Connecting Health Equity with Health Literacy through Message Testing

Every October, CDC joins together with other agencies and organizations in observing Health Literacy Month. In addition to raising awareness about the importance of accessible health information for all audiences, the Office of Health Equity (OHE) invites you to learn more about the connection between health equity communication and health literacy.

Reframing Communication Efforts to Explain Underlying Drivers of Inequities

Applying best practices in health literacy through simple and effective communication is important to the overall goal of achieving health equity. OHE conducted message testing in 2022 to learn more about what general audiences think, understand, and feel about health equity, and identify ways to neutralize opposition to messages about health equity. Participants in the message testing were diverse in terms of race/ethnicity, gender identity, social/political views, age, and knowledge on the topic of health equity. Findings from the message testing underscored that in order to effectively address skepticism toward achieving health equity, as well as improving health literacy, we need to reframe communication efforts to explain the underlying drivers of inequities.

Guided by message testing findings, OHE is leading the way in reframing messages to communicate about health equity rather than focusing on health disparities. In doing so, we are shifting the focus to systemic and structural issues and communicating about pathways to addressing health disparities in a meaningful and sustainable way that audiences can understand. This approach encourages strategies to address root causes and boosts broader systems-level changes. We have identified three evidence-informed communication principles and solutions to help other communicators and scientists switch the conversation from the typical approach of naming and quantifying health disparities to a more solution-oriented approach for addressing health equity.

Principle 1: Meet the Audience Where They Are.

This means learning about our audience’s beliefs, attitudes, values, and biases to know which approaches and messages will resonate with them from the start. Knowing our audience’s understanding of and resistance to certain words and concepts, such as equity, equality, and social determinants of health, can help us tailor messages for better reach and reception. This might be shown as using audience-appropriate language, images, examples, and spokespeople to relate messages to the audience’s community and background, as well as framing facts, data, and new ideas with the audience’s values. For example, framing equity—a frequently misunderstood term to audiences who more commonly associate it with finance—as a step toward achieving equality, as many people believe equality to be a foundational value. This can help to avoid unintentionally blaming or stereotyping individuals or groups of people, which also enables the audience to potentially draw new conclusions by reflecting on their assumptions.

Principle 2: Communicate Health Equity as a “We” Issue.

This means building on society’s shared values, interconnectedness, and empathy to help the audience see themselves as impacted by inequities and prevent an “us versus them” mentality. Negatively framed messaging that highlights disparities as the problem instead of as the outcome of the problem may inadvertently create fear in some audiences and thus be less effective in conveying the importance of addressing health equity as an issue. Actions taken to ensure equity for one group of people does not take away from the health of any other group, and can actually lead to benefits for everyone. For example, ensuring that information about vaccines is available in large print helps people with limited vision but does not lead to any negative effects for any other group. Curb-cuts are another example of something initially intended to help people in wheelchairs, but they benefit people with strollers, limited mobility, and more.

Principle 3: Frame Health Equity as Achievable.

This means showing our audience what solutions and successes may look like at different levels, so they believe that health equity is possible. For example, providing examples of how health equity can be achieved in the social and community levels, as well as within public health agencies, healthcare delivery systems, and/or state, tribal, local, and territorial governments, can be helpful for people to understand different perspectives. Framing health disparities as outcomes caused by systems and structures rather than personal behaviors may make people feel that they have limited control to change their health outcomes. This can get in the way of the person’s efficacy, or motivation to take action. For example, using actionable terms when educating the audience about the situations, conditions, and policies that create inequities can show pathways to address disparities that the audience believes are feasible and within their control instead of just highlighting disparities.

Next Steps

Recognizing that this is an area of communication science where more research is needed and that all these principles should be adapted by audience, OHE is currently developing new resources that build upon these concepts. This includes updated health equity infographics and an interactive tool to help public health professionals grasp health equity concepts and how to communicate about them. OHE also used lessons learned from these findings to develop a Health Equity Video Series to help practitioners explain these complex topics. Visit OHE’s Health Equity site to stay up to date as new resources are developed.

What strategies have you used to improve communication about health equity and incorporate into your everyday public health work?