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Chapter 1

Overview of Communication and Health

This second edition of Health Communication in the 21st Century provides an in-depth look at one of the fastest growing and pragmatic areas of research in the communication discipline: health communication. Most people would agree that our health and our ability to communicate are two central and very important aspects of human life. Yet, at some point in your study of communication, you may be asked the same thing that family members and friends frequently ask us: What exactly is health communication? Many people do not understand how the concept of health is related in any way to the term communication. For most people, the term health conjures up images that seem to have little or nothing to do with communication, including doctors, laboratory tests, waiting rooms, dieting, and exercise regimes. Moreover, the term communication is usually associated with things like interpersonal relationships, the Internet, and radio and television.

However, as we will see throughout this book, many different aspects of health and a variety of communication processes are intertwined in complex and interesting ways. We will examine many contexts of communication and communication-oriented topics, including communication and perceptions of health, provider–patient relationships, everyday relationships and physical health, communication networks within health organizations, intercultural communication and health beliefs, health risk messages, health campaign message design and dissemination, health information and images in the mass media, and the use of new communication technologies in healthcare. We hope that as you read this book you will be excited and intrigued by the rich perspective the study of health communication can bring to our everyday understanding of health and healthcare.

Arguments for the Need to Study Health Communication

Despite vast improvements in public health and healthcare in the US and worldwide over the last century, we still have a long way to go in terms of making our society and the world a healthier place. Within the US, we currently spend over one trillion dollars a year on healthcare services, making it the leading sector of the US economy (US Census Bureau, 2005). However, a wide variety of problems still exist in terms of our nation’s ability to provide adequate care for everyone and in terms of maximizing efforts to prevent and control diseases and other health problems. It appears that the severity of many of these problems could potentially be reduced by improving communication among providers, between providers and patients, between health researchers, and between public health leaders and the public.

One-half of all deaths in the US can be attributed to preventable behavioral and social factors, such as unhealthy diets, smoking, alcohol use, and inadequate exercise (Neuhauser & Kreps, 2003). Over 60 percent of Americans are overweight and only 24 percent engage in moderate physical exercise on a regular basis (Neuhauser & Kreps, 2003). Current disease screening is inadequate. Cancer mortality rates alone could be reduced by 60 percent if people were to follow early detection recommendations (Willett, Colditz, & Mueller, 1996). Cancer is still one of the most significant health challenges facing society, and the second leading cause of death in the US (American Cancer Society, 2006). A lack of health maintenance behaviors among people who are currently living with a disease has been found to be significantly related to mortality rate. For example, one study found that only 30 percent of hypertensive men act to control their high blood pressure (US Department of Health and Human Services (USDHHS), 1999). In addition, there have been relatively few studies of how to improve the quality of life among people living with disease, such as cancer and HIV survivors, especially the ways in which communication processes and practices may help people to cope with living with disease (Kreps, 2003a).

In terms of health promotion, a large portion of health campaigns have not led to substantial health behavior change among members of the US population (Snyder & Hamilton, 2002). For example, health campaign designers spent millions of dollars on California’s 5-a-day campaign, which was designed to raise people’s awareness of the benefits of eating more fruits and vegetables. While the campaign was successful at raising people’s awareness of the issue, researchers found that relatively few people actually increased their consumption of fruits and vegetables following the campaign (Foerster & Hudes, 1994).

Worldwide, we see a number of health issues that are directly and indirectly related to communication. Global issues such as lack of access to adequate healthcare, war, poverty, hunger, environmental injustice, and lack of education about health issues continue to pose problems for people around the world. Unfortunately, many of these issues have had the greatest impact in underdeveloped countries and among the underserved populations. In Africa, for example, over nearly 25 million people are living with HIV/AIDS, and over 6 million are living in Asian countries (Joint United Nations Program on HIV/AIDS, 2004). More recent issues, such as avian flu and terrorism, present health communication researchers with numerous challenges in terms of finding ways to best communicate information about health risks and in terms of coordinating efforts to cope with these types of crises after they occur.

Health communication researchers are currently working to better understand these issues so that they can offer suggestions for improvement. While communication issues may not account for all of the problems mentioned above, it is clear that communication is an important underlying factor for most of them. A better understanding of how communication is related to these and other health problems may ultimately help to reduce incidents of disease, human suffering, and mortality rates while increasing physical and psychological well-being and satisfaction with healthcare among members of society. The chapters in this book examine multiple ways in which a better understanding of health communication in a variety of contexts, including relationships, organizations, and the mass media, can improve health outcomes.

Defining Health Communication

Despite the fact that we all have ideas about what it means to be healthy or ill, the term health is a complicated concept to define, due to multiple interpretations based on individual experience and culture. The World Health Organization (WHO) defines health as a “state of complete physical, mental and social well-being” (cited in Costello, 1977, p. 558). Moreover, the WHO definition conceptualizes health and disease as dynamic processes as opposed to stable entities. In other words, both health and disease are seen as being in a constant state of change. This definition also recognizes that health goes beyond physical and psychological health to include aspects such as a person’s quality of life. As we will see in this book, a variety of communication problems can occur in healthcare settings due to different conceptions of health and disease.

Defining communication presents similar challenges. Most definitions of communication view it as a process that involves a sender, a receiver, a message, and a channel. However, a variety of issues, such as the ability of multiple messages to be communicated simultaneously through both verbal and nonverbal channels, the transactional nature of communication (when sender and receiver mutually influence one another), physical and psychological noise in the channel, channel limitations on multiple senders and receivers, and many other facets of the communication process, make it difficult to define.

If you are a communication major, then you may have noticed that communication courses typically focus on one context of communication (e.g. interpersonal or mass communication). Health communication research encompasses many different contexts of communication. For example, researchers who study health communication from an intrapersonal communication perspective tend to focus on people’s attitudes, beliefs, values, and feelings about health-related concepts and messages. Interpersonal health communication scholars tend to focus on relationships, such as those between providers and patients, or they study how everyday relationships (i.e. family members, co-workers, and friends) impact our health.

Other health communication scholars examine health from an organizational standpoint, and they tend to focus on features of the health organizations such as hierarchies, information flow in organizations, and employee–management relationships. Intercultural health communication scholars tend to focus on the unique role that culture plays in terms of how people understand health and illness as well as how intercultural differences affect healthcare relationships. A large number of health communication scholars focus on social influence and they devote their efforts to understanding how health messages and campaigns can be improved in terms of leading to health behavior changes for large groups of people. Many health communication researchers are interested in the role of the mass media in helping to shape our understanding of specific health-related issues and our more general conceptions of health and illness. Finally, a growing number of health communication researchers are interested in the role that new technologies play in disseminating health information, facilitating relationships among people who share similar health conditions, and improving communication between providers and patients and within health organizations.

A Brief History of Health Communication Research

Although the term health communication has only been around since the mid-1970s (Atkin & Marshall, 1996; Rogers, 1996), communication scholars have taken a scientific approach to studying communication within health contexts for decades. Prior to the formation of the communication discipline in the 20th century, the US has had a rich history of communication campaigns addressing a variety of health issues, such as alcohol abuse, smallpox, improper handling and storage of food, and inadequate healthcare for underserved populations (Paisley, 2001). According to Thompson, Robinson, Anderson, and Federowicz (2005), research in the area of health communication has grown exponentially over the last 30 years. This growth has not only occurred in the US, but can also be seen in the work of scholars from around the world, including researchers from the eastern European/Scandinavian countries, Australia/New Zealand, Asia, and the UK. Organizations such as the European Association for Communication and Healthcare now publish the journal Patient Education and Counseling, and it sponsors a conference every two years that attracts interdisciplinary health communication researchers from all over the world.

Scholars in the social sciences who were interested in the study of communication began to examine the healthcare system in the late 1960s, which encouraged communication scholars to follow. Korsch and Negrete’s (1972) “Doctor–Patient Communication,” published in Scientific American, is still regarded as a foundation of the field (Thompson et al., 2005). Much other work came from medical researchers, influencing the study of provider–patient interactions in particular. In 1972 a group of scholars with backgrounds in communication formed the Therapeutic Communication interest group of the International Communication Association (ICA), which was renamed the Health Communication Division in 1975 (Thompson et al., 2005).

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