Talking About Health; Why Health Communication Matters

How might communication–including access to the internet–relate to health disparities?

butterfly-picture May 19, 2010

Health disparities…differences in the health status of some of us compared to others–have many links to communication. We could place more emphasis on efforts to address some of these as part of health care reform.

One communication contributor to health disparities is a lack of equal access to health information. In particular, a digital divide has been identified as leading to differences in people’s awareness and understanding of ways to promote health and treatments for various diseases.

The digital divide has been discussed for years in terms of the affordability and availability of computers. This contributed to programs to increase access to computers in public schools and public libraries. Access to sources of health information is an important goal–one that may be enhanced by improving the nation’s infrastructure. I was struck by a colleague’s recent revelation on our way to a meeting in a rural community in Pennsylvania. He said that he seldom uses the internet from home. In his location, internet access still depends on the use of a dial-up modem. The slow and painful effort to get online just isn’t worth it. Libraries and schools in his area suffer from the same challenges.

The effort to reduce the digital divide by increasing access to online health resources is a good start but reminds me of the ‘just build it and they will come’ fallacy. Once we get on the computer, and we use our favorite search engines to look for health information, how do we decide whether the information is useful and relates to us? How do we understand the information? How do we harness resources to apply the information when we do understand it? That includes having sites for care and providers for care. …that includes having the ability to pay for care, time off to receive care, and transportation to sites for care.

Health disparities becomes a communication issue with many facets and many audiences to consider. If we approach health disparities as only an issue relating to access to information, we risk placing blame for continuing and/or growing disparities on people experiencing the disparities.

In a world where access to health information was supported by access to services, products, and care–our individual perceptions still may lead to disparities. Understanding related to the information and choices to apply the content depends on some knowledge of health terms and ability to translate the metaphors so often used to commmunicate in health information. Understanding also depends on the cultural and social lens through which we view the information. And on our own goals–including where we place responsibility for health.

Some of us assume more personal responsibility for our health than others. Some of us believe more in the role of family history and genetics than others. Some of us believe that the environment plays a greater role in our health than our own behavior. And some of us believe in a role for spirituality and religious faith. When we combine these into our health perspective, sometimes health disparities emerge… Can erasing a digital divide make a difference in these issues? Perhaps if we communicate about them directly, online and in other settings where we talk about health.

How will health care reform change how our country communicates about health?

118_1806 May 12, 2010

Watching my 5 year old granddaughter play youth soccer was great fun. Such energy. Such excitement. Such effort. Everyone running toward the ball and doing their best to get in a good kick. Sometimes in their enthusiasm, they lost sight of which goal they should be aiming for and may even accidentally kick the ball into the other team’s space. It’s a bit like health care reform in the U.S.

Keep ‘health’ in health communication… this is one of my mantras. I remind myself of it when thinking about the value of my own health communication research and the value of work that I review. It reminds me to consider, “how will the work make a difference in the health of someone?” Will it, for example, help someone to make a decision about which treatment to choose, which food to eat, how important rest and fun can be for health? Will it help someone to talk with family members about health history or to disclose to family members, doctors, or others important information about health status? Will it enable others to provide emotional or tangible social support to keep to a health regimen? …and so on.

So when I listen to conversation about health care reform, I am struck by several trends. First, there is so much fear and anger in the discourse. My mom, for example, will be having hip replacement surgery this summer. She is in her late 70s and on Medicare. She is convinced that her doctor will be paid very little for her surgery because of health care reform. She is also fearful that if she doesn’t act now, she may not be able to even find a doctor who will do the surgery soon…because the doctors won’t be paid well and won’t accept patients on Medicare.

We know quite a bit about fear appeals in communication. And sure enough, what I hear suggests to me that for many, the talk about health care reform and the actual reform itself does not make the efficacy of the actions clear. How will this reform be an effective response in both promoting ‘health’ of citizens and in limiting the runaway expenses? How might each one of us feel more confident or gain the ability to make decisions about our own health based on the reform? Made to feel fearful, many become angry and direct it toward the source.

Second, there has been too little direct translation of how health care reform will benefit health. Health illiteracy and science illiteracy often provide a way to explain our lack of understanding about health issues. Health insurance illiteracy is a whole new ball game. Most of us have some experience with car insurance or home owner insurance or life insurance, so we fall back on those as a way to understand health care insurance and health care reform. We need some help here. We need to know what ideas from other insurance contexts apply and what ideas don’t apply.

In some cases, if you get ticketed for speeding or running a red light, it shows up as higher premiums on your car insurance for awhile. Generally, we think that buying life insurance when we are younger rather than older will be less expensive. And if we fail to prune the tall tree near our home and it falls onto our roof, causing us to file a claim–some increase in our premium isn’t too surprising. So how do these ideas relate to health care reform? And if they don’t, why not?

Third, the optimistic outcome relating to health care reform and changes for how our country communicates about health is that we all become wiser about how politics relates to health… So we participate in the political process with our vote in elections and our voice in debate… not just in overcrowded town hall meetings but in the online forums available to us through access to our representatives where we ask questions and persist until we have answers… often and not just when something ‘big’ seems to be in the wind.

In short, we need to keep our eye on the ball and the goal, and make sure that those who represent us do the same…

What is math anxiety and what’s it got to do with my health?

117_1754 March 16, 2010

Math anxiety is the tendency to feel anxious at the thought of doing math. This feeling may happen when faced with making change, calculating a tip for the waiter or waitress, balancing a checking account, figuring out how much of an over the counter medicine to take, or adding up how many calories or other nutrients food contains. Not surprisingly, if we feel anxious about these everyday tasks, the prospect of trying to understand health statistics seems even more daunting and causes even greater anxiety.

Math anxiety causes people to avoid situations that might lead to the feeling. In other words, if math makes us feel anxious, we avoid numbers and statistics and any situation where we might have to face dealing with math. Of course, such avoidance means that we miss opportunities to practice math and succeed, which would reduce our anxiety and increase our confidence in our ability to do math.

This reality is particularly alarming when it comes to our health. To make informed decisions, we will probably have to consider some information that is presented as health statistics. It may be information about our risk for a disease, or it may be information about our benefit from a treatment. In either case, it is information that would help us make a more informed decision.

What is the solution? Don’t avoid math. Make the extra effort in whatever situation it might be to understand the statistics and practice the math. In the end, it will pay off. Make the extra effort to be sure your doctor knows you want to know the numbers and what they mean. Make the extra effort to be sure that your local school system is providing opportunities for students to practice math, reduce, their anxiety, increase their confidence in doing math, and improve their skills…

What about public health care reform?

117_1784 January 10, 2010

I never hear anyone talk about public health when they talk about ‘health care reform.’ This bothers me because we have a univeral system of public health in the U.S. and we spend quite a lot of resources on it. The services linked to our public health care system range from checking the quality of restaurants and ‘grading’ them to providing newborn screenings. We spend quite a lot of time deciding what services to provide in each state. Besides registering births and deaths, and newborn screenings, many states have prenatal care programs, other women’s health programs, and a wide range of programs from smoking cessation to drug prevention to cancer screenings.

We don’t talk much about public health. But what might a connected system of health care built on the system of clinics and services for public health look like? How would doctors and health care staff feel about building on their infrastructure? Some states have regional health care directors? How would they regard an effort to connect the services they oversee to a broader range of services for the public to consider as a choice for care?

Anyone?

What’s new for HPV in 2010?

imgp0009 January 2, 2010

Near the end of 2009, the U.S. FDA approved the use of an HPV prevention vaccine for boys. It will be interesting to see how this will be sold in the marketplace. After taking such care to sell a vaccine as a strategy to reduce the incidence of cervical cancer with the slogan, “I want to be one less,” and assuming that even among a public with moderate to low levels of health and science literacy — most know that males do not have a cervix, what will the pitch be to convince parents to vaccinate their sons? It seems unlikely that any ad will focus on selling a vaccine to parents that implies that their sons could be the vectors of disease for girls, as that would turn attention toward sex which the advertisers so carefully avoided in focusing on cervical cancer.

Whatever the pitch, part of our conversation should focus on the vaccine’s efficacy. Clinical studies vary in estimating how many years of protection a vaccine affords, but it seems to be around three years. Some say it may be five years. In either case, there is no revaccination policy at present. As consumers, parents, patients…we need to advocate for a policy.

We need to ask ourselves if and when it is the right time to be vaccinated. We need to understand what HPV is and how it is transmitted. Since the virus is spread in skin to skin contact, a condom may not be enough protection from getting the virus if we come in contact with it during sex. We should talk about that fact with our daughters who may be trying to decide if the use of a condom is the best way to protect themselves from sexually transmitted infections and diseases. And we need to talk with our sons about the fact as well, and remind them that the HPV prevention vaccine does not protect from HIV.

We need to realize that for women, being vaccinated does not mean we do not need to have cervical cancer screenings. Will the advertisers include that in their future messages?