Can you talk about some specific initiatives that have incorporated communication strategies to reduce racial/ethnic/other health disparities at the local level in your region?
Through its regional offices, the U.S. Department of Health & Human Services (HHS) works with community partners and other individuals and organizations to implement activities from its many initiatives. One such initiative is the National Partnership for Action to End Health Disparities (NPA), which came into being over a two- to three-year period of holding town halls all around the United States to get information from community partners and stakeholders on what they felt needed to be done to eliminate health disparities within their communities. The NPA Toolkit for Community Action includes strategies to mobilize community-driven and sustainable activities to reduce health disparities. The regional offices work closely with faith-based partnerships, universities, and beauty and barber shops to improve the health of the community.
More recently, the HHS established the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards) which is an implementation guide to advance and sustain culturally and linguistically appropriate services within health and health care organizations, to advance health equity and improve health care services for underserved populations.
Of the HHS' approximately 150 different strategies, many others are also pertinent to the reduction of health disparities and rely on communication strategies in key areas as cardiovascular diseases, obesity, HIV/AIDS, as well as within an overall focus on disease prevention among vulnerable and underserved populations.
Raising awareness of health disparities is often the first step in the movement towards health equity. In talking about health disparities and social determinants of health, what are some common communication challenges, and how can we develop better messages that spur a healthy dialogue and debate about this topic?
Many individuals within our community have difficulty understanding exactly what they need to do to be healthy. Improving the health literacy of the population so that they can understand some of the medicalese; having health care providers speak at a level understandable to their clients; having materials written at or below the reading level of target audiences, and developed in multiple languages; having images that are culturally sensitive and representative of the intended audience; increasing access to certified translations services; and increasing the number of bi- and multi-lingual staff in health care settings are some key challenges.
Messages should focus on creating attention and broadening access to information. We need to diversify the means through which we reach community members, and employ not only newspapers, pamphlets and brochures, but also use social media and infographics. Being a merger of data and pictures, infographics are easy for individuals, especially those with low levels of literacy or education, to understand the types of behaviors they should utilize in order to be healthy. The HHS, for instance, has some infographics on Flickr, informative videos on its YouTube channel, and useful visual information on Pinterest. We need to use a variety of dissemination approaches to accommodate different learning styles. Messages always need to be simple, clear, precise and relatable to the target audience.
Keeping in mind the various programs and initiatives you have been part of, can you discuss the top three lessons learned as they apply to health communication interventions to promote understanding of health disparities and improve health equity?
Firstly, community partners need to be educated about what their health status is, what our goals are, and they should participate in the planning of the strategy that will be implemented in their community. The mission and vision of an initiative should be inclusive of the intended populations and communities, and the staff that is going to implement the interventions should be representative of the community. The intervention planning committee should be diversified in terms of race, ethnicity, age, gender, education and socio-economic status, and include community leaders, community health workers and health care professionals.
Another lesson we have learned is to really know our audience, and understand what their needs are, and how best to communicate and interact with them - Do some community members only want to be reached through social media? Do others want to have in-person meetings? Do we want to have conference calls or video conferences to share information and plan interventions? We also need to bring community organizations into the mix. It is also important to know what partners have done in the past, and their successes and challenges, so while we don't make the same mistakes, we follow-up on things that worked well.
Finally, research is vital. In order to develop a strong intervention, we need to conduct a needs assessment of the target community and identify and connect with community leaders and stakeholders.
What are some of the capacity building needs among various stakeholders and organizations that you feel should be prioritized to address health disparities?
First of all, there needs to be an awareness of the resources available—services at the local, state and federal levels, as well as human capital and other tangible resources that can be utilized to support implementation and evaluation of interventions. Stakeholders and organizations need to be trained on priority health areas, so that they have actual data, and not just anecdotal data, to inform the direction they take. Other capacity building needs include skills to support uniform data collection, grant writing, conducting outreach and evaluation activities, and developing a sustainability plan in conjunction with the communities. I think that the infrastructure of community organizations also needs to be strengthened.
No single organization can address health issues all by itself. We need to have multi-disciplinary, inter-agency collaboration, which also involves and utilizes the leadership and skills of community members and the many positive attributes that communities can contribute to the development of initiatives.
Closing thoughts
Collaboration and partnerships are key for successful planning and implementation. Recruiting non-traditional partners who work with the same communities, such as those who work for parks and recreation, criminal justice or in law, can lead to better implementation of activities as there is strength in numbers.
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Michelle S. Davis currently serves as the Regional Health Administrator (RHA) for the U.S. Department of Health and Human Services (DHHS) New York Region (NJ, NY, PR, and the USVI). As RHA she serves as the principal federal public health authority. The RHA ensures that the numerous priorities of HHS are better incorporated at the local, state, territorial, tribal and national levels through partnerships. Prior to her current position, she worked in a variety of public health positions including; Deputy RHA for the Philadelphia Region, Deputy State Health Officer for the Commonwealth of Pennsylvania, Deputy Health Commissioner for the City of Philadelphia and Senior Epidemiologist with the Centers for Disease Control and Prevention (CDC). She matriculated at the University of Michigan for her undergraduate education and at the University of South Carolina, Johns Hopkins and University of North Carolina for her Masters’ and Doctoral education in epidemiology.
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Interviewed by Radhika Ramesh, MA, Editorial Assistant, Journal of Communication in Healthcare (JCIH): Strategies, Media, and Engagement in Global Health. The interview was solicited and organized by the Journal's Editor-in-Chief as part of a series of expert interviews JCIH publishes on topics of current interest, and their implications for health communication.