit from include media literacy skills associated with understanding gatekeeping relating to content. As discussed in the former post, media stories about medical research likely appear far ahead of therapies to benefit our well-being related to the research findings. Understanding that media seek to give us novel content supports our ability to reflect on the gap between a story and its translation to our care.

So a competent health communicator likely begins with our intention…to understand, to reflect, and to participate in making decisions about our health in informed ways guided by our efforts and experiences. 119_1914

What is race-based medicine?

Winter afternoon January 31, 2010

Medical research has shown that there are some patterns linked to racial group categorization in how some medicines work. Some medicine may metabolize faster or slower for some racial groups–in general. Lower does of some medicne may be required for treatment of members of some racial groups–in general. Similar patterns have been observed when comparing how men and women respond to some medications or therapies–in general.

What’s wrong with talking about race-based medicine?

First, stereotypes emerge from communicating about any group as if every member of the group behaves and responds in the same way to anything. Not everyone in the group will respond as suggested.

Second, it may seem to suggest that others who are not members of the racial group are less at risk for a condition. If we are a member of a different group, we may distance ourself from feeling at risk for the condition and socially distance ourselves from those who are at risk. This may happen because communicating the medical research that finds members of a particular group seem likely to respond in a particular way may seem to suggest that anyone not mentioned is not at risk. If, for example, efforts are made to commmunicate about a particular group’s response to treatment for heart disease becomes the focus of advertisements aimed at selling the treatment to members of the group, the unintended message may be, ‘They aren’t talking about me so I have less risk for heart disease.’ When communicating about therapies for men, for example, women may have long assumed that they were not a risk for heart disease, and that, of course is not true.

Third, communicating about race-based medicine may unintentionally contribute to the formation of stereotypes. As shorthand, classifying someone as a member of a group reduces our uncertainty about how we expect he or she will ‘be.’ As a result of such communication, we may, for example, form views that all members of a particular racial group are at risk for a particular health condition.

Finally, stereotypes of others and our own feelings of social distance from them often forms the foundation for stigma…our feelings of stigma about people and conditions, and our behavior toward those we consider to be members of a stigmatized group.

In sum, communicating about race-based medicine must be done with care to achieve valuable health outcomes and to limit harmful social outcomes.

How do you talk to your kids about sex?

roxgrace-beach_1370a January 21, 2010

How odd that we have such difficulty talking with our kids about things that are so important. Why is that?

For one thing, it might lead to questions we can’t answer. Once we open the door with a toe halfway wedged, we know we shouldn’t be surprised if we get asked questions. We might not be able to answer questions because we don’t know the answers. They just might be asking about technical stuff that relates to science and biology, and we might not know. So, agree to find the answers. If your child is of an age where it seems appropriate, find the answers together.

Another thing that happens, of course, is that we want to save face–for us and for them. We don’t want to appear to fail to practice what we preach, whether it is having engaged in premarital sex or failing to protect ourselves from sexually transmitted infections. And we just know that if it sounds like we are trying to control our kids’ behavior, they won’t like it anymore than we do when sometimes tries to control us.

So, how do you do it–talk with your kids about sex? Listen. What do they have to say and what are they asking you? That is the part of talking that we so often forget…listening.