Rethinking Culture in Health Communication

Social Interactions as Intercultural Encounters

Elaine Hsieh, Eric M. Kramer

• Publisher: Wiley-Blackwell
• Year: 2021
• ISBN:
  9781119496106
• Edition: 1
• Topic: Languages & Linguistics
• Subtopic: Communication Studies
• Index: Languages & Linguistics

Rethinking Culture in Health Communication

An interdisciplinary overview of health communication using a cultural lens—uniquely focused on social interactions in health contexts

Patients, health professionals, and policymakers embody cultural constructs that impact healthcare processes. Rethinking Culture in Health Communication explores the ways in which culture influences healthcare, introducing new approaches to understanding social relationships and health policies as a dynamic process involving cultural values, expectations, motivations, and behavioral patterns. This innovative textbook integrates theories and practices in health communication, public health, and medicine to help students relate fundamental concepts to their personal experiences and develop an awareness of how all individuals and groups are shaped by culture.

The authors present a foundational framework explaining how cultures can be understood from four perspectives— Magic Consciousness, Mythic Connection, Perspectival Thinking, and Integral Fusion —to examine existing theories, social norms, and clinical practices in health-related contexts. Detailed yet accessible chapters discuss culture and health behaviors, interpersonal communication, minority health and healthcare delivery, cultural consciousness, social interactions, sociopolitical structure, and more. The text features examples of how culture can create challenges in access, process, and outcomes of healthcare services and includes scenarios in which individuals and institutions hold different or incompatible ethical views. The text also illustrates how cultural perspectives can shape the theoretical concepts emerged in caregiver-patient communication, provider-patient interactions, social policies, public health interventions, and other real-life settings. Written by two leading health communication scholars, this textbook:

• Highlights the sociocultural, interprofessional, clinical, and ethical aspects of health communication
• Explores the intersections of social relationships, cultural tendencies, and health theories and behaviors
• Examines the various forms, functions, and meanings of health, illness, and healthcare in a range of cultural contexts
• Discusses how cultural elements in social interactions are essential to successful health interventions
• Includes foundational overviews of health communication and of culture in health-related fields
• Discusses culture in health administration, moral values in social policies, and ethics in medical development
• Incorporates various aspects and impacts of the COVID-19 pandemic as a cultural phenomenon through the lens of health communication

Rethinking Culture in Health Communication is an ideal textbook for courses in health communication, particularly those focused on interpersonal communication, as well as in cross-cultural communication, cultural phenomenology, medical sociology, social work, public health, and other health-related fields.

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Rethinking Culture in Health Communication

The chapter provides an overview of traditional and emerging fields of health communication, highlighting its interdisciplinary and applied nature as a field of research and practice. We will then explore how culture has been incorporated in health communication and examine the failure in organizing and conceptualizing the field in general through a cultural lens. We will present theoretical backgrounds and a conceptual framework that grounds the cultural perspectives discussed in this book. We will propose some learning objectives for our readers.

I. The Expanding and Interconnected Fields of Health Communication

This book is published at a historical moment that is seared into everyone’s memory and is likely to transform our everyday life and redefine who we are. On December 31, 2019, the World Health Organization (2020b) received a report of a cluster of cases of pneumonia in Wuhan, Hubei Province in China. By July 4, 2020, the COVID-19 pandemic has reached over 11 million cases and over 530,000+ deaths worldwide, including 2.8+ million cases and nearly 130,000 deaths in the United States (Johns Hopkins Coronavirus Resource Center, 2020). At this writing, the numbers are accelerating in growth (see Figure 1.1). In 15 weeks, over 48 million Americans have filed for unemployment since mid-March when President Trump declared a national emergency concerning the COVID-19 outbreak (Menton, 2020; White House, 2020). Among those who lost jobs, poor Americans were hit the hardest: 39% of former workers living in a household earning $40,000 or less lost work; in contrast, among those making more than $100,000, 13% lost jobs (Smialek, 2020; see Figure 1.2). Worse yet, it is estimated that COVID-19 may leave 27 million Americans to lose their employer-sponsored health insurance coverage after being laid off (Garfield et al., 2020) – during a time when healthcare coverage is essential to protect individual health and family wealth.

Figure 1.1 Global map of total cases of the COVID-19 pandemic (September 30, 2020). Adapted from the interactive map by CNN (Pettersson et al., 2020). Source: Adapted from Pettersson, et al. (2020, July 5).

Figure 1.2 Long lines for food bank. Drivers in hundreds of vehicles wait for central Texas food bank volunteers to deliver 28-pound boxes of staples during a food giveaway in Austin, Texas. Almost 1,500 families picked up boxes in response to extensive COVID-19 pandemic job losses and general economic fallout. Source: Bob Daemmrich / Alamy Stock Photo

On May 25, 2020, George Floyd, a 46-year-old African American, repeatedly said, “I cannot breathe,” and eventually died in police custody after an officer kneeled on his neck for 8 minutes and 46 seconds during an arrest (see Figure 1.3). Despite the risk of exposure to COVID-19, numerous protests were held in small towns and big cities in the United States and internationally to demand justice for George Floyd, raise awareness of unconscious bias, and seek solutions to structural racism. During the eight days of national civil rights protests, 62,000 National Guard soldiers and airmen were deployed to protests in 24 states plus the District of Columbia (Sternlicht, 2020). Over 4,400 people have been arrested as protests occur in all 50 states (Sternlicht, 2020). Over 40 cities have instituted curfews, including Minneapolis, New York, Louisville, Philadelphia, Chicago, and San Francisco (Sternlicht, 2020).

Figure 1.3 A mural dedicated to George Floyd. The mural also includes names of many other victims in honoring the Black Lives Matter movement in Minneapolis, MN, on May 29, 2020. Souce: Sipa USA/Alamy Stock Photo

We do not see the pandemic, the economic crash with millions losing health insurance, and the civil rights protests as three independent, random events that just happened to take place at the same time in history. Rather, these events are interconnected, highlighting the social injustice and structural barriers faced by the poor and the marginalized. Of the three, the pandemic and structural inequality along racial lines exist all over the world. However, the lack of universal health insurance in the United States is unique among wealthy industrial nations (Béland et al., 2016), which compounds the damages from the other two crises. Together, they tell a story of institutional failures to effectively protect, communicate, and listen to its most vulnerable citizens, responding to the social injustice and structural barriers that have limited their ability and potential to thrive over time, from one generation to the next.

Health and illness are pervasive in our everyday life. How we live our life, structure our social system, and respond to health disparities have consequences not only to our individual health, but also our family’s financial well-being and our community’s ability to thrive as a whole. How we conceptualize health and illness will define our abilities to find solutions and address injustice. To this end, we must see health and illness more than a biological phenomenon.

A. The Landscape of Health Communication

Caring for patients can be traced back thousands of years to ancient times in Greece and Roman; however, modern medicine only emerged in its current form in the 19th century (Bynum, 2008). The latest trends in medical science have become increasingly focused on advancing the institutional and scientific knowledge of the biological body (Bynum, 2008; Mukherjee, 2016). Medicine and healthcare providers also have begun to recognize that health and illness are situated in social, cultural, and economic contexts (Rosen, 1958/2015). The 19th century sanitary movement (i.e., the introduction of piped water to people’s homes and sewers rinsed by water) is considered the greatest medical advance since 1840 (Ferriman, 2007). Medical sociology first emerged in the 1950s to address how the politics and of health and illness can maintain and even reinforce systemic disparities and social injustice in the post-WWII period (Brown, 1991; Bury, 1986).

Compared to these fields, health communication, first formalized in the early 1970s, is a relatively young but rapidly growing discipline (Kreps, 2014). Health Communication and the Journal of Health Communication, two leading academic journals in the field, were established in 1989 and 1996 respectively. From its beginning, health communication has been influenced by a wide range of disciplinary approaches, including communication, psychology, medical sociology, and clinical medicine (Kreps et al., 1998). A review of published articles in Health Communication, the first academic journal focused solely on health communication scholarship, from 1989 to 2010, found that the field has been heavily influenced by western scholarship because the nationality of first authors was mostly United States (90.5%), followed by Canada (2%) and Australia (1.5%; Kim et al., 2010). In addition, over 50% of the total publications aimed at improving the penetration of health messages (i.e., persuasion) to targeted groups (Kim et al., 2010). Notably, Kim et al. (2010) concluded that individuals have been the focal level of analysis and there is “an absence of focus on structural factors or social policies that are more conducive to improving the health conditions of social members” (p. 500).

However, the landscape of health communication has expanded significantly since 2010 (Kreps, 2014). In particular, health communication scholars have collaborated with researchers from other disciplines, including medicine, public health, social work, critical studies, cultural studies, education, history, humanities, ethics, public policy, and law, to create new understandings and new approaches to the investigation of communication in health contexts. Here are some of the major themes and trends in health communication, along with some exemplars from this book.

1. Persuasion and Behavioral Change: Public Health Campaigns

As a major theme within health communication, health promotion centers on the persuasive use of communication messages and media to promote public health (Kim et al., 2010; Kreps et al., 1998). Scholars of mass communication, message designs, message effects, social influence, persuasion, and even political communication scholars have long investigated the development, implementation, and evaluation of persuasive messages in inducing behavioral changes in the public. As a result, this is a field that includes theory-oriented research (e.g., testing and evaluating message designs and effects) as well as practice-oriented fieldwork (e.g., executing actual campaigns through mass media).

Public health campaigns represent a valuable and rewarding testing ground to examine how persuasive messages can maximize public health benefits through (a) promoting specific health behaviors, including one-time health behaviors (e.g., vacci...

Table of contents

• Cover
• Title page
• Copyright
• Dedication
• Table of Contents
• Acknowledgement
• 1 Rethinking Culture in Health Communication
• 2 Cultural Consciousness I: Magic Consciousness and Emotions in Health
• 3 Cultural Consciousness II: Mythic Connection and the Social Meanings of Health and Illness
• 4 Cultural Consciousness III: Perspectival Thinking and the Emergence of Modern Medicine
• 5 Cultural Consciousness IV: Integral Fusion and Health Professionals in Healthcare Settings
• 6 Culture and Health Behaviors: Culture Assumptions in Health Theories and Practices
• 7 Health Literacy: Cultural Approaches to Health Behaviors and Decision-Making
• 8 Group-Based Identities: Cultural Approaches to Social Stigma and Health Practices
• 9 Uncertainty in Health and Illness: From Perspectival Thinking to Integral Fusion
• 10 Social Support: Understanding Supportive Relationships Through Cultural Perspectives
• 11 Transformative Technologies: Cultural Approaches to Technologies in Health Contexts
• 12 Health Disparities: Observations and Solutions Through Different Cultural Approaches
• 13 When Cultural Perspectives Collide: Community-Based Health Interventions in Marginalized Populations
• 14 Distributive Justice: Embedding Equity and Justice in Structural Barriers and Health Policies
• Index
• End User License Agreement