Dani Filc and Nadav Davidovitch
The medical encounter is one of the most important channels of communication between the patient and his or her caretaker. Apart from its therapeutic effect, the medical encounter serves to convey information about a symptom or disease; construct a diagnosis and give information about the expected course of a disease (“prognosis”); and discuss treatment plans, including risks and benefits. The centrality of the medical encounter makes ethical considerations fundamental, not only within the clinical context but also within the broader context of health promotion. Furthermore, since the medical encounter is characterized by asymmetry and dependence, it can create problems of abuse of power or subordination. The current dominant liberal bioethical approach tends not to take into account the power relations within the medical encounter, or the social context in which the medical encounter takes place. It is in this sense that a republican egalitarian approach to bioethics can be of use. Instead of traditional bioethics emphasis on the individual and on personal autonomy, a radical egalitarian health rights approach will stress the importance of social structures, and the need for a different institutional framework that works toward making a universal right to health possible. Such an approach also emphasizes the centrality of politics in building adequate institutions and in modifying those social structures that cause inequities in health. These considerations have important consequences on how the medical encounter should be constructed, such as in the case of conveying risk and disclosing medical errors.
Amy E. Chadwick
Hope has been defined in primarily two ways, and both have implications for message design within health and risk communication. First, hope has been defined as a way of thinking, or disposition, that affects how people pursue goals. Dispositional hope manifests in beliefs about one’s capacity to initiate and sustain action toward goals (agency) and one’s ability to generate ways to reach those goals. Dispositional hope has been associated with positive physical and mental health outcomes. For example, high-hope women have greater intentions to engage in cancer prevention behaviors than do low-hope women. Numerous studies have associated higher hope with better pain management, and people who are higher in hope have a greater pain tolerance than people lower in hope. Hope is also related to better psychological adjustment.
Much of the research on dispositional hope focuses on correlating hope with a variety of positive health and non-health outcomes; however, psychotherapeutic interventions have also been designed to increase dispositional hope. These interventions have shown improvements in health-related outcomes. Although their potential is not yet realized, interventions for developing dispositional hope could improve compliance with medical recommendations, increase adoption of health behaviors, and decrease risk behaviors.
The second way that hope has been defined is as a discrete emotion. Discrete emotions are brief, intense, psychological, and evaluative reactions directed at external stimuli (e.g., people, events, or objects). In response to these external stimuli, emotions help individuals adapt to their environment by activating a unique pattern of thoughts (cognitions), physiological changes, subjective feelings, motor expressions, and action (or behavioral) tendencies.
Lazarus’s cognitive-mediational theory has been one of the most influential theories of discrete emotions that includes a definition of hope. Lazarus identifies the core relational theme of hope as “fearing the worst but yearning for better.” Lazarus deems hope to be a problematic emotion because he believes hope contains both positive and negative elements. Despite uncertainty about the exact nature of hope, Lazarus believes that hope is vital to coping with stress. Hope enables people to believe in the possibility of better circumstances and therefore is critical as a coping mechanism against despair. Lazarus does not provide guidance for what a message might need to include to evoke hope.
Drawing on Lazarus and appraisal theories in general, MacInnis and de Mello suggest tactics that consumer marketing advertisements could use to induce hope. Specifically, the authors focus on turning “impossibility into possibility” and enhancing “yearning.” De Mello and MacInnis also theorize that hope can lead to motivated processing of information resulting in both positive (e.g., coping, well-being, and goal achievement) and negative (e.g., risky behavior, self-deception) outcomes. Unfortunately, the theorizing of de Mello and MacInnis was never empirically tested.
To further explore how feelings of hope are created, Prestin examined underdog narratives in entertainment media. Underdog narratives show characters who are attempting to meet a goal despite unfavorable circumstances and odds. These narratives evoke hope and make people more motivated to meet their own personal goals. Although their potential has not been fully explored, underdog narratives may assist individuals in overcoming challenging circumstances, such as battling addiction or developing new health habits. There are numerous mechanisms still to be examined that may explain the effects of underdog narratives beyond their ability to evoke hope.
Recently, Chadwick defined hope as a future-oriented, discrete emotion that focuses on an opportunity to achieve a desired future outcome. Her definition builds on the work of Lazarus and Roseman and has implications for the design of messages that evoke hope. According to Chadwick, hope is evoked by appraisals of a future outcome as (a) consistent with goals (goal congruence), (b) possible but not certain (possibility), (c) important (importance), and (d) leading to a better future (future expectation). All four of these appraisals combine to create a perception of opportunity and the discrete emotion hope. Hope motivates behavior by focusing one’s thoughts on capitalizing on an opportunity. Chadwick states that hope also involves (a) an approach action tendency that motivates individuals to take, or continue, action to achieve the desired outcome, (b) increased heart rate and skin conductance, (c) an open facial expression, heightened focus, and alert body posture, and (d) a feeling of eager attention.
Chadwick’s definition has clear implications for developing messages that evoke hope. Messages designed to create appraisals of the importance, goal congruence, positive future expectation, and possibility of a future event evoke hope and are called hope appeals. Like other theoretical explications of emotional appeals, a hope appeal has two components: (a) the inducement of hope through the presentation of an opportunity and (b) the presentation of recommended actions to achieve the desired outcome. The recommended actions component includes information designed to (a) increase the receiver’s perception of his or her ability to perform the recommended action (i.e., self-efficacy) and (b) demonstrate the ability of the recommended actions to achieve the desired outcome (i.e., response efficacy).
Empirically, scholars have tested the effects of hope and messages that evoke hope. Hope appeals increase attention to messages about climate change and increase mitigation behavioral intention and mitigation behavior. In addition, feelings of hope increase interest in climate change protection and are positively correlated with pro-environmental behaviors and support for climate change policies. Feelings of hope significantly predict interest in climate protection, self-efficacy, interpersonal communication intention, information seeking intention, and behavioral intention. Hope and hopeful narratives have also been associated with greater perceived message effectiveness and more agreement with the message content. After a stressful experience that accelerates heart rate, evoking hope decelerates heart rate and decreases state anxiety. This research provides evidence that messages that evoke hope can counter the psychological and physiological effects of stressful events. In addition, researchers have examined the effects of hope on a variety of health, persuasion, political communication, and marketing outcomes. Preliminary evidence indicates that hope appeals are equally as or more effective than guilt and fear appeals at increasing interpersonal communication intention, self-efficacy, information seeking intention, and behavioral intention. In addition, hope appeals create less reactance (anger) than fear appeals. Together these results indicate that hope and hope appeals have substantial potential to influence health and risk behavior.
The focus of intergroup communication research in the Baltic countries is on interethnic relations. All three countries have Russian-speaking urban minorities whose process of integration with Estonian, Latvian, and Lithuanian majorities has been extensively studied. During the Soviet era when the Russian-speaking communities in the Baltic countries were formed, they enjoyed majority status and privileges. After the collapse of the Soviet Union, there was a status reversal as Russian speakers become minorities in the newly emerged national states. The integration of once monolingual Russian-speaking communities has been the major social challenge for the Baltic states, particularly for Estonia and Latvia where they constitute about 30% of the population. Besides the Russian-speaking minorities, each of the Baltic countries has also one other significant minority. In Estonia it is Võro, a linguistically closely related group to Estonians; in Latvia it is Latgalians, closely related to Latvians; and in Lithuania, it is the Polish minority. Unlike the Russian-speaking urban minorities of fairly recent origin, the other minorities are largely rural and native in their territories.
The intergroup communication between the majorities and Russian-speaking minorities in the Baltic countries has often analyzed by a triadic nexus consisting of the minority, the nationalizing state, and the external homeland (Russia). In recent analyses, the European Union (through its institutions) has often been added as an additional player. The intergroup communication between the majorities and the Russian-speaking communities is strongly affected by conflicting collective memories over 20th-century history. While the titular nations see the Soviet time as occupation, the Russian speakers prefer to see the positive role of the Soviet Union in defeating Hitler and reconstructing the countries’ economy. These differences have resulted in some symbolic violence such as relocation of the Bronze Soldier monument in Estonia and the riots that it provoked. Recent annexation of Crimea by the Russian Federation and the role of the Ukrainian Russian speakers in the secessionist war in the Eastern Ukraine have raised fears that Russia is trying to use its influence over its compatriots in the Baltic countries for similar ends. At the same time, the native minorities of Võro and Latgalians are going through emancipation and have demanded more recognition. This movement is seen by some among the Estonian and Latvian majorities as attempts to weaken the national communities that are already in trouble with integrating the Russian speakers. In Lithuania, some historical disagreements exist also between the Lithuanians and Polish, since the area of their settlement around capital Vilnius used to be part of Poland before World War II. The Baltic setting is particularly interesting for intergroup communication purposes, since the three countries have several historical parallels: the Russian-speaking communities have fairly similar origin, but different size and prominence, as do the titular groups. These differences in the power balance between the majority and minority have been one of the major factors that have motivated different rhetoric by the nationalizing states, which has resulted in noticeably different outcomes in each setting.
Norms are regularized patterns of attitudes and behavior that characterize a group of individuals, separate the group from other groups of individuals, and prescribe and describe attitudes and behaviors for group members. Relying on social identity theory and self-categorization theory, the role played by group norms within groups and the processes by which such norms are promulgated within groups are discussed. Norm talk or the communication of normative information within groups is explored, as a major proportion of communication within groups is dedicated to clarifying ingroup identities and group attributes such as attitudes and behaviors that characterize the group. Group members can glean normative information by attending to norm talk for instance, by listening to the content of fellow group members’ communications, from their behavior, and from influential or prototypical sources within the group.
According to self-categorization theory, once individuals categorize themselves as members of a salient group or category, they represent normative information cognitively as ingroup prototypes. Prototypes are a fuzzy set of group attributes (such as attitudes and behaviors that characterize the group) and simultaneously minimize differences within groups while maximizing differences between groups. Thus, clear group prototypes help create distinct identities that are clearly demarcated from other groups. Group members should be especially attentive to information that flows from prototypical sources within groups—such as leaders and ingroup media sources—while efforts should be made to differentiate from marginal or deviant members who deviate from the prototype and reduce clarity of ingroup prototypes. The processes through which attending to information communicated by different sources within groups—both prototypical and non-prototypical—help group members seek normative information and clarification of ingroup prototypes are discussed.
Paul W. Speer and Leah Marion Roberts
Agents of change serve as catalysts for stimulating social change, particularly at community and societal levels of analysis. We often think about the characteristics of individuals who act as change agents, such as their capacity to motivate others or their training skills. However, organizations and disciplinary fields can also serve as agents of change. There is an emerging awareness in the fields of public health and community organizing as to how these respective fields can collaborate to leverage their collective insights and skills to become effective agents of change for community health outcomes. Importantly, while public health is concerned with the social determinants that shape health inequities in all communities, community organizing is focused on community issues that residents confront as constraints or problems in their daily lives. There is an inchoate understanding within the fields of public health and community organizing that the social determinants addressed in public health are often the same issues identified and addressed by community organizing groups.
Both disciplines work as agents of change through their traditional efforts; however, there is promise in the evolving collaborations between these two fields. Recognition that both fields are addressing the same community phenomena is an important step, but whether collaborations and shared practices become distributed and institutionalized is an open question. Public health possesses research and analytic sophistication capable of identifying different social determinants and the pathways through which such determinants contribute to poor community health outcomes. In contrast, community organizing supplies an understanding of social change that requires the exercise of power through the participation and active engagement by those most directly affected by local issues or social determinants. One tension in this emergent collaborative practice stems from the fact that, at times, these different disciplinary skill sets are at odds. Whereas public health has a deep value of data analysis and expertise, community organizing prioritizes the participation and self-determination of those impacted by community problems. Fundamentally, the tension here is between the value placed on expertise versus the value placed on public participation. Neither value is inherently superior to the other; understanding how these two values can complement one another to address social determinants that shape community health outcomes is critical for realizing the promise of these organizational agents of change.
Catherine Chaput and Joshua S. Hanan
Depending on how you approach it, economic justice is either an extremely old intellectual tradition or a relatively new one. From the first perspective, economic justice is part and parcel of classical political philosophy—Plato’s The Republic and Aristotle’s The Politics, for instance, both discuss property distribution in an ideal society, emphasizing the philosophy of justice over economic precepts. From the second perspective, the one we embrace, economic justice is a uniquely modern inquiry that emerged with the writings of Karl Marx and his revolutionary critique of the capitalist political economy. For Marx, economic justice can be understood as a critical enterprise that attempts to locate contradictions between universal and particular conceptions of human freedom and intervene politically into these contradictions with the aim of creating a more just, equitable, and egalitarian society. So conceived, economic justice liberates the collective potential of humanity from its exploitation and degradation by capitalism as well as the various legal institutions it develops to control human behavior for the purpose of extracting of surplus-value. It is this Marxist perspective and the various historical reformulations that it has authorized that influence the way rhetoricians and scholars of cultural studies conceptualize economic justice in the discipline of communication. While not all of these scholars endorse an explicitly Marxist line of thought, they all attempt to conceptualize economic justice as a normative political category that influences various models of rhetorical agency and social change.