Why is this important?
Recent years have witnessed increased attention to health equity – defined by the CDC as a circumstance where “every person has the opportunity to attain [their] full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.” While many scholars have explored the role of communication in reducing, maintaining, and even widening health inequities, comparatively less attention has focused on the content and effects of communication about health equity (and inequity) itself. Our research explores public understanding and concern about health inequities, examines how various audiences react to messaging about health inequity, and describes strategies to avoid common pitfalls and misunderstandings that stem from depictions of health disparities without explicit attention to the social, economic and environmental circumstances that produce them.
What do we know?
There remains a lack of consensus on the meaning of health equity in the first place. Different health organizations employ different definitions of the concept that emphasize different aspects of equity (see here, here, here, and here for examples). Americans also vary widely in the extent to which they value health equity and government investments in population health. Our research has found that while political liberals tended to see equity as an aspirational value on par with other values like care for others (protecting people from harm), political conservatives did not view equity as important as notions of security, authority, sanctity, and care – see here for more detailed definitions of these moral foundations). Communication about health equity thus has to contend with both varying definitions of the concept and the fact that a large proportion of the population does not currently view the concept of equity as aspirational.
Despite widespread news media attention to issues of racial inequity in the impact of COVID-19, surveys conducted in 2020 reveal limited movement toward greater public understanding of systemic racism as a cause of health inequality and relatively low recognition of racial and economic disparities in COVID-19 outcomes generally. Our research has also found that depictions of differences in health outcomes by social groups (including race and class) can trigger different types of causal attributions for these differences. As a result, communicating about health disparities runs the risk of increasing stigma and blame on people who face disproportionate health burdens and undermining support for collective action to address these disparities.
Research has also shown that the specific groups being compared matter. There’s a long tradition of research in political science and related fields that confirms that Americans’ attitudes about social policy are “group-centric”, that is, how the specific groups described as beneficiaries of policy will shape Americans’ perspectives about support for those policies. Prior research has shown that public support for interventions to address group-level differences in health was highest when groups were defined by income, and lowest by race. However, we have found that even describing the social factors that contribute to differences in life expectancy–without ever mentioning specific racial groups–can still activate audiences’ underlying values related to political ideology and personal responsibility (see here).
Despite these challenges, our team has demonstrated that it is indeed possible to shift public attitudes toward greater understanding of social, economic and environmental factors that shape health inequities. For example, several studies described here have found that well-crafted stories that describe systemic and structural challenges faced by empathetic characters can invite audiences to think differently about health and health inequity (see here and here). Other studies described here demonstrate how messages framed to align with moral and/or partisan values can enhance the likelihood of generating support among audiences from diverse political ideologies (see here). Our ongoing work will identify evidence-based strategies to overcome biases that can stem from reference to specific racial groups in messaging about health and racial equity.
Implications for Journalists, Advocates, and Policymakers
Communicators discussing health equity should be sure to define what they mean, rather than just using the phrase “health equity” with no context. Many audiences may not be familiar with the term, may not share your working definition, or may not share an aspiration for equity as a guiding value. Further, data on health and health inequities do not speak for themselves. Simply displaying the dramatic differences between groups (such as COVID-19 mortality statistics) is unlikely, in and of itself, to mobilize the general public (or policymakers) to action; or, they may impute their own, often individualistic, explanations for those differences. Communicators cannot assume that people will recognize the persistent and systemic social, economic, and environmental factors that contribute to those disparities. It is thus the communicator’s job to make those connections, tell stories that illustrate them, give concrete examples of their implications, and suggest solutions to address the structural factors that contribute to health inequity.
Niederdeppe, J., Bigman, C., Gonzales, A., & Gollust, S. (2013). Communication about health disparities in the mass media. Journal of Communication, 63, 8–30.
Gollust, S. E., & Cappella, J. N. (2014). Understanding public resistance to messages about health disparities. Journal of Health Communication, 19, 493-510.
Gollust, S. E., & Lynch, J. (2011). Who deserves health care? The effects of causal attributions and group cues on public attitudes about responsibility for health care costs. Journal of Health Politics, Policy and Law, 36(6), 1061-1095.