When it comes right down to it, we in health promotion and communication set out to change people’s behavior by focusing on the medium and the messages we create. Accurate, timely, trustworthy and understandable information will win the day. Sort of like “inject with information and voila!”
The blame for the public’s persistent unhealthy behaviors and the baffling increase in rates of preventable illness are the result of things like: the patient’s low health literacy; the complicated language of health content that we must fix; or choosing the wrong mode of message delivery – technical problems that we can tinker with to get things right. (Zarcadoolas, 2011)
Health communicators, promoters, health literacy experts generally focus on people needing to comprehend the language of health. Along with behavioral scientists, we may along the way, delve into the cognitive and motivational roles – is the information relevant and valuable to the patient? Does the public have the capacity to use this information?
But theory and practice in health promotion falls short when we’re faced with the sobering reality that “fixing” as much of the message as we know how to doesn’t yield the informed, right-minded, decision making patient we had in mind.
In the background of our failures lurks a closet-full of clanking objects- cultural perspectives, lived experience of the patient, unnamed things that hobble our efforts – what Burke& Barker call the perceived “noise” in the system.
For many health communication folks, the “noise” is conceived of as a barrier that should be overcome.
- The patient doesn’t return for followup treatment once they see what their advanced treatment will cost.
- The region receives severe hurricane warnings 2 seasons in a row and grows skeptical of forecasts, and doesn’t prepare.
- The public recalls many instances where experts find out that a recommended medication is now deemed unsafe – and therefore doesn’t trust taking any medication on a daily basis.
- The parent who believes that breakfast must include a hot meal – and doesn’t allow their child to participate in the school breakfast program.
- The patient, the public, who’s experienced racism, sexism, ageism….and has no expectations for care and little trust in the messenger.
- The internet savvy consumer who would rather “Google” to make a diagnosis, and then crowd source best treatments online.
I was talking to a woman in East Harlem last week about the Zika virus, the risk of microcephaly and the concern that so many black and Hispanic women in the neighborhood travel back and forth from New York to the Caribbean and Central America. She said:
“It’s a new way for the government to track us – find the illegals- just wait. You’ll see.”
How can we recognize, better understand and embrace these powerful realities in the private, public and institution spheres? It seems without doing so we really are part of the “noise.”
Zarcadoolas, C. (2011) The simplicity complex: exploring simplified health messages in a complex world. Health Promot Int. 26(3): 338-50
Nancy J. Burke & Judith C Barker (2014) “Health Communication Noise:Insights from Medical Anthropology“. In H. Hamilton and Chou, W- Y. (eds.), Routledge Handbook of Applied Linguistics and Health Communication, New York, NY, Routledge.