Health Communication

Health communication is the study and application of the generation, creation, and dissemination of health-related information, health-related interactions among individual social actors and institutions, and their effects on different publics including individuals, community groups, and institutions.

The challenges inherent in disease prevention and health promotion warrant a multidisciplinary and multilevel approach that examines the role of distal factors such as social and economic policies and health policies, near proximal factors such as neighborhoods and health-care organizations, and proximal factors such as individual lifestyles to explain individual and population health. Some have argued that communication is one thread that could connect the distal and proximal factors to explain individual and population health. Given this charge, health communication, though primarily a derivative field, draws from and contributes to such fields as mass communication, journalism, communication studies, epidemiology, public health, health behavior and health education, medicine, sociology and psychology, among others.

The Emergence of the Centrality of Health Communication

The precise “origin” of health communication is difficult to pinpoint though its evolution could be traced to campaigns in public health to promote hygiene and immunization in the eighteenth and nineteenth centuries, persuasion studies during and after World War II, and the development communication campaigns in the 1970s. At the same time, the importance of communication in health-care delivery and health services provided the foundation for health communication that focused on patient–provider communication. Some recent developments in health communication, however, have contributed to its emergence as one of the more dynamic areas in communication studies. In many countries these developments include reports by major academic think tanks and professional organizations calling for communication to be included in curricula in medical and public health schools, for funding to be available from major national and international agencies, and for the inclusion of health communication goals in governments’ national health agenda.

The Institute of Medicine (IOM), a major research organization in the United States, published several reports that highlight the centrality of Communication in health, including Speaking of health: Assessing health communication strategies for diverse populations, and Who will keep the public healthy?, a report on the future of public health education that identified communication as a cross-cutting area of critical importance for training future public health professionals. The IOM also released several research reports including Unequal treatment: Confronting racial and ethnic disparities in healthcare, Health literacy: A prescription to end confusion, and Fulfilling the potential of cancer prevention and detection, among others that clearly identify a role for communication in the health-care continuum of prevention, detection, diagnosis, treatment, and survivorship or end-of-life stages.

Major funding agencies in the United States including the National Institutes of Health (NIH), agencies in Europe such as institutions of the European Union, and international bodies such as the World Health Organization (WHO) and the International Bank for Reconstruction and Development (IBRD), also known as the World Bank, have recognized the contribution of communications to population health and, accordingly, have begun major funding initiatives in this area. In addition, in the United States, the National Cancer Institute (NCI) of the NIH established a branch dedicated to health communication research, the Health Communication and Informatics Research Branch (HCIRB) whose presence provided the impetus for increased funding and large-scale initiatives in communication research.

Two such initiatives are worth noting: the funding of four Centers of Excellence in Cancer Communications Research (CECCRs) and the start of a national survey of health communication behaviors of American adults, the Health Information National Trends Survey (HINTS). The latter, arguably, is the first public use dataset on health communication in the world. As a part of its “Futures Initiative,” the Centers for Disease Control and Prevention (CDC) recently established the National Center for Health Marketing, with communication playing a central role. The presence of formal health communication programs at the NIH and CDC, coupled with major funding initiatives from NIH and the United States federal government on anti-drug campaigns, heart health, antitobacco, and AIDS/HIV prevention campaigns among others has attracted funding and interest from a variety of scholars from many different disciplines including communication, public health, psychology, sociology, and epidemiology among others. The United States federal government’s action plan for health, Healthy People 2010, devoted an entire chapter of its report to health communication. Finally, there are now at least two major journals, Health Communication and the Journal of Health Communication, that exclusively publish research in this area in addition to other journals in social sciences and health that publish health communication research. These developments have precipitated and accelerated the establishment of health communication specialization in academic disciplines in major American and European universities.

Organization of The Field

There is no simple or complete way to organize the field of health communication though several sub-fields have existed depending on one’s research interests, as well as due to adventitious and historical circumstances. While not necessarily perfect, a more heuristic way to locate one’s interest is along levels of analysis: individual, interpersonal, social network, organizational, and mass or societal levels. Such an approach is not meant to be comprehensive but is a way to organize the large amount of research, as well as to locate the interests of a variety of practitioners as well as researchers.

In general, at the individual level, the focus is twofold: (1) how health cognitions, affect, and behaviors influence and are influenced by, health communications; and (2) how interpersonal interactions between patients, family members, and providers, and with members of their social network, influence health outcomes. At the organizational level, some have studied the role of communication within health-care systems and how organization of media and the practices of media professionals may influence population and individual health. Finally, at the societal level, the focus is on large-scale social changes and the role of communication with such changes. For example, one might examine how strategic communications as well as natural diffusion of information impact individual and population health; or how communication mediates and is influenced by social determinants such as social class, neighborhood, social cohesion and conflict, social and economic policies, and how that impacts individual and population health.

Even as these levels provide a useful organizing framework, two caveats are warranted. First, policymaking and research related to health may affect more than one level. For example, one might be interested in how communication between patients and physicians may influence patients’ adherence and compliance with medical regimens, satisfaction, and quality of life. At the same time, advertising of drugs, or “direct to consumer advertising” (DTCA), on television may motivate the patient to discuss the drug with the physician thus affecting their interactions. Thus, while organizing the field along the different levels may be utile, one must be cognizant of actions and outcomes occurring across levels of analysis.

Second, interest in a level of analysis and pursuit of work at one level is not inconsequential. Locating a problem at one level, and studying it at that level has implications for the kind of policy or practice that is likely to emerge from that research. For example, if a researcher finds that social norms may lead an individual to abuse alcohol, a solution may focus on addressing those norms at the individual or interpersonal level. On the other hand, if it was found that advertising is responsible for influencing social norms and subsequent binge drinking, solutions may focus on the environment including communication policies and regulation of advertising. In short, choosing one’s level of analysis is neither trivial nor inconsequential.

Dimensions of Health Communication

Several dimensions of communication have been studied at the individual level, both focusing on psychological factors within individuals, as well as the interactions between individuals and among small groups and how they affect health.

Models of Health Behaviors

Several theories from psychology and communication inform how psychosocial determinants such as health cognitions, emotions such as fear, beliefs, motivations, and perceptions among others influence individual behaviors insofar as they affect health. There are a variety of individual-level theories that have informed the work in health communication. These include expectancy value theories such as the health belief model, the theory of reasoned action and the theory of planned behavior, the protection motivation theory, and the transtheoretical model, among others.

Expectancy value theories make a number of core assumptions. Health behavior is an outcome of a series of contingent conditions starting with beliefs and norms leading to behaviors. People have “expectancies” or beliefs about certain outcomes and these beliefs are either valued or not valued by them. In making their choices, people strive to maximize benefits and minimize costs. Individuals make rational choices affecting their health based on information available to them and the choices could be influenced by providing appropriate information pertaining to those beliefs. Fishbein et al. (2002) developed the “integrated model” of health behavior combining elements of several health behavior theories. They argued that there are only a finite number of determinants of behavior and they can be integrated to explain and predict health behaviors. An addition to the integrated model, self-efficacy from social cognitive theory, is worth noting.

While the expectancy value models treat environment as a background that works through individual norms, beliefs, and attitudes, social cognitive theory (SCT) proposes that human behavior is a dynamic product of three sets of factors: personal, behavioral, and environmental (Bandura 1994). SCT assumes that humans are active agents capable of self-assessment, evaluation, and learning and react to, and in turn influence, their social environment. They can learn via “symbolic modeling” from the media or through interpersonal contacts. If they value a behavior and feel that it has positive consequences they are capable of imitating the behavior, but if they believe that it has negative consequences they may not adopt it. Lastly, they must believe that they are capable of engaging in the recommended behavior, i.e. have self-efficacy for the behavior in question.

Health Communication and Information Processing

The impact of persuasive communications through communication campaigns, providers, or casual exposure to health information depends on how the information is processed by the recipient. Two dual-process models of information processing, the elaboration likelihood model (ELM) and the heuristic systematic model (HSM) (Chaiken 1980; Petty & Cacioppo 1996) have been popular in health communication. In essence, both models posit that change in one’s attitude (in terms of both whether or not it happens and for how long) depends on the route through which the information has been processed, and the motivation and ability to process the information.

Many persuasive campaigns in health communications used the dual-process models to design and evaluate health communications. More recently, however, several advances in psychology call for a revision of conventional assumptions about attitude change, suggesting that: (1) there are multiple pathways in changing attitudes (e.g., Cohen & Reed 2006); (2) attitudes are less stable than originally assumed and they may vary across time and situation; (3) attitudes may be less enduring and may form quickly; (4) attitudes may be of two types: explicit attitudes reported more consciously and implicit attitudes that are more automatic and based on deeply held affect (Greenwald & Banaji 1995).

Interpersonal Communication

Interpersonal communication, or communication among dyads or small groups, has a remarkable effect on several individual-level health outcomes. Much of the attention and energy has been focused on communication between health-care providers and consumers, and has attracted attention from a diverse range of disciplines including researchers from communications, health services, and primary care physicians, among others. Other dimensions such as the role of significant others in influencing social norms, providing social support, and social capital have also been pursued at this level.

Consumer–Provider Communication

Extensive attention has been given to understanding the consequences of communication between physicians and patients on patient satisfaction, adherence, and quality of life. Even though most attention has been focused on the interaction between physicians and patients in a medical encounter, it is now recognized that the field of study should expand beyond physicians and patients to the context of the communication and the actors engaged in it. For example, it is recognized that patients interact not just with physicians but also with other providers including nurses, specialists, pharmacists, patient navigators, and other clinical staff. In addition, patients are assisted by other family members whose presence influences medical interactions. Furthermore, larger social forces such as direct-to-consumer advertising and the burgeoning influence of the Internet are also influencing the nature of physician–patient interactions.

The research on patient–provider interaction runs along several streams. One theme is who controls the interaction between providers and patients, known as “relational control.” The traditional paternalist model, where the physician as an expert exercised greater control, is yielding to more participatory or consumer-oriented models, where patients seek a more active role in their treatment, leading some to focus on “patient-centered” communication.

A second theme focuses on the outcomes of patient–provider interactions. Extensive research has documented that patient–provider communication influences patient satisfaction which, in turn, is related to patient adherence and compliance to treatment regimens, ease of distress, physiological response, length of stay in the hospital, quality of life, and health status among others. In turn, providers also benefit from better communication where patients are less likely to change providers, fewer malpractice suits are initiated, and patients are more compliant with recommendations.

Third, recent examination of determinants of disparities in health-care paid attention to communications including patient–provider communications and patient information seeking. The health-care system is complex and patients typically are forced to deal with a remarkable array of health-care personnel making it difficult to navigate the system and negotiate care. Researchers have documented stark differences in patient preparation and access, and in care received and health outcomes, between social classes as well as racial and ethnic groups. For example, racial and class differences between providers and patients influence the duration and informative nature of discussions and the emotional support and question-asking by patients, resulting in shorter visits, less participatory decision-making, lower satisfaction, and lower compliance (Cooper & Roter 2003). This is likely to put the underserved groups at a disadvantage as they are much less likely to seek information from outside the medical encounter.

Social Support, Social Capital, And Social Networks

The implications of interpersonal interaction in the context of families, friends, coworkers, and voluntary associations on health outcomes has emerged as one of the most dynamic areas of research in health communication. This topic has been pursued from diverse theoretical viewpoints by researchers focusing on social networks, social support, family communications, and social capital based on the researcher’s disciplinary origins and research interests. It is a mistake to infer that social support and social capital are the same given their different theoretical underpinnings and intellectual interests. It is, however, reasonable to assume an overlap between these distinct areas.

In the context of patient health, social support mechanisms, through which relationships with others such as family members, friends, and co-workers eases stress, has a salutary impact on health. Social support could be in the form of information on how to address problems, encouragement and support for behavior changes, or reinforcing healthy behaviors, and/or tangible support in the form of resources or services such as transportation to a clinic (House 1981). Patients endowed with such support generally do well and enjoy enhanced quality of life (QOL).

In addition to social support, interpersonal relationships among social networks may have other outcomes. Social networks can accelerate or decelerate diffusion of new information, and also influence how it is interpreted (Valente 1995). Members within networks can serve as role models for lifestyle behaviors such as in smoking and obesity.

Last, interpersonal interactions could generate social capital, defined as norms of reciprocity, interpersonal trust, solidarity, and cooperation, that seem to characterize most relationships within social networks or informal organizations (Putnam 2000). It is widely documented that social capital is positively related to lower stress, lower risky behaviors, lower mortality, higher self-rated health, and lower psychological distress. Social capital is a product of interaction between two entities and the interaction is sustained by communication (Viswanath 2007). Social ties and the advantages emerging from those ties are related to media use, identification and involvement with the community, and promotion of interpersonal trust, allowing for the spread and interpretation of health information.

The emergence and spread of the Internet has broadened the scope of interpersonal interaction and its influence in health communication by moderating the limits of geography. While one may still need geographical proximity to provide instrumental social support, the emergence of disease-focused support groups on the world wide web, provision of health information, and facilitation of electronic communication with family, friends, and physicians is a dynamic area that will attract more attention from health communication researchers.

Risk Communication

Risk communication is a well-established area of research in health communication and its study cuts across all levels of analyses. Risk is the probability of negative outcomes as a result of certain events or behaviors. Communication about risk may occur through interpersonal interactions from physicians, family members, and friends or through mass media. For example, a physician may try to communicate the likelihood, or “risk,” of a negative or adverse outcome to a patient. Or a news story on avian flu in the media may include discussion of the risk of its spread to humans. In general, the goal of risk communication is to increase the perception of risk, that is the possibility of negative outcomes with the hope of changing audience behavior. As risk, by definition, deals with uncertainty, it involves explaining the determinants of risk, the likelihood of negative outcomes, and their consequences. The recipient of communication is expected to weigh these different components before deciding on a course of action. Clearly, this places a considerable burden on both the communicators as well the recipients. Much attention in risk communication has been given to communicating probabilities. Given that probabilities and other risk metrics are difficult for lay individuals to understand, alternative forms of communication are necessary.

Some work in risk communication has examined how community structural factors and social conflict (“outrage”) may influence how risk is framed and amplified, and the consequences of the coverage of risk in the media. Overall, risk communication is an important area that connects conceptual work tightly with application.

Mass Media and Health

Mass media emerged as one if not the most powerful agencies of socialization in the twentieth century. Mass media may be defined as organizations explicitly structured and organized to create or gather, generate, and disseminate news and entertainment, which distinguishes them from others such as families, friends, or churches (Viswanath et al. in press). Media products range from strategic communications such as advertisements and press releases, entertainment products such as movies, television programs and books, and informational products such as news.

The power and appeal of the media stem from three sources. First, thanks to the technological revolution, media have penetrated the farthest corners of the globe, a reach that is virtually unrivalled to this point. Second, media institutions are organized to efficiently produce, process, and disseminate media products. Third, despite the strategic focus on catering to narrow segments of population sub-groups for marketing purposes, the appeal of media products, within reason, transcends boundaries of race, ethnicity, culture, and class. These reasons, in combination with emerging media platforms such as the Internet, mobile phones, and other mobile technologies will likely maintain the power of media over other ways to communicate and socialize.

In health, media influence may occur in two ways: (1) exposure to messages through routine use of the media, leading to effects on people’s cognitions, affect, and behaviors and on institutions and groups in reaction to media messages; and (2) strategic use of media in health promotion and disease prevention. Both routine use and strategic use of the media have a profound impact on individual and population health as well as on institutions involved in health.

Routine Use of Media and Health

The incidental and routine use of media for news and entertainment serves four functions in health (Viswanath 2006). The informational function is served when casual use of media for news or other purposes may expose the audience to developments on new treatments or new drugs, alert them to risk factors, or warn them of impending threats such as avian flu.

Media serve an instrumental function by providing information that facilitates action. For example, in times of natural disasters the audience may learn about places where they should take shelter. Information of this kind allows for practical action.

Media defines what is acceptable and legitimate, performing a social control function that has been widely used in health promotion. For example, media have been enlisted to create new social norms (e.g., engage in physical activity) or change existing norms (e.g., discourage binge drinking or smoking).

The communal function is served when media provide social support, generate social capital, and connect people to social institutions and groups. Media may promote trust in local institutions through its coverage. As discussed earlier, social support and social capital are associated with better health outcomes.

Purposive and Strategic Use of Media

Strategic or purposive use of media may take several forms. Individuals may deliberately seek information to learn more about a health topic that is of relevance to them or their referent other. Public health agencies have extensively used media alone or media as a part of a larger arsenal to promote knowledge, or to change beliefs, attitudes, and behaviors that impinge on health. Social movement groups, among others, have engaged in media advocacy to draw the attention of policymakers to policies that affect population health.

Information Seeking

Information seeking, as a construct, has gained greater currency in recent times as more information on health has become routinely available because of greater coverage of health in the media, the spread of health-related content on the world wide web, or the consumerist movement in health that promotes informed or shared decision-making. It is widely assumed that some people under certain conditions actively look for health information to seek a second opinion, make a more informed choice on treatments, and learn in greater depth about a health problem that afflicts them or their friends or family members.

However, not everyone actively seeks information. Some look less actively but indulge in scanning the environment for information because of perceived salience. Some avoid information, often characterized as “blunting.” Others do not seek at all, often those from lower socio-economic status groups. The consequence of actively looking or scanning for health information is that such strategic use may result in greater attention to and processing of media messages and, as a result, greater learning and behavior change.

Media, Agitation, And Advocacy In Health

Some have drawn lessons from social movements in using the media to agitate and advocate for changes that may affect the health of populations and communities and in health policies. The rich history of collective action when activist groups confronted powerful institutions and interests to correct social injustice and rectify inequities has provided a fertile ground for activists in health.

Activists have drawn lessons from the experiences of social movements to speed up or even change drug approval policies in HIV/AIDS; drawn attention to the profound disparities and inequities in health where certain population groups and communities suffer disproportionately compared to others; and frequently agitated to draw attention to environmental factors such as polluting factories that seem to affect the dispossessed and the disenfranchised much more than others. In the initial stages, mainstream media were seldom hospitable to activist groups and some groups have even been derided and their concerns delegitimized, an experience faced by many groups including women’s, civil rights, and green movements.

The media have been integral to the strategy of activist groups who strived to attract attention, frame issues, and influence public opinion. Activists have used a variety of tactics to attract attention including creating dramatic events, holding sit-ins, and disrupting routines. Often, movements created their own vehicles such as songs and music, newspapers or magazines, documentaries, books and recently websites, which (1) help to present their point of view, and (2) serve to inspire and mobilize supporters and maintain morale. Over time, movements have evolved into legitimated institutions funding research, communicating with policymakers, and mobilizing supporters as in the case of breast cancer, heart disease, or tobacco campaigns.

Health Campaigns

The most visible and popular means of strategic communications is through health campaigns which have become a critical arsenal in health promotion. A typical health campaign attempts to promote change by increasing the amount of information on the health topic, and by defining the issue of interest in such a way as to promote health or prevent disease. For example, an anti-drug campaign may attempt to make visible not only a message against illicit drugs but also the reasons why drug use is undesirable and not normative. The outcomes of focus in health campaigns include raising awareness about a problem, increasing knowledge, changing beliefs around behaviors that impinge on health, influencing social norms, and changing and maintaining health promotive behaviors.

Expectations of the effects of health campaigns have always been high, though in reality their actual impact has been more modest (Snyder & Hamilton 2002; Fishbein 1996). Comparing expectations in the commercial world, Fishbein argued that while marketers may consider a 3 to 4 percent increase in market share as successful, in public health an effect size in this range may be considered failures. Moreover, the campaigns are not designed to detect such small effects. A collection of case studies of successful campaigns as well as a review of campaigns edited by Robert Hornik (2002b) clearly demonstrates that: (1) campaigns to promote change can be successfully mounted even with modest budgets, as was shown in the anti-tobacco, seatbelt use, sudden infant death syndrome (SIDS), and heart disease campaigns among others; and (2) evaluation of campaigns calls for creative research designs that can document both intended and unintended changes.

Recent reviews of the vast literature on health campaigns have identified conditions under which health campaigns can be successful (Hornik 2002a; Noar 2006; Randolph & Viswanath 2004): (1) Insure “exposure” to the campaign messages, a problem that has plagued most health campaigns, which rely on limited budgets. In addition to exposure, it is essential that the definition of the issue at hand is favorable to the promoted topic. (2) Use social marketing tools to create the appropriate messages for distribution and dissemination, including formative research, audience segmentation, and creative media mix. (3) Develop messages, taking into account research in the areas of (a) executional elements such as message construction, and (b) determinants of health behaviors. (4) Facilitate changes in the environment that allow the audience to practice the recommended behaviors and reduce, if not eliminate, barriers to change.

In summary, strategic use of communications through health campaigns remains a promising means for practitioners to promote social change in health and for researchers to examine health-related social change.

Use of Media and Media Effects in Health

At the outset, research has documented an association, of varying degrees of strength, between media use and media exposure and health outcomes, including beliefs and behaviors around sex, obesity, violence, smoking, and cancer screening among others. Research shows that exposure to violence on TV is associated with aggressive behavior in some children and acceptance of TV-portrayed reality, or cultivation, among adults. Exposure to portrayal of smoking in movies is positively related to experimenting with smoking among teenagers. Lastly, a plethora of studies report that time spent watching television is associated with obesity and being overweight, though the studies are fraught with methodological problems. Nonetheless, it is reasonable to assume that exposure to some media content under certain conditions is likely to have some effects on a subset of people some of the time. It is also plausible to argue that the effects found in studies with defined populations or in experiments with small groups could be considered serious when projected to population level, a fact that is often overlooked in the debates about media effects on health.

Part of the explanation for the effects was discussed earlier under the theories of health behavior. But, more to the point, the effects of media on health could be due to the broad reach and hence exposure to media content, and perhaps also to the very structure of media messages. Irrespective of the genre of media content – news, soap operas, talk shows, movies, or opinion pieces – there are certain common message elements that can potentially influence how the information is processed and its impact on people. Some common message elements, including format or structure (how the messages are constructed), that are attracting attention in health communication research at present include sensation seeking, fear appeals, narratives, framing, and exemplars among others.

Framing in health messages emphasizes the consequences of adopting or failing to adopt certain health behaviors. It has also been conceptualized as a way to define or construct a health problem. Narratives are stories with meaning that appeal to an audience and offer symbolic models for behaviors to emulate (e.g., smoking in movies). Fear appeals are messages with high negative emotions that are aimed at increasing perceptions of threat and severity of risk but are effective only when accompanied by messages that tell the audience how to reduce the threat. Exemplars are used to represent a general class of events as typifications and purport to be more effective than factual presentation in recall and learning. Finally, sensation seeking is a personality trait that is characterized by thrill seeking, the search for novelty and intense stimulation, which may lead to potentially risky behaviors such as the use of illicit drugs or unprotected sex.

The outcomes of exposure to different media content and formats are discussed extensively in the literature on media effects. For example, research on cultivation analyses has shown that sustained exposure to media images may cultivate mediated reality among heavy viewers. A fear of crime as a result of exposure to violent programs may discourage the viewer from engaging in physical activity outside the home. Exposure to news programs may influence the priorities people assign to the topics that receive attention in the media; this is called agenda setting. In fact, the media may define or frame how an audience may want to think about a given health issue and what they should do about it. The knowledge gap hypothesis proposes that media effects, particularly learning, are actually likely to be not uniform but different across audience sub-groups subject to individual and social factors.

The role of the mass media and its offshoots such as the Internet remains a subject of intense interest to the communities of practitioners and researchers in communication, public health, and medicine, and is a significant area of contention between industry and the public health community.

Some Major Public Use Datasets

In keeping with its emerging central role in health, both public and private sector agencies are beginning to invest in surveillance mechanisms that can track health communication trends in the population, particularly in the United States. This may be in the form of a few questions on national surveys such as the Behavioral Risk Factor Surveillance System (BRFSS) of the US Centers for Disease Control and Prevention (CDC), or surveys devoted exclusively to health communication as with the NCI’s Health Information National Trends Survey (HINTS), a dataset devoted primarily to tracking communication behaviors with particular reference to cancer control. The Pew Internet and the American Life surveys, one of the most visible and prominent surveillance mechanisms in understanding the role of the Internet in the US, also fields occasional surveys that focus exclusively on health and the Internet. Finally, efforts are underway to develop the tracking of patient information needs and behaviors through clinical informatics systems, which is sometimes discussed under “e-health.” These public use datasets, which serve academic as well as practical purposes, may provide health communication researchers and practitioners with some useful surveillance information similar to what the public health community has enjoyed for decades.

Emerging Challenges/Dimensions

Some significant developments in the field of biomedical sciences and information technology have important implications for health communication. Four are worth mentioning here: informatics, consumer movement and decision-making, increasing disparities and communication inequalities, and research dissemination.

The combined impact of computers and telecommunications on society, needless to say, has been transformative, impinging on almost every facet of human life including art, culture, science, and education. Health communication is no exception. Consumer informatics integrates consumer information needs and preferences with clinical systems to empower patients to take charge of their health-care, bring down costs, and improve quality of care. For example, the integration of electronic medical records with communications should facilitate communications between patients and providers, send automatic reminders to patients to stay on schedule, and help patients navigate the health-care system. Informatics also allows for more precise tailoring of messages to the needs of the intended audience. It remains for the implications of fast-emerging informatics systems for communication and health to be investigated.

Technological developments are coinciding with the consumerist movement in healthcare. The paternalistic model that characterized the physician–patient relationship is slowly being complemented by alternative models such as shared/informed decision-making models (SDM/IDM), which in essence means expecting or allowing the patient to take a more active role in her or his care. Another approach that has been advocated is patient-centered communication (PCC). Some evidence suggests that a more participatory role could have positive outcomes on health, including greater patient satisfaction and QOL. The SDM/IDM movements have been facilitated by new developments in technology that allow patients to access more information outside the clinical context and be more proactive in their own health-care.

The significant investments in biomedical research enterprise in the developing world, and movement toward more evidence-based medicine, have led to calls for translation of the knowledge from the laboratory to the clinic and the community. This movement to bring knowledge from “bench to bed” and “bench to trench” is researched under the areas of knowledge integration, knowledge transfer, and research dissemination. Funding agencies in medicine and public health in North America and Europe are investing resources to develop a science of “translation and dissemination,” and the impact of this area on population as well as practitioners bears watching.

Lastly, an urgent and a moral imperative in health is addressing the profound inequities in access to health-care and the disproportionate burden of disease faced by certain groups. These disparities are prevalent between rich and poor nations as well as between the rich and poor within nations. Complementing the health disparities are communication inequalities: differences in access to information, the benefits that accrue from it and the ability to act on information at the individual level, and the differences between social groups in generating, processing, and disseminating information. While the idea of inequity is not new in communication, the formalization and integration of research into a theory of communication inequality is. Research is beginning to accumulate that shows that inequalities in communication could exacerbate health disparities. The primary determinants, precise mechanisms, and ultimate consequences of communication inequalities are yet to be investigated.

Communication is a central factor in the four aforementioned developments and health communication researchers should be vigilant in monitoring and understanding these developments and their implications for health.

The biomedical and information revolutions that characterize our time will have a far-reaching impact on personal and population health. The possibilities for providing access to information, improving physician–patient interaction, empowering patients, influencing the information environment on health, blunting the negative effects of media, and promoting pro-social change have never been more promising. Practitioners and researchers are looking toward health communication, both its study and its practice, to be a key player in the unfolding scenario to promote individual and population health. It remains to be seen how health communication practitioners fare in this central casting role.

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