Communicating Health: Priorities
and Strategies for Progress

Introduction to the Health Communication Action Plans

• Reference

Communication is increasingly recognized as a necessary element of all efforts to improve health. Health communication is the study and use of communication strategies to inform and influence individual and community decisions that enhance health (U.S. Department of Health and Human Services, 2000, p. 11-3). The inclusion of the Health Communication Focus Area for the first time in Healthy People 2010 confirms the importance of communication as an intellectual framework, a scientific endeavor, and a set of processes and interventions for health improvement. Communicating about health is also an everyday part of life. Mass media coverage, entertainment programming, and public policy debates are important places for public communication about health.

Health communication can contribute to all aspects of disease prevention and control, health promotion, and medical and dental care. It is relevant in a number of contexts of our lives as individuals, patients, members of families and communities, workers, civic participants, and voters. Thus, health communication is critical for people's exposure to, search for, and use of health information; individuals' ability to reduce or eliminate unhealthy behaviors and adopt healthy behaviors; and individuals' and community groups' ability to make decisions about the health of their workplace, their community, and our society. Furthermore, health communication is central to people's ability to gain access to the public health and healthcare systems; health professional-patient interactions; people's ability to engage in appropriate self-care and chronic disease management; and people's understanding of clinical recommendations and expected outcomes. Communication is critical to the work of health professionals and their interactions with each other, their patients, and the information they create and use. Health communication principles must inform the dissemination of information about individual and population health risks, the construction of public health messages and campaigns, the images of illness and health in the mass media and the larger culture, and the development of e-health applications, including online personal health records, health Web sites, interactive personal health tools, and telemedicine systems.

Health communication research, teaching, training, and practice cross many disciplines and academic boundaries. Health communication is an established category of research and teaching within the discipline of communication. Health communication is also a part of many elements of public health, medical, dental, and pharmacy training and practice, particularly in the areas of public information campaigns, community and patient education, and provider-patient communication. Some of these same aspects of health communication are also part of the field of medical sociology. The study and application of communication and information technologies to health and health care is a part of communication research and medical informatics, an area of research in academic medical centers, healthcare organizations, technology companies, and the government.

The six objectives in the Health Communication Focus Area represent this diversity of topics and variety of theoretical and methodological approaches. The objectives are designed to stimulate actions that result in progress in each area by the year 2010. The six objectives address the diffusion of the Internet to households, the quality of health Web sites, health literacy, provider-patient communication, research and evaluation of communication programs, and Centers of Excellence in health communication. Even though each of the objectives can be considered independently, there is considerable overlap among them. For example, making sure that patients and providers can adequately share useful information with each other is critical to improve both health literacy and provider-patient communication. Another example is the pair of objectives on the use of the Internet for health improvement. One objective focuses on increasing access to the Internet in households and the other on improving the quality of health Web sites. Both are necessary to ensure that the Internet becomes an equitably distributed resource to deliver health information and services that users can trust.

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The eclectic and innovative nature of the objectives presents two challenges: (1) how to measure multifaceted phenomena to establish baselines, targets, and progress and (2) how to identify appropriate actions that will produce change and movement toward the targets. When the chapter was published in Healthy People 2010 in January 2000, five of the six objectives were labeled "developmental." This designation means that there were no recognized national data sources to measure five objectives. Since then, two new data sources are being created, and one data source has been identified as part of an ongoing national survey. These sources are discussed in more detail in the relevant action plans. The process of creating and identifying data sources has had the additional benefit of generating lively discussion in the health communication field about the relevant concepts and dimensions for each objective and topic area. Although individual programs and interventions have had specific targets and outcome measures in the past, the idea of national objectives that encompass issue areas with many different types of programs, interventions, and activities is an innovation in the field.

The second challenge—identifying appropriate actions to achieve progress—is addressed by the six action plans in this publication. The action plans are a product of discussion and collaboration among individual drafters of background papers, small groups of subject experts, the Office of Disease Prevention and Health Promotion (ODPHP), which is the lead agency for the Health Communication Focus Area, and the health communication field at large. In the summer of 2001, ODPHP convened a Steering Committee to help plan a 1-day meeting to bring together small groups of subject experts for each objective. ODPHP then commissioned individuals to draft background papers for each objective. Steering Committee members, drafters, and small group members are listed at the end of this report. Each paper was reviewed by the Steering Committee and distributed to the relevant participants of the small groups. During the meeting on October 12, 2001, each small group spent the day in discussion and rewriting of its own paper and action plan. Each group was given the same set of section headings and decided for itself how much detail to put into each of the sections. For example, some groups identified lead organizations and responsibilities, and others did not. These revisions were reviewed by ODPHP, and the papers were rewritten in the form of expanded action plans. The plans were redistributed to the small group members, the Steering Committee, and members of the Health Communication Focus Area Work Group. The action plans also were presented at the 2001 American Public Health Association meeting, the 2001 National Communication Association meeting, and the 2002 Kentucky Conference on Health Communication. The names of the organizations and individuals who participated in the October 12 meeting and the drafting and review of the action plans are listed in the acknowledgments section at the end of this publication.

The purpose of the action plans is to focus the attention of researchers, teachers, practitioners, policymakers, and organizations on the general strategies and specific steps that they can take in support of the objectives. In general, the strategies and action steps aim to raise awareness, generate new information, stimulate funding and innovative policies, promote evaluation, and encourage development of programs and interventions that support progress toward the targets for each objective. The action plans are not intended to be definitive in their current form. They are works in progress and will be reviewed and updated as needed.

Each of the action plans follows the same format and leads the reader through an understanding of the issues underlying the objective and its importance, some of the main factors that will affect progress on the objective, key participants needed to work on the strategies and action steps, and the strategies and action steps themselves. The interests of the public and specific populations in the objectives, strategies, and action steps are broad, diverse, and relevant to each of the plans. Some plans identify lead organizations and responsibilities, others do not; all the plans need more attention to these two categories. Where lead organizations and responsibilities have not yet been identified, public- and private-sector groups working in each of the areas can identify them as relevant activities emerge. ODPHP will continue in its traditonal role of coordination of public and private efforts rather than implementation and funding of specific activities.

The action plans represent the best ideas to date about how to make investments—financial, intellectual, educational, political, and practical—in health communication count. They provide a foundation on which to bring together individuals and groups that have a stake in the achievement of shared objectives.

Reference
U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000.

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