 EDITORIALS 

The pressing need to eliminate ence of health communication services; refute myths and mis-
The health disparities calls on public throughout the agency. The Na- conceptions; and strengthen or-
health professionals to use every tional Cancer Institute, in 1999, ganizational relationships.1(p3)
Contributions effective tool possible. Health
communication, defined as the
developed an “Extraordinary Op-
portunity in Cancer Communica-
However, health communica-
tion alone, without environmen-
of Health study and use of methods to in-
form and influence individual
tions,” which included awarding
Centers of Excellence in Cancer
tal supports, is not effective at
sustaining behavior changes at

Communication and community decisions that

enhance health, was first recog-
Communication to 4 universities;
2 of the 4 centers explicitly focus
the individual level. It may not
be effective in communicating

to Eliminating nized as a subset of the field of

communication in 1975, when
on research in health communi-
cation aimed at health dispari-
very complex messages, and it
cannot compensate for lack of

Health the Health Communication Divi-

sion of the International Com-
ties. In addition, for the first
time, health communication is
access to health care or healthy
environments.1(p3) Nonetheless,
munication Association was part of the Healthy People 2010 we believe that public health
Disparities founded.1,2 The National Com- objectives.3 professionals should use the full
munication Association formed range of health communication
a division of the same name in THE SCOPE AND strategies in the effort to elimi-
1985. In 1997, the Public LIMITATIONS OF HEALTH nate health disparities.
Health Education and Health COMMUNICATION
Promotion section within the THE RANGE OF HEALTH
American Public Health Associa- These achievements not with- COMMUNICATION
tion formally recognized health standing, the public health com- STRATEGIES
communication as part of its munity seems to have a limited
group. The peer-reviewed journal understanding of what health Many are familiar with mass
Health Communication began in communication can offer to the media campaigns aimed at stimu-
1989, followed 7 years later by elimination of health disparities. lating individual behavior change.
the Journal of Health Communica- According to the National Cancer However, there is less familiarity
tion. Today, while many commu- Institute, health communication with other forms of health com-
nication departments and schools can increase the intended audi- munication that can be effective
of public health offer limited ence’s knowledge and awareness in the context of health dispari-
graduate course work in health of a health issue, problem, or ties. Health communicators can
communication, there are fewer solution; influence perceptions, bring their expertise to bear in
than a dozen comprehensive pro- beliefs, and attitudes that may entertainment-education, media
grams in health communication. change social norms; prompt advocacy, new technology, and
The federal government has action; demonstrate or illustrate interpersonal communication,
recognized the contributions of healthy skills; reinforce knowl- including patient–provider
health communication. The Cen- edge, attitudes, or behavior; communication.
ters for Disease Control and Pre- show the benefit of behavior
vention developed an office of change; advocate a position on Entertainment-Education
communication in 1996 with a health issue or policy; increase Entertainment programming
the purpose of diffusing the sci- demand or support for health in the media is a powerful way

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  EDITORIALS 

to communicate health informa- town cigarettes in African Ameri- between patient and provider munication that could contribute
tion, especially for minority audi- can communities. can exacerbate health disparities. to reducing disparities. Certainly,
ences, who are heavy consumers Van Ryn and Fu8 suggest that the impact of interpersonal com-
of this type of media. Several re- Interactive Health providers may contribute to munication through the use of
search studies have demon- Communication health disparities by influencing lay health advisors, respected in
strated that even brief exposure Interactive technology, clients’ views of themselves and their communities, is well docu-
to health information and behav- “computer-based media that en- their relation to the world, by dif- mented. Extensive research on
iors through entertainment able users to access information ferentially encouraging health tailoring and targeting health
media can have strong effects. and services of interest, control promotion and disease preven- messages promises new opportu-
In surveys (n = 3719) conducted how the information is presented, tion behaviors and services, and nities for reaching those who suf-
by Porter Novelli during 2001, and respond to information and by withholding access to treat- fer most from health disparities.
more than half of regular prime messages in the mediated envi- ments or services and denying
time and daytime drama viewers ronment,”6(p2) has created new benefits and rights. They cite CULTURAL DIFFERENCES
reported that they learned some- opportunities for health commu- evidence of physicians’ contribu- AND HEALTH
thing about a disease or how to nication that can overcome barri- tions to racial/ethnic disparities COMMUNICATION
prevent it from a TV show. ers such as low literacy and ex- in kidney transplant rates and
Among minority viewers who pand opportunities to tailor and cardiac procedures, in pain as- However, in all these efforts,
watch regularly, 70% of His- personalize information. One of sessment and control, and in health communicators often
panic women, 65% of Black the pioneer applications of such mental health services. They struggle to understand the audi-
women, and 64% of Black men technology is the Comprehensive argue for interventions to help ences they seek to reach, fre-
said they took some action after Health Enhancement Support providers avoid their own biases quently equating culture in a
hearing about a health issue or System (CHESS), for which there as one way to reduce disparities. simplistic fashion with race and
disease on a TV show.4 More is impressive research evidence Ashton and colleagues9 exam- ethnicity. The Institute of Medi-
than 50% of Black men and of its potential for reducing dis- ined communication between cine13 argues that culture has
women reported that a storyline parities. In a study of the use of providers and minority patients been poorly examined in the
helped them to provide informa- an HIV CHESS application, and found that poor communica- context of health communica-
tion to friends or family, as did women and minorities made tion is linked to health disparities tion, asserting that to consider
60% of Hispanic women.4 En- more use of several information and requires specific interven- culture requires significant ex-
tertainment programming has tools than men and nonminori- tions to address communication ploration beyond the typical
the capacity to reach significant ties, and minorities and those patterns. variables of race, ethnicity, and
proportions of the populations with less education used the deci- Social support is another com- socioeconomic status. According
experiencing health disparities. sion and analysis tools more than munication behavior that has to the Institute, health commu-
nonminorities and people with profound consequences for men- nication campaigns typically ad-
Media Advocacy more education, even though tal and physical well-being.10 Yet dress the issue of diverse audi-
Media advocacy is defined as these tools were the most com- there is evidence that kinship ences in 1 of 3 ways: by
the strategic use of mass media plex in the system.7 Similar re- support networks are deteriorat- developing a communication
and their tools, in combination sults were found in a pilot study ing in low-income and minority campaign with common-denom-
with community organizing, for of low-income, African American communities because of unem- inator messages relevant to
the purpose of advancing healthy women with breast cancer.7 Yet ployment, transience, and sub- most audiences; by developing
public policies.5(p338) Because the computer access issues prevent stance abuse.11 Virtual support a unified campaign with system-
roots of health disparities extend these approaches from achieving networks are becoming increas- atic variations in messages to in-
to social, economic, and political their potential in reducing health ingly important, but again, access crease relevance for different
conditions, media advocacy, disparities. is an issue in underserved com- audience segments, retaining
which moves beyond the focus munities. Much more needs to be one fundamental message; or
on the individual, holds promise Interpersonal Communication learned about the impact of cul- by developing distinctly differ-
as one form of health communi- Interpersonal communication ture on both expectations of sup- ent messages or interventions
cation to address health dispari- theory helps us understand the port and the effects of support. for each audience segment.13
ties. One example of such a cam- provider–client interaction, the Cline’s12 argument for shifting Many health communication
paign is the Uptown Coalition in role of social support in health, the focus of interpersonal com- interventions address what
Philadelphia, which used the and the ways in which interper- munication about health from Resnicow and Braithwaite14 refer
media and community organiz- sonal relationships influence formal to informal contexts such to as the surface structure of a
ing to defeat RJ Reynolds’s pro- health behaviors and decision- as everyday talk highlights a rich culture. Addressing surface
posed campaign to market Up- making. Clearly, the relationship and untapped dimension of com- structure includes matching

2054 | Editorials American Journal of Public Health | December 2004, Vol 94, No. 12
  EDITORIALS 

messages and channels to ob- multiple determinants of health Project at the Center for Minority crises: the experience of the CHESS
servable social and behavioral that underlie disparities. How- Health, Graduate School of Public project. In: Street RL Jr, Gold WR, Man-
Health, University of Pittsburgh (grant ning T, eds. Health Promotion and Inter-
characteristics of a culture, for ever, to design effective interven- P60 MD-000-207-02 from the Na- active Technology. Mahwah, NJ:
example, familiar people, foods, tions, we must understand the tional Center on Minority Health and Lawrence Erlbaum Associates Inc;
music, language, and places. It complexity of culture and inte- Health Disparities, National Institutes of 1997:79–102.
Health).
may be more important to ad- grate cultural factors into our 8. Van Ryn M, Fu S. Paved with good
intentions: do public health and human
dress deep structure, which re- health communication efforts.
service providers contribute to racial/
flects the cultural, social, psycho- Furthermore, we must work col- References ethnic disparities in health? Am J Public
1. Making Health Communication Pro-
logical, environmental, and laboratively with communities Health. 2003;93:248–255.
grams Work. Bethesda, Md: National
historical factors that affect experiencing disparities to over- Cancer Institute; 2001. 9. Ashton C, Haidet P, Paterniti D, et
health for a minority community. come the historical context of al. Racial and ethnic disparities in the
2. Freimuth V, Cole G, Kirby S. Issues
use of health services: bias, preferences
Resnicow and Braithwaite argue distrust and create meaningful, in evaluating mass media health com-
or poor communication? J Gen Intern
munication campaigns. In: Rootman I,
that when health communica- effective health communication Goodstadt M, Brian Hyndman, et al.,
Med. 2003;18:146–152.
tion appropriately addresses sur- interventions. eds. Evaluation in Health Promotion: 10. Albrecht T, Goldsmith D. Social
face structure, it increases recep- Principles and Perspectives. Copenhagen, support, social networks, and health.
Denmark: WHO Regional Office for Eu- In: Thompson T, Dorsey A, Miller K,
tivity to and acceptance of the Vicki S. Freimuth, PhD, rope; 2001:475–492. Parrott R, eds. Handbook of Health
campaign, but when it also ad- Sandra Crouse Quinn, PhD Communication. Mahwah, NJ: Lawrence
3. Healthy People 2010: Understand-
dresses deep structure, it con- Erlbaum Associates Inc; 2003:
ing and Improving Health. Washington,
263–284.
veys true salience to the commu- DC: US Dept of Health and Human
Services, Office of Disease Prevention 11. Roschelle A. No More Kin: Explor-
nity it seeks to reach. Clearly, About the Authors and Health Promotion; 2000. ing Race, Class, and Gender in Family
there is much to learn about cre- Vicki S. Freimuth is with the Department
4. Office of Communication, Centers for Networks. Thousand Oaks, Calif: Sage
of Speech Communication and the Grady
ating health communication in- School of Journalism, University of Geor- Disease Control and Prevention. Entertain- Publications; 1997.
terventions that appreciate the gia, Athens. Sandra Crouse Quinn is with ment Education: Overview. Available at 12. Cline R. Everyday interpersonal
complexity of culture, and then the Graduate School of Public Health, Uni- [Link] communication and health. In: Thomp-
versity of Pittsburgh, Pittsburgh, Pa. surveys/[Link]. Accessed July son T, Dorsey A, Miller K, Parrott R,
evaluating the impact of such Requests for reprints should be sent to 21, 2004. eds. Handbook of Health Communication.
programs on eliminating health Sandra Crouse Quinn, PhD, 230 Parran 5. Institute of Medicine. The Future of Mahwah, NJ: Lawrence Erlbaum Associ-
disparities. Hall, 130 DeSoto St, Pittsburgh, PA the Public’s Health in the 21st Century. ates Inc; 2003:285–318.
15261 (e-mail: squinn@[Link]). Washington, DC: National Academies
Eliminating health disparities This editorial was accepted August 24,
13. Institute of Medicine. Speaking of
Press, 2003. Health: Assessing Health Communication
requires that public health pro- 2004.
6. Street RL Jr, Rimal RN. Health Strategies for Diverse Populations. Wash-
fessionals expand their use of ington, DC: National Academies Press;
promotion and interactive technology:
health communication strategies A conceptual foundation. In: Street RL 2002.
Acknowledgments
in comprehensive interventions S. C. Quinn is supported in part by the
Jr, Gold WR, Manning T, eds. Health 14. Resnicow K, Braithwaite R. Cul-
Promotion and Interactive Technology. tural sensitivity in public health. In
aimed at effecting individual, Centers for Disease Control and Pre-
Mahwah, NJ: Lawrence Erlbaum Associ- Braithwaite R, Taylor S, eds. Health Is-
community, organizational, and vention and the Association of Schools
ates Inc; 1997:1–18. sues in the Black Community. 2nd ed.
of Public Health (cooperative agree-
policy change. Such interven- ment S2136-21/21CDC/ASPH). She is 7. Hawkins RP, Pingree S, Gustafson San Francisco, Calif: Jossey-Bass; 2001:
tions can effectively address the also supported by the EXPORT Health DH, et al. Aiding those facing health 516–542.

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