The US is a segregated and stratified society in which people are geographically separated by race and class. This social structure affects many facets of life, including the health policies the nation creates, the implementation of those policies, and how people think about and make sense of their experiences in the broader health ecosystem. Specifically, wealthier, and White Americans tend to have better health outcomes and live for more years than their lower-income and racially minoritized counterparts. These differences in experience affect how Americans from different backgrounds think about their health, their willingness to engage in health behaviors, how they interpret what happens in encounters with health systems, and how they perceive the broader health system. This interplay between the structure of the American health system, and Americans’ psychological experiences in it, matter for our ability to productively communicate about health and health policies. In other words, it is important to take into account the perspectives and experiences of the people with whom we are trying to speak to effectively make healthy changes in society.
Although racialized and class-based policies affect much of American life, White Americans do not like to talk about those facts–in fact, they often go out of their way to avoid the subject. Americans find interracial interactions cognitively and emotionally draining, and White Americans in particular will put greater distance between themselves and Black conversation partners, unless conversations about race are framed as opportunities to learn. For Black Americans, cross-race communication can also create discomfort. When interacting with White Americans, Black Americans often engage in “code-switching” to avoid confirming negative racial stereotypes; navigating those situations can take a psychological toll.
In health, these fraught communication dynamics have numerous consequences. They undermine the quality of cross-race doctor-patient interactions, which results in worse health outcomes for patients. It is not only interpersonal interactions that are affected, news coverage of policy issues often privileges stories of White Americans and the wealthy even when non-white and poor populations faces greater hurdles to accessing benefits. For example, in covering paid leave in 2018-2019, local television news was much more likely to depict mothers and specifically white mothers as current or potential beneficiaries, and in the 2013-2014 coverage of the Affordable Care Act roll-out, only 7 percent of news stories mentioned Medicaid or the availability of subsidies.
The breadth of these disparities and their impact on underserved populations highlights the need for effective interventions and careful messages to improve equity in health and intersecting domains. These interventions and messages will have to contend with longstanding structural disparities that affect how people think about each other. For instance, our research suggests that the public holds high levels of stigma and blame toward people with obesity (including children), people who have experienced childhood adversity, and people with mental health and substance use issues, including opioid use. In addition, we have found that racial stigmas and stereotypes affect whether people attend to health messages.
What this means is that if journalists, advocates, and policymakers are not careful in their communication, they might inadvertently perpetuate negative perceptions and stereotypes that have consequences for health. For instance, telling individual stories about people with weight issues exacerbates blame placed on these children, which can undermine their willingness to engage in healthy behaviors.
However, certain types of carefully constructed narratives can reduce stigma, although the effects differ by type of health issue. Providing information and context, in a way that is cognizant of the lived experiences of the communities policymakers are trying to reach, can help to promote broader understanding among the public and policymakers which can help to build the support needed for health and policy action to advance health equity.
Earl, A., & Lewis, N. A., Jr. (2019). Health in context: New perspectives on healthy thinking and healthy living. Journal of Experimental Social Psychology.
McCluney, C. L., Robotham, K., Lee, S., Smith, R., & Durkee, M. (2019, November 15). The Costs of Code-Switching. Harvard Business Review.
Michener, J. (2018). Fragmented Democracy: Medicaid, Federalism, and Unequal Politics. Cambridge University Press. https://www.cambridge.org/core/books/fragmented-democracy/9A69DF1567190EF38883D4766EBC0AAC
Our core team includes researchers at three institutions: Cornell University, Wesleyan University, and the University of Minnesota.
Support for this website was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.