Most of the readers of the Journal of Health Communication clearly
value health information, scientific inquiry and the epistemological
and ontological approaches of what contributes to health. Nonetheless,
the progress in how we communicate health presents new challenges.
Some diagnose today’s information age as a wild, wired world.
Others look to the new technologies as a panacea to further harness
our understanding of health. While it is impossible to predict
the ultimate impact of technology on humankind, we undoubtedly are all
engaging in a redefinition of the world “as we know it” today.
The progress in health and communication is staggering. But few
continue to stir debate more than the advances in biotechnology.
The successful mapping of the human genome along with the understanding
of the genetic structure of plants and animals present new opportunities
to enhance public health.
If one looks back to the early part of the 20th century, goiter, rickets,
and scurvy were relatively common in the United States. The response:
fortify milk with vitamin D, cereal grain with vitamin B and flour with
other nutrients. After such direct vitamin deficiencies were reduced,
the nutritional intervention matured to address the known relationship
with diet and chronic disease, most notably cancer and heart disease.
In the last decade, we have advertisements and labels suggesting low-sodium
foods can help reduce blood pressure, products with soluble fiber can
reduce the risk of heart disease (and cancer), and calcium enriched
orange juice can build stronger bones. Some have direct
links with audiences-at-risk such as foods with added folate for pregnant
women to prevent neural-tube birth defects in their offspring.
In 1990, nearly a third of food advertising dollars was spent on health-related
statements.
In this new century our public health interventions may include a diet
of functional foods, some with limited proven benefit. For lunch
today one could have split pea soup with St. John's wort to “give your
mood a natural lift”, bread made with genetically fortified flour covered
with cholesterol-lowering margarine (made from pine tree stanol esters),
and dessert with carrot cake with heart-healthy (read not cancer preventive)
fiber.
Within our lifetimes, we can choose the benefits of pharming, with
biotechnical impregnation of “vaccines” and other pharmacologic “drugs”
in dairy products, milk, vegetables and meat products for all sorts
of diseases. These may treat infections, prevent cancer, and protect
against communicable diseases. Bioengineering and technological
advances can breed nanoimplants. These may help monitor physiologic
function, deliver drugs, and even alter the genetic structure of their
target.
There are other interventions in the works that we can only dream about
today.
All of these advances are not without critics. The incremental
and imprecise nature of science and experimentation thrives on criticism
and debate. While the shortsighted can point to theoretical causality
and “risk” as well as to a few products that have not delivered on their
advertised benefit, the consequences of such challenges threaten our
public health. Stem cell research, vaccine development, and genomic
manipulation are but a few of the areas under attack. Not to mention
the current public health successes that have lessened morbidity and
mortality: vaccination, air bags, and fluoridation. While scientific
and health literacy require understanding, it is often difficult to
build such capacity in an era when progress and decision-making is compressed.
The challenges to health progress are not in the laboratory, but in
communication; effective communication is not merely transmission of
information that translates into knowledge, or wisdom. Absent
a clear and consistent voice, today’s new media maze catalyzes emotionally
driven health arguments that suggest negative consequences.
The media advances the vocal minorities disconcerted spin on science,
with politicians and policymakers presaging public health. The
political answer: shortsighted simple solutions that thwart and hinder
scientific and medical advances. These decisions are not wise,
but instead kakistocratic.
Many of us in the field of health communication continue to profess
the writings of Aristotle and Plato, who suggested the source of the
message has always been and continues to be the most crucial and fundamental
trait of effective communication. What constitutes the ethos of
the source? One needs to know the identity—the trustworthiness,
predictability and credibility of the source of the information.
From that information, an audience—in this case, the reader—can ascertain
the intent of the message and determine its value and relevance to his/her
daily practice.
A concerted effort to develop a common lexicon in developing health
literacy, risk comprehension, and public health priorities ought to
be developed. Infinitesimal, hypothetical and probable have different
meanings, but not for all readers. There are recent suggested
criteria developed by researchers at Baylor College of Medicine to help
public understanding of: (1) strong statements, (2) substantial statements,
(3) limited statements, (4) minimal statements, and (5) no scientific
evidence. Similarly, Consumer’s Union has suggested a hierarchy:
what we know, what we don’t know, and what we can’t know through the
scientific method. Of course, these have limitations and have
not undergone extensive formative research or development. But,
they can challenge us to develop meaningful labels and methods for comprehension.
Simply put, in the near-term there is a great responsibility on those
in a position to determine what is valuable and salient for their audience.
There is even a higher ethical standard necessary among the purveyors
of health—whether they are those in academia, marketing, publishing,
or (new) media—to maximize quality over quantity of information to facilitate
ideal decision making for the public good.
Ideally, readers and contributors to this journal will continue to
advance ethical communication by providing salient, valuable and factual
information in our quest for truth.
