Health and Risk Communication

An Applied Linguistic Perspective

Rodney Jones

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781134078264
• Topic: Languages & Linguistics
• Subtopic: Linguistics
• Index: Languages & Linguistics

Health and Risk Communication provides a critical and comprehensive overview of the core issues surrounding health and risk communication from the perspective of applied linguistics. It outlines the ways applied linguistics differs from other methods of understanding health and risk communication, assesses the benefits and limitations of the approaches used by different scholars in the field, and offers an innovative framework for consolidating past research and charting new directions.

Utilizing data from clinical interactions and everyday life, this book addresses a number of crucial questions including:

• How are the everyday actions we take around health constructed and constrained through discourse?
• What is the role of texts in influencing health behaviour, and how are these texts put together and interpreted by readers?
• How are actions and identities around health and risk negotiated in situated social interactions, and what are the factors that influence these negotiations?
• How will new technologies like genetic screening influence the way we communicate about health?
• How does communication about health and risk help create communities and institutions and reflect and reproduce broader ideologies and patterns of power and inequality within societies?

Health and Risk Communication: An Applied Linguistic Perspective is essential reading for advanced students and researchers studying and working in this area.

1

COMMUNICATING HEALTH AND RISK

‘The thing I'm most worried about,’ I told my sisters over Christmas dinner, ‘is Alzheimer's. Because there's nothing you can do about it.’

We're debating the pros and cons of my decision to have my genome analysed by a company in California called 23andMe. All you have to do is spit into a test tube and six weeks later they report back to you through a secure website about your ancestry, your susceptibility to a host of diseases, and the presence of genetic markers for various traits like physical endurance and whether or not your urine smells funny after eating asparagus. The company also provides a social networking platform through which customers can share their genetic information with one another and participate in scientific research.

I explain to my sisters how the test will help me to make better health decisions. I'll find out, for example, how often I should have a colonoscopy or a test for glaucoma and whether or not I should keep eating meat or return to the vegetarian diet I maintained in my youth. There is also, I have to admit, a certain prurient curiosity on my part at the prospect of peeking into the ‘secret’ of my own genetic code. But my sisters are skeptical. And they are not alone. Many experts have grave misgivings about such services, arguing that laypeople don't have sufficient knowledge to interpret genetic data. They also point out that while some knowledge is ‘actionable’ — if you find you are susceptible to heart disease, for example, you can adjust your diet or your exercise regimen — there is nothing you can do about other kinds of knowledge — except worry. The presence of a variant of the APOE gene associated with Alzheimer's disease is an example. In fact, when the famous geneticist James Watson had his genome scanned, he explicitly instructed scientists to leave information on the APOE gene out of his report.

I'm discussing this with my sisters because I need to know how much they want me to tell them about my results, since whatever I find out about my ‘genetic fate’ will also likely apply to them. My younger sister cautiously agrees to be privy to my report. My older sister, on the other hand, wants nothing to do with it.

‘I don't want to know,’ she says. ‘Too much knowledge is a dangerous thing’.

*

On September 18, 2007, one day after her book Louder than Words: A Mother's Journey in Healing Autism was released, actress Jenny McCarthy appeared on The Oprah Winfrey Show to talk about how she came to believe that vaccinations had caused her son's autism and that he could be cured with a special diet free of wheat and dairy products.

She said that the first thing she did after she received her son's diagnosis was to type the word ‘autism’ into Google. To her surprise, one of the first websites to be returned by her search claimed that autism was reversible and treatable. At first she didn't believe it. She figured that if autism were really reversible and treatable, she would have seen it on Oprah . But the more she read, the more convinced she became.

When asked by Oprah how she decided which of the things she read on the internet were true and which weren't, McCarthy summed up her decision-making process with two words: ‘Mommy instinct’.

*

At a public forum entitled ‘Speaking about Sex in Silent Spaces’ held at the University of California at Berkeley in 1999, a middle-aged man stood up and relayed the following story to a hushed crowd:

So it was a weird thing, we're using a condom but we're talking about ‘yeah, I'm going to come inside you and I'm gonna fuck you without a condom,’ that sort of thing. And it was just really hot and very compelling … and we pull off the condom, and we're doing it.

And you know I'm not high, I'm on no drugs. I am who I am. I know what's going on, and it's really hot, it's really compelling. He comes inside me, it's really brief, he pulls out. I get off and I'm nearly in tears now, it's all hitting me like, ‘How could I do this, what did I just do, oh my God. I just broke this intense barrier. I went on the other side.’

(Cotten et al., 1999)

The year 1999 marked the beginning of a resurgence of HIV infection among gay men in industrialized countries after rates of transmission had been on the decline for more than a decade. Between 2000 and 2005, new HIV diagnoses among men who have sex with men in the United States rose by more than 13 percent (Centers for Disease Control and Prevention, 2007), and in Europe they increased by almost 55 percent (Herida et al., 2007). Against the backdrop of declining HIV prevalence among other groups, the group that in many countries has the most access to information about how to prevent infection continues to be disproportionately affected by the virus. There are many possible explanations for this: a feeling that, because of effective anti-retroviral treatments, HIV infection is not so bad, the popularity of drugs like methamphetamines and ecstasy that affect people's sexual decision-making, and, of course, the internet, which makes hooking up for casual sex easier than ever before. None of these explanations, however, can fully account for what happened to the man who told the story above. None of the conventional explanations are able to penetrate that moment when the words this man and his partner were speaking were suddenly transformed into actions, when they ‘went to the other side’.

*

The theme of this book is the relationship between discourse — what we say, write, and otherwise communicate about health and risk — and action — what we actually do in our everyday lives that affects our health. What these three stories dramatically illustrate is the fact that this relationship is not simple or straightforward. Our response to health-related discourse is not always predictable. Sometimes we neglect easily perceptible risks, and amplify ‘virtual’ ones, we give credence to the opinions expressed on internet websites and ignore the assessments of experts, and we even appropriate the language of health and safety in ways that may facilitate unsafe or unhealthy behaviors. These stories show how in communicating about health and risk people draw from a wide range of different sources as diverse as biomedical discourse, television talk shows, and their own sexual fantasies. They also demonstrate that many of the most important conversations that people have around health do not occur in clinics or hospitals, but rather in other places like bedrooms and around dinner tables, and the people who most influence our health may not be our doctors, but rather our sexual partners, our friends, our family members, or our favorite television personalities.

Talking about health in any context is a complicated thing, first because when one is talking about health one is usually talking about other things as well, things like fear, trust, commitment, love, money, morality, politics and death, just to name a few. Second, communicating about health can be used to accomplish many different social actions from making an insurance claim, to making love, to making conversation around the dinner table, and how one talks about it depends on what one is doing with the talk.

It is the aim of this book to show how applied linguistics provides uniquely effective tools with which to understand the complex relationship between how people communicate and the actions that they perform around health and risk, actions like having a genetic test, putting on a condom before sex, and taking a child to be immunized against measles. I will describe the ways applied linguistics can deepen our understanding of how people make sense of and use medical and media texts such as health promotion pamphlets and pharmaceutical advertisements, as well as how they conduct interactions around health and risk both with professionals like doctors and nurses, and with other people like friends and family members.

Health and risk in the twenty-first century

Although the main aim of this book is to review the kinds of contributions applied linguistics can make to our understanding of health and risk, an equally important aim is to demonstrate how attention to health and risk can challenge applied linguists to more fully engage with a number of fundamental issues associated with communication in post-modern societies: issues arising from the changing nature of expertise and authority, the erosion of traditional social, disciplinary and institutional boundaries in many domains of life, and the increasing role of technology in mediating our experiences.

The multiple ways in which health and risk are constructed in contemporary societies are complex and paradoxical. At no time in history have humans enjoyed longer lives and better health and had access to such sophisticated tools for assessing and addressing health risks. At the same time, these incredible advances in biomedicine and public health seem to have engendered among many people more rather than less anxiety about their health as they find themselves having to negotiate an increasingly voluminous and contradictory array of health-related discourses. In the 1980s the cultural critic Paula Treichler (1988b) used the term ‘epidemic of signification’ to refer to the discursive environment surrounding AIDS. Today this term seems an apt description of the discursive environment around health in general. Discourse about health and risk has reached ‘epidemic proportions’.

What is ‘health’?

One major reason for the proliferation of discourse about health and risk has been the shift in industrialized countries from a preoccupation with communicable diseases like tuberculosis and polio, to a focus on chronic conditions like heart disease, cancer, and other illnesses related to lifestyle and behavior, primarily thanks to advances in antimicrobials and hygiene throughout the twentieth century (Institute for the Future, 2003; Lalonde, 1974). What this has meant is that, at least in richer societies, illness has come to be seen less as a result of external risks and more as a result of individual behavior. The focus of health-related discourse has moved away from the curing of illness to the maintenance of health.

There has also been a discursive ‘upping of the ante’ in the way we define health. No longer is it just a matter of being free from disease. It is now, according to the World Health Organization's 1978 Alma Ata Declaration, something much more ambitious: ‘a state of complete physical, mental and social well-being’. While this redefinition is useful in highlighting the important psychological and social dimensions of health, it is hard to imagine many people who would describe themselves as being in this state. Instead, the ‘worried well’ of the developed world find themselves spending more and more time and money in search of a seemingly unattainable state of ‘wellness’, a state which they are meant to display to others through a combination of ways of speaking, and behaviors around diet, exercise, fashion, and drug and alcohol consumption (Davison and Smith, 1995; Skrabanek, 1994). In other words, health has become not just a matter of physical, mental and social well-being, but primarily a discursive exercise of constantly reproducing ‘health’ in our daily lives as part of ongoing identity projects (Giddens, 1991; Kellner, 1992). The consequence of this has been the increasing ‘medicalization’ of everyday life in which nearly every moment is the potential site of a ‘health decision’, whether it has to do with where we live, what we eat, who we have sex with, or what kinds of consumer products we buy (Lupton, 1995; Prior, 2000).

At the same time, the access laypeople have to knowledge about health and risk is also changing. No longer solely the property of experts, medical information circulates freely through the print and electronic media, public discourse, and the everyday conversations of laypeople, being constantly reinterpreted and repackaged as it moves from scientific journals to newspaper reports to online social networking sites to dinner-table conversations. On the one hand, greater and greater hopes are pinned on biomedical advances as the solution to all of our woes, while on the other hand, people are increasingly skeptical of biomedical discourse, which seems every day to yield a different set of pronouncements about what's ‘good for us’ and what's not. The more we are able to calculate and ‘manage’ our health risks, the more uncertain and unpredictable our lives seem to become (Beck, 1992).

The new ways health and illness are coming to be defined and represented in discourse present a number of challenging questions for applied linguists: questions about the ways social practices and social identities are constructed, maintained, promoted and undermined in texts about health, questions about how meanings associated with health and risk change as they travel from genre to genre and context to context, and questions about how particular discursive constructions of health and illness create affordances and constraints on how people can think about their health and what they can do about it.

Interacting around health and risk

Along with these changing discursive constructions of health and risk in public discourse have also come dramatic changes in the ‘interaction orders’ (Goffman, 1983) within which people negotiate health risks and exchange health-related goods and services. Since the 1950s expectations about how health professionals and their clients are supposed to treat each other have undergone a profound transformation. The most prominent aspect of this has been a move away from expectations that patients comply unquestioningly with doctors’ instructions towards models in which medical consultations are seen as exercises in ‘shared decision-making’. Much of the impetus for this change came out of a realization within the medical establishment itself in the 1970s and 1980s that more patient participation in care resulted in better health outcomes (Katz, 1984; Korsch and Negrete, 1972). Since the mid-1980s, ‘effective communication’ has regularly been championed in the medical literature as an essential aspect of effective clinical care (Armstrong, 1984; Lupton, 2003).

At the same time, with the increasing fragmentation and specialization of health services, the number of different kinds of professionals people interact with around their health has increased, and these different professionals often speak ‘different languages’ and structure interactions with clients differently. Furthermore, within institutions, healthcare workers from different disciplines are increasingly required to interact in teams in which they must be accountable not just for their professional differences but also for their different ways of communicating (Iedema, 2003a; Iedema and Scheeres, 2003). People also regularly engage in conversations about health with people outside of mainstream medical professions, like massage therapists, yoga teachers and health food store clerks, not to mention financial advisers and the representatives of insurance companies. Finally, with the heightened awareness of health and risk in everyday life, more and more of our daily interactions around activities like eating, sex, shopping, parenting, work and recreation have become occasions for conversations about health and risk.

These new orders of interaction around health and risk also present a number of challenging questions for applied linguists, questions about what constitutes ‘effective communication’ in healthcare encounters and whose agenda it is designed to promote, questions about how people in various settings enact and negotiate power and expertise around questions of health and risk, and questions about the new kinds of discursive demands that are being made on people both inside and outside of institutional settings in encounters having to do with health (Sarangi and Roberts, 1999).

Technology and the body

Yet another important change in the way we communicate about health and risk has to do with the fact that, more and more, our experiences of our bodies are mediated through technologies of representation like laboratory tests and high-tech scans. One consequence of this is that the body as an object of medical knowledge has become increasingly separated from the actual physical body of the patient (Atkinson, 1995; Berg and Bowker, 1997; Iedema, 2003b). Doctors spend less time examining their patients' bodies, and more time examining texts about these bodies, to the point where some fear that the ability to make an accurate diagnosis using a physical examination is a...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of illustrations
• Acknowledgements
• Transcription conventions
• 1 Communicating health and risk
• 2 Applied linguistics: discourse in action
• 3 Entextualizing health and risk
• 4 Sites of engagement
• 5 Beyond the clinic
• 6 Health, risk, and the entextualized body
• 7 Virtual bodies
• 8 Cultures, communities, and social networks
• 9 Conclusion: discourse itineraries and research itineraries
• References
• Index