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date: 17 October 2017

A Culture-Centered Approach to Health and Risk Communication

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Communication. Please check back later for the full article.

Health and risk are constituted globally amid structures of unequal flow of labor, capital, commodities, and communication, shaped by the material inequalities in the distribution of resources. Globalization—the accelerated flow of goods, people, services, and capital across spaces—has been accompanied by large inequalities in economic access to resources; inequalities in access to health opportunities, health resources, and health care services; and inequalities in health outcomes (reflected in mortality and morbidity rates). Disparities in health outcomes observed within and across nation states are shaped by economic inequalities, noting the structural determinants of health, the inequities in access to health services, as well as the local-national-global policies that constitute health. Drawing upon the foundations in postcolonial and Subaltern Studies theories, the culture-centered approach (CCA) examines the communicative processes by which marginalization takes place in global contexts and the ways in which health risks and vulnerabilities are constituted amid material inequalities in distributions of resources.

With an emphasis on the processes of erasure of diverse voices, the CCA asks the question: What are the processes, strategies, and tactics through which the voices of subaltern communities are erased? The access to communicative spaces, platforms, strategies, and tools is shaped within material structures, thus shaping messages, processes, and discourses within the agendas of powerful political, social, and economic actors with economic access to resources. The disenfranchised, with limited access to the communicative spaces and to the spheres of voicing, are often absent from the discursive spaces where health policies and programs are discussed, the sites where interventions are planned, and the processes where communicative strategies targeting them are carried out. The agency of the subaltern is erased from the sites of recognition and representation where policies are debated, decided upon, implemented, and evaluated.

Connecting communication to materiality, the CCA suggests that erasure of the subaltern sectors of the globe is tied to their material disenfranchisement. Materially disenfranchised communities are missing from the policy platforms that target them through a wide variety of interventions. To understand the unequal distribution of health resources and opportunities, we need to closely examine the inequality in opportunities for having a voice and for participating in decision-making structures and processes. Putting forth the argument that inequalities in health outcomes need to be situated amid economic structures that determine how health resources will be distributed and the ways in which these mechanisms will be discussed and determined, the CCA foregrounds strategies for listening to voices that have hitherto been erased. Through strategies of listening, locally grounded understandings are placed within the discursive spaces of policy formulation and program development. In understanding the health experiences of communities that experience poor health outcomes, the emphasis is on creating spaces for listening that foreground local experiences, interpretations, and understanding. Alternative imaginations of the political economy of health are rooted in the voices of local communities at the margins, foregrounding contextually embedded interpretive frames for organizing health, healing, and curing.

Communication is understood in relationship to materiality, acknowledging the interplays between the symbolic and the material in generating health risks and vulnerabilities, and further suggesting strategies of resistance and participation that seek to invert these inequities by foregrounding subaltern rationalities of health and wellbeing. The presence of subaltern voices brings forth alternative imaginations of health, offering new theoretical frameworks that point toward alternative ways of structuring health, economics, and politics. Attending to differentials in distributions of material and communicative infrastructures, the CCA resists the marginalization of the subaltern sectors through the foregrounding of opportunities for local grassroots participation, in the definition of problem configurations and in the corresponding articulations of locally meaningful solutions. The presence of subaltern voices in discursive spaces offers alternative logics of political and economic organizing that challenge the commoditization of health as private property and suggests ideas of health rooted in community life, sustainable practices, and cooperative economies. Local interpretations of health are foregrounded, situated in relationship to the structures within which these meanings are constituted and fostering openings for imagining new structures of health grounded in local understandings. These local understandings offer entry points of solidarity for re-envisioning global practices that challenge the hegemony of neoliberalism as a universal solution to health and development.