Silence as a Risk Factor for Health Disparities

Having been raised in the South by my grandmother, I was taught there were topics that were inappropriate to discuss in public. There often was a culture of silence around issues of sexuality, marital infidelity, homophobia and other forms of sexual difference, poverty, neglect and abuse, and specific health problems people were experiencing. It wasn’t that people didn’t talk about these matters; they just didn’t regularly talk about them in public spaces. Instead, we whispered about them in safe, private spaces with people who shared our sensibilities. Any public talk that would expose, embarrass, alienate, or bring harm to a member of our family or close social network was avoided. While some of this silence was meant to be protective, there were unintended negative health consequences that emerged.

In this blog I argue that a culture of silence continues to exist in some communities, and that silence can be a risk factor for health disparities. In deference to scholars like Paulo Freire who have more fully and theoretically described the existence of a “culture of silence,” my purpose is more practical and interpersonal in that I want to spark a conversation about ways silence can undermine important health decisions and enable preventable health disparities. I conclude with the idea that giving voice to issues that have been silenced and related to health outcomes might contribute to reducing and eliminating health disparities.

A risk factor is a characteristic, condition, or behavior that increases the possibility of disease or injury; a factor that causes a person or a group of people to be particularly susceptible to an unwanted, unpleasant, or unhealthful event; and, any factor, based on epidemiological research, known to be linked to a particular disease—e.g., smoking and lung cancer; red meat and colorectal cancer; sedentary lifestyle and heart disease. Silence – experienced as quietness; as a refusal or inability to mention, comment or express a concern about an issue; as concealment and/or secrecy – is a form of communication and likely present in all cultures. Meanings ascribed to silence do vary by context, culture and cultural groups. From the health standpoint, periods of silence and solitude can be physically and mentally invigorating particularly given the noise and demands of contemporary lifestyles. For example, positive health benefits have been associated with meditation. This silence is encouraged. However, silence is problematic when it contributes to a culture that perpetuates misunderstanding, inaction or avoidance of issues that impact the community’s health.

For example, African Americans are the racial/ethnic group most affected by HIV. Most (85%) of African American women with HIV acquired it through heterosexual sex. Removing the silence that inhibits real talk about the attitudes, beliefs, and practices that enable this epidemic, coupled with the policies intending to increase access to HIV screening and treatment, can reduce this disparity. Being obese is a stigmatized condition in the U.S. Uncounted women of color are struggling to be healthy (physically and mentally) while trying to survive and thrive in stressful professional, social and economic environments. They are silent about their struggles – lest they be viewed as not up to the tasks before them – even though it is vital for them to share the challenges they face in order to overcome them.

Let’s talk to each other about our weight, activity patterns, and dietary practices in public and private spaces with empowering information and testimonials. Let’s create a space in private and in public to talk about intimate partner violence, the truth about our relationships, and what we need in order to experience quality life and good health. Be open to discuss, interrogate, and understand difference in the human experience. There is power and freedom in knowing when to be silent and when silence is a risk factor for poor health and health disparities. What conversations are you not having that could help eliminate health disparities and improve your own health?