Health Advocacy

← viii | ix →ACKNOWLEDGMENTS

Marifran appreciates her Mom, Berni, and Dad, John, for instilling in her the desire and responsibility to serve others, especially those less fortunate. She also acknowledges all those she learned the motivation for and the skills of campaigning from, including her fellow amputees and her professors and mentors. She also recognizes and greatly appreciates Chervin’s enthusiasm for and engagement with this book project. Without his effort, this project would still be in process.

Chervin wishes to thank Jesus Christ for the opportunity of graduate school, for helping him throughout this entire book project, and for giving him the strength and ability to write for prolonged hours over many months. Chervin also wishes to thank his parents, Thomas and Doris, for their love and support. Lastly, Chervin wishes to thank Professor Mattson for allowing him to co-author this book; although it was a tiring experience, it also was thoroughly enjoyable and rewarding. ← ix | x →

← x | 1 →·1·

INTRODUCTION

It was October 4th, a beautiful fall day. The leaves were ablaze in yellow and orange and the sun warmed my cheeks as I admired the scenery. “It’s a perfect day!” I thought, as I rode my motorcycle with a few friends. It was a picture-perfect day. I was smiling and relatively relaxed; it was blissful. And then it happened. A truck appeared before me. My mind recognized danger, and a flurry of warning signals hit my senses. I had to dodge, but I knew it was too late—the truck was already too close to me. All I could do was scream.

I knew something bad had happened. I lay motionless on the road and looked up at the perfect blue sky, but its beauty eluded me. There was a deafening silence, an eerie gloom that engulfed me. My friends soon surrounded me, and their expressions confirmed that something serious had occurred. I thought to myself, “Well, I’ll let them take care of things here. Maybe I’ll just close my eyes and go to sleep.” But the idea that I might never wake up suddenly seized me. I was afraid. That pretty fall day turned hostilely cold.

It felt like eons before help arrived. A nurse appeared over my right shoulder, and she said “good that y’all used a tourniquet…but it isn’t going to be strong enough.” I knew what a tourniquet is. A tool to prevent blood loss. I suppose someone fitted that on me, but I wasn’t sure. I couldn’t feel pain or comprehend fully the predicament I was in. Someone suggested using a crowbar as reinforcement and ← 1 | 2 →then, having found one, wedged it beside my leg. Suddenly a sharp, disturbing pain seized my whole body, and I yelled out in agony. The pain was so piercing it almost caused me to lose consciousness. Soon thereafter my mind finally grasped what had happened to me. My leg was severed.

During this encounter, Professor Mattson lost two-thirds of her blood and, after briefly visiting a hospital emergency reception and talking with her husband, she was rushed via helicopter to a trauma center. The impact with the truck resulted in the amputation of her leg, and she acquired a prosthetic leg months later. After this accident that changed her life, she began to witness problems within the prosthetic community that she never knew existed. Soon, she led an advocacy movement that addressed those problems. She led a legislative effort that resulted in bill HB1140 being passed and signed into law. For amputees in Indiana, this law grants fair access to health insurance coverage for prosthetics (Mattson, 2010). Some of the content in this book explains and illustrates this concept of championing for policy change that impacts the health concerns of specific populations. This notion is known as health advocacy.

Before expounding on health advocacy, it is necessary first to understand some background information and basic definitions that will lead to a more comprehensive appreciation of what health advocacy is. This information includes a brief history of Health Communication, definitions of health, Communication, Health Communication, and health advocacy. Lastly, the Health Communication Advocacy Model will be explained, followed by an exemplar of a health advocacy initiative for illustration.

Abridged History of Health Communication

Communication as an academic discipline has quite a history and many progressive episodes. Its inception often is attributed to Shannon and Weaver’s Mathematical Theory of Communication, which was developed during the inimical years of the Second World War (Fiske, 2002). Since then, the discipline has proliferated, and its expansion reaches into a variety of areas of interaction such as mass media, organizations, interpersonal relationships, rhetoric, and many more. Extending from the tree of this discipline is Health Communication. This branch is a relatively recent and burgeoning area of study; the Health Communication Division of the International Communication Association was founded in 1975. Prior to 1975, research in Health Communication was ← 2 | 3 →sporadic, but ever since the field has grown exponentially (Thompson, 2003). However, this growth is not merely expansion, rather it is productive advancement. The field of Health Communication also has been a significant contributor to forwarding academia, with journals such as Health Communication making a consistent and significant impact on the social sciences, including disciplines outside of Communication (Feeley, Smith, Moon, & Anker, 2010).

With the size and continuous growth of the field, one might expect scholars to have already reached consensus regarding the definition of Health Communication. Yet, the term still is somewhat obfuscated. Scholars have debated about precise definitions of concepts within the discipline of Communication (Andersen, 1991; Popoff, 2006). Thus, in order to engage in meaningful discourse and study, a conclusive definition of Health Communication has to be established. To achieve this, a perusal of the terms Health and Communication is required. By ascertaining what these two concepts mean, the notion of Health Communication can be better understood.

Defining Health

When discussing the term health, many refer to the World Health Organization (WHO) for its definition, which asserts that “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (2006, p. 1). This definition has been preserved since 1948, but increasingly is met with criticism (Jadad & O’Grady, 2008). One critique is that the idea of being complete is far-fetched and impractical. To be absolutely free of any undesirable condition is a lofty goal especially when taking into account the surge in chronic illnesses (Dans et al., 2011; Hamer & El Nahas, 2006; Strong, Mathers, Leeder, & Beaglehole, 2005). Furthermore, the concept of complete is dauntingly remote and would label most individuals as ill (Huber et al., 2011). Taking this into account, Huber and colleagues (2011) proposed that instead health should be considered “the ability to adapt and to self-manage” (p. 3). That is, to be able to cope independently.

However, the term “independently” should be carefully considered. For example, a person with a disability may be considered independent and self-managing if he or she can make and carry out decisions in the routines of everyday life. This means that requesting and achieving assistance (e.g., assistance into a wheelchair) is a form of independency because the person with a disability had a choice in the matter—from whom he or she requested ← 3 | 4 →assistance, the time to assist, the manner it should be performed, and so on. Therefore, independence does not necessarily mean accomplishing everything single-handedly. Rather, independence involves having the autonomy to decide how life tasks should be accomplished. Furthermore, in relation to health, it would be ludicrous to deem someone with a disability as unhealthy, when he or she is independent and is not suffering from virus or disease (Brisenden, 1986).

It also is essential to understand the components that comprise health. Bircher (2005) suggested that components of health include psychological, physical, and social aspects. The WHO defined mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (Herrman, Saxena, & Moodie, 2005, p. 23). Physical wellbeing, on the other hand, is the retention of physiological equilibrium in the face of a malignant environment (Huber et al., 2011). As for social health, Russell (as cited in McDowell, 2006) suggested that it is “that dimension of an individual’s well-being that concerns how he gets along with other people, how other people react to him, and how he interacts with social institutions and societal mores” (p. 150). These three elements—psychological, physical, and social states—holistically represent the concept of health.

Taking into consideration the aforementioned concepts, we forward the following definition of health:

Health is the ability to cope independently in opposition to forces that disorientate the psychological, physical, or social equilibrium by staying oriented to or realigning to that equilibrium.

Defining Communication

Communication, in its barest and simplest form, is the “process of understanding and sharing meaning” (Pearson & Nelson, 2000, p. 3). This definition suggests that communication occurs copiously everywhere in everyday life. It is present in daily human interactions, organizations, mass media, and in any form of medium (see Akkirman & Harris, 2005; Chen & Huang, 2007; McQuail, 2010). Most often communication involves primarily two parties—a sender of a message and a receiver of the message. In a scenario ← 4 | 5 →where congruent interaction is desired, the former should have clarity and succinctness in delivering a message, while the latter should pay attention and have effective and coherent decoding of the message (Dewatripont, & Tirole, 2005). The message can be verbal and nonverbal—the former being the spoken word and the latter being symbols not represented by language, including gestures, appearance, vocal cues, eye movements, and so on (Knapp, 2012). It is difficult to establish whether these are intentional or unintentional, and there is ongoing debate among scholars over the two perspectives (Andersen, 1991; Motley, 1986). However, most scholars agree that communication occurs only when there is a receiver who takes in the message. Without the recipient of the message, there is no communication (Andersen, 1991). Based on the need for a receiver, communication would only occur if there are two or more individuals. Mattson and Hall (2011) echoed this by highlighting that communication is a transactional process (p. 22), which involves a sender of a message, a recipient, and an avenue for feedback. Although there may be instances where communication is somewhat one-sided (e.g., radio, television), most communication occurs within transactional situations.

Thus, taking all this into account, we offer the following definition of communication:

Communication is a verbal and nonverbal transaction where a message is generated by a sender and received and interpreted by a receiver who provides feedback in an effort to achieve mutual understanding.

Defining Health Communication

Now that the terms health and communication have been respectively elucidated, it is necessary to integrate the two into one single concept: Health Communication. In order to achieve a comprehensive definition, it also is imperative to examine the objective of this discipline and discover how it is distinct from other forms of Communication Studies.

A key goal of Health Communication is to impact people and communities for the betterment of their health (Schiavo, 2007). For example, a $48 million public health communication campaign in Thailand influenced the decline in new HIV infections from 143,000 in the year 1991 to 29,000 in 2000. This included large communicative efforts as 488 radio stations and 15 television stations were utilized to air HIV/AIDS prevention messages each ← 5 | 6 →hour (Singhal & Rogers, 2003). Evidently, such public health communication campaigns have impactful and positive outcomes. The ability to fuse academic findings with practical action can result in huge benefits for society, and there is a need for more scholars to be involved and to engage in greater collaboration with field practitioners (Babrow & Mattson, 2003; Clift, 1997; Nzyuko, 1996). This notion of applying theory to service action is congruent with the service-learning approach, during which learning and engagement intersect. Such a method is increasingly popular in academia, and it is potentially beneficial for academics to adopt because skills and knowledge may be enhanced from community service involvement. There has been incremental use of the service-learning method, and students have experienced the heightening of multicultural awareness through such application (Oster-Aaland, Sellnow, Nelson, & Pearson, 2004). Engaging with people in action is thus a mutually advantageous responsibility that academics, students, and communities can thrive from. Therefore, a crucial aspect of Health Communication is to serve or engage people in improving health concerns.

Health Communication is a branch of Communication Studies, legitimate and distinct from its sibling subfields such as interpersonal communication, mass communication, and organizational communication. There were criticisms surrounding this claim of distinctiveness, but increasingly, it is clearer how Health Communication is truly unique (Nussbaum, 1989). Although there may be instances of interpersonal or media communication processes mentioned in its literature, the settings, agenda, and focus are so markedly different that it has become a field of its own. Also, there are a lot of interpersonal, media, and psychological elements in Health Communication (Ratzan, 1996), but if scholars refuse to accept it as a distinct field, a problem arises in that academics would never agree on which field it should be subsumed under—interpersonal communication, media studies, or psychology. The reason there can be no consensus is because all three are prominently used. The word “used” is stressed because theories and ideas are plucked from these other disciplines as tools to build an academic arena, in this case Health Communication. The utilization of various disciplines is ultimately for the purposes of construction, not imitation.