Interview with Specialty Chief Editor Professor Mohan Jyoti Dutta on a culture-centered approach for community-driven health communication for addressing health disparities.
Your work focuses on a culture-centered approach — what does this approach mean and how is it utilized?
A culture-centered approach to health communication makes the argument that when you think about the basic health challenges in the world today, you need to think about them in terms of structural inequities and conditions that constitute those health experiences.
It is a paradigm shift in terms of how we think about doing health communication – from a situation where most health communication comes from a message-based behavior approach to one of community advocacy and building communicative infrastructures.
We need to anchor culture at the center. This means creating spaces for cultural voices to make articulations about their health needs. When we talk about grounding health needs in cultural communities, that also means that when creating spaces for cultural voices, those are engaged with what we know in terms of signs, evidence and overarching structures, and finding sites of community organizing to best organize structures to enable the health of communities.
A culture-centered intervention goes all the way from building a hospital infrastructure to a public health infrastructure, to community spaces for community members to practice their cultural artefacts, their song, dance, and art, because those are also resources for building health. This opens the conversation on health, talking about structural inequities, and redefining health beyond the narrow biomedical framework to look at cultural resources that enable health.
Your Specialty Grand Challenge explains the challenge for health communication scholarship is to interrogate the discipline’s fundamental assumptions, and how these assumptions perpetuate inequities in health. What form do these inequities take? What are these assumptions and how can we challenge them?
Structures are fundamentally economic and material. The way in which local economies and workplaces are organized, the way in which healthcare delivery is organized and the way in which prevention is organized, schools, neighborhoods and childcare centers, are material physical structures. But structures are also communicative.
The fundamental argument of the culture-centered approach is that we need to think of these physical structures as symbolic and communicative, so that communities can articulate what their health is in ways that are meaningful.
One easily accessible example of structure is the extent to which domestic workers in Singapore have access to healthcare. What you find is that, even though in the policy guidelines it states you need to insure your domestic workers, there are limits to the kind of insurance that domestic workers can access. As a result, when domestic workers get sick in a serious way they are without access to healthcare and often they are sent back to the countries they are from – that’s the kind of precarity and protection they do not have and an example of a structure of healthcare organization. But it is also communicative, because domestic workers don’t have the rights of citizens, they don’t have the rights of articulating these needs, they aren’t represented by unions and have no rights of collective bargaining, and so their voice is also erased. The absence of these communicative infrastructures for communities are intertwined with the absence of health infrastructures.
There is a lot of work suggesting poverty passes down intergenerationally. If your parents are poor, it is quite likely that you would be poor due to limited access to educational opportunities for upward mobility. Limited opportunities for employment also have an impact. For example, garment workers in Bangladesh work in extremely limited conditions without collective bargaining rights but also in an environment that is fundamentally toxic. You have buildings that are falling apart and no mechanism for fixing this because it is a ‘rush to the bottom’ kind of economic logic – there is no thought about the nature of workplace. The kinds of rights they do or do not have access to has an impact on their health.
The challenges are fundamentally economic and political, and that is the challenge in redefining health communication because the dominant power structures in society are invested in keeping those structures intact.
The powerful political and economic actors in any social system are not invested in giving over or transforming power to create conditions that would be healthier. That really is the uphill challenge of culture-centered health communication.
One of the anchors to how we do our work is redefining health as a human right. When we start to define health as a human right and therefore as a universal right, and when you are working through those local cultural contexts to leverage the claims to rights, health communication looks like media advocacy, communication advocacy working in solidarity with communities in the margins.
Health communication becomes a communicative claim to social justice and human rights within the lens of health.
What are the key aims of your section?
There are some fundamental issues in defining health communication as a human rights issue. I am hoping that in the section we increasingly get submissions that start questioning the organizing logics of society and the ways in which these structures put communities in the margins, the ways in which logic deprives access of communities to health.
Secondly, I hope that we start seeing more scholarship in Health Communication that explores how we can change structures. If you think about the world in which we are living today it is entirely an unhealthy and precarious world brought about because of directions in politics and economics. The question for health communicators is how we can change the status quo, toward producing forms of politics and economics that are humane, just and healthy. I hope to see more submissions that are connected to questions of what is humane. Workers in China are working in electronic manufacturing, exposed to toxic chemicals, which is basically inhumane. How do we find ways of transforming these basic inhumane structures?
That is the task of communicators — I don’t think we as a discipline have started to grapple with the tools and strategies we need to create a more just and humane world healthier for everyone.
Finally, taking seriously the concept of culture, tied to the ideas of participation and listening. How do we build infrastructures for participation, so that the marginalized have access to platforms where they can articulate their needs and work toward finding structures that are meaningful to them?
Can Open Access help?
Open Access can partake in this. There are two ways in which Open Access can do an amazing job.
Firstly, in finding a way to bridge between academics and practitioners because nothing can be done meaningfully without engaging practitioners. One of my hopes is that with this section we will generate not only academic articles offering prescriptions, but also academic articles thinking about the practice through the process of practicing, accessible to practitioners.
Secondly, in revolutionizing where and how knowledge is produced this is an incredible opportunity to Open Access to communities in the Global South and build truly global relevance.
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