Communication, Health, and Equity

Structural Influences

Authored by: Kasisomayajula Viswanath , Rachel F. McCloud , Mesfin A. Bekalu

The Routledge Handbook of Health Communication

Print publication date:  September  2021
Online publication date:  September  2021

Print ISBN: 9780367488956
eBook ISBN: 9781003043379
Adobe ISBN:


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Communication inequalities, defined as the differences in how individuals or groups access, engage with, process, and act upon health information, are key drivers in health disparities, particularly impacting individuals with limited social resources or social power. Communication theory and methods predominantly focus on individual-level approaches to health communication, which do not fully account for the cultural, political, and social spaces in which communication inequalities may manifest. This chapter emphasizes the need to broaden the scope of influences considered to fully understand and account for communication inequalities, examining how communication at multiple levels contributes to or mitigates health disparities and influences health and well-being. First, the chapter introduces social determinants of health and ecological influences on health, connecting the interplay of factors presented in these models to health communication campaigns and their outcomes. Communication inequalities and their impacts are then discussed through the lens of different ecological levels, including culture, socially constructed harms (with a focus on racism), policy, social networks, and individual-level factors. Finally, the chapter emphasizes the need for participatory processes that involve target communities when developing strategic communication efforts and approaches that consider potential communication inequalities across ecological levels, to improve health communication intervention, research, and policy.

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