Health Equity Considerations for Developing Public Health Communications

Overview

When developing public health communications, consider the following:

• Build a diverse workforce throughout levels, including leadership positions; consider the benefits of hiring people from the communities you serve, including those who are disproportionately affected, and who "look and sound" like the communities you serve.
• Work with community partners to identify priorities and strategies, including the need to build community awareness and acceptance, before communication products are developed and released.
• Avoid jargon and use straightforward, easy to understand language.
• Ensure information is culturally responsive, accessible, and available. Information should represent people in the communities for whom the information is intended.
  • Similarly, ensure that information is available in appropriate formats (for example, audio, video, braille or large print formats, visual/graphic imagery).

Images used in communications

Decide whether a particular image or set of images (including infographics) is culturally appropriate, clear and inclusive for diverse audiences, and not unintentionally reinforcing stereotypes or perpetuating health inequities. Include members or representatives of your intended population of focus in the decision-making and review process, and include representatives from diverse racial/ethnic and cultural populations when reaching the general U.S. population. See Inclusive Images for more information.

Note: Some images are not understandable to people with disabilities. Emphasize the need for alt text and/or ensuring webpages don't include graphics that cannot be understood by a screen reader as the main source of guidance.

Avoid the following:

• Always using traditional or cultural dress images (for example, American Indian or Alaska Native person in a headdress, Asian person in cheongsam or hanbok, Black or African American person in a dashiki).
• Showing inequity with status in images (for example, patient is a person of color and the doctor is White; person who is homeless is shown as a person of color).
• Images that perpetuate unhealthy body images (for example, models in pictures are all excessively thin or enforce narrow standards of beauty).
• Caricatures of any racial or ethnic minority group (for example, red-inked caricature of American Indian or Alaska Native persons, yellow-toned Asian persons).
• Using illustrations, cartoons, or humor carefully; humor can sometimes be based on inappropriate stereotypes.

Gender, ability, and race or ethnicity representation

Consider the gender, ability, and race or ethnicity of the people in the images used in communications. Avoid stereotypes and ensure equity with status.

Gender representation should be diverse (for example, not only women as parents, not only male physicians or female nurses), and depictions of families should reflect a variety of family structures as well as racial and ethnic groups. Show people from communities of color in leadership positions – as clinicians, speakers, etc. Do not only show them communicating with other people in their communities.

Include persons with visible disabilities in any communication, not just those focused on ability status.

People from diverse racial/ethnic groups should be represented in images, where appropriate and to the extent feasible; however, images should avoid unintentionally conveying that the efforts to address disparities are the responsibility of the people experiencing the disparities.

If you need to bring out certain characteristics of people in images, such as gender expression, sexual orientation, race, ethnicity, age, religion, where they live (rural, urban), or disabilities, make sure these characteristics are portrayed in positive ways, and consider using lifestyle photos that show people engaging in everyday activities.

Only use cultural artifacts, products, or other things when they have appropriate meaning to the communications (for example, colors have specific, sometimes different meanings in various cultures). Consider whether depicting people in ceremonial or traditional garments is appropriate or necessary and whether such depictions are used uniformly or only for certain population groups.

Considerations to improve cultural responsiveness

Insufficient consideration of culture in developing materials may unintentionally result in misinformation, errors, confusion, or loss of credibility. Ideally, images should be created by communication professionals from that culture. Please check materials for the following:

• Are there words, phrases, or images that could be offensive or stereotypic of the cultural or religious traditions, practices, or beliefs of the intended audience?
• Are there words, phrases, or images that may be confusing, misleading, or have a different meaning for the intended audience (for example, if abstract images are used, will the audience interpret them as intended)?
• Are there images that do not reflect the look or lifestyle of the intended audience, or the places where they live, work, or worship?
• Are there health recommendations that may be inappropriate for the social, economic, cultural, or religious context of the intended audience?
• Are the toll-free numbers or reference web pages, when applicable, included in the document in the language of the intended audience?
• Are resources such as teletypewriter or chat functions available?

Materials should be translated into the preferred language of the intended audience, and a native speaker should review once the material has been translated. Work with community members, leaders, and population-specific experts to develop content.

Considerations of ability to follow guidelines & appropriateness of guidelines

Work with established community leaders and community serving organizations to incorporate needs, priorities, and opportunities into the design of public health interventions tailored for their specific communities. For example, the ability to follow recommendations may vary among different groups and households depending on their particular circumstances and access to resources.

Not everyone has a regular healthcare provider. Additionally, not everyone trusts medical professionals, so guidance to have and talk with a regular primary care provider might not be accepted.

Access to medical and mental health care and needed services (for example, social services, preventive screenings, syringe service programs) might be limited. An epidemic might further reduce access, and some clinics may be closed or have limited hours or alternate services available.

People may not have full control over their work environment/work conditions. Also consider the employer's responsibility to provide certain resources to workers (such as workplaces where respiratory protection is mandated by law).

Adjust recommendations that do not make sense for specific situations, communities, or cultures (for example, asking people in Florida to go to a basement during a hurricane or asking people in Caribbean areas to use long sleeves or closed shoes to avoid mosquito bites).

Disability

Information should be made available in accessible formats (for example, large print, braille, American Sign Language, closed captioning, audio descriptions, plain language) for people with vision, hearing, cognitive, and learning disabilities.

Ensure equal access to public health services for people with disabilities and operation of disability services before, during, and after public health emergencies.

Mental health & behavioral health

Disparities in mental health outcomes are a public health issue that should be considered in addition to physical health outcomes.

Consider that people might experience poor mental health outcomes due to multiple factors, including limited access to appropriate, accessible, and affordable mental health care services; cultural and social stigma surrounding mental health care; experience with discrimination; and other factors.

People may experience symptoms of poor mental health or mental illness that are undiagnosed, under-diagnosed, or misdiagnosed.

Older adults

Age and associated risk are often a continuum. Risk for many diseases and severe outcomes increases with age, with increasing risk among middle-aged adults, and older adults being at highest risk.

Guidance should be tailored to specific setting of interest within this age group (for example, community dwelling, those living in multigenerational homes, those living in long-term care facilities or nursing homes, those living in retirement homes). Communication and outreach efforts should be tailored according to audience-preferred channels and platforms.

Signs and symptoms of many diseases and conditions may sometimes be atypical, delayed, or attenuated in older adults.

Consider risks to caregivers of older adults as well; caregivers themselves are often older adults or may have other risk factors.