Part 2 – Bridging the gap: how health communications can address health inequalities

Welcome to the second blog in our series “Placing accessibility at the heart of your health communication strategy”.
In this blog, we’re looking at communicating in an accessible and compassionate way with those from low socio-economic groups to help close the health gap. Being able to effectively communicate with and reach out to those from areas of deprivation is an important step in helping to reduce health inequalities – but how do we do it?

What’s in a name?

To start, we need to discuss the debate about how this audience is addressed. You may have heard terms like ‘deprived households’, and ‘low-socioeconomic groups’ used in the past; depending on where you read, you may also see conflicting information on which of these is an appropriate term to use. The term ‘hard to reach’ is also being recognised as inappropriate, as it places the onus onto the audience as opposed to acknowledging the systems and institutions that have created these challenges. Instead of seeing these audiences as ‘hard to reach’, it is really ‘we haven’t worked hard or smart enough to reach people’. Here, we’ll be using variations of ‘areas of deprivation’ and ‘low socioeconomic groups’.

Language matters when addressing any audience and can make or break a campaign.

As health communicators, we have a responsibility to do no harm and to ensure that what we are saying not only resonates with the audience but affirms and empowers them as well. Taking the time upfront to understand the best way of speaking to your audience and understanding their lived experience is fundamental to crafting messages and strategies that make an impact. View our blog on championing the patient voice in health communication programmes for actionable advice you can start implementing today.

Understanding the health gap

To get started, we have to be clear on the difference between health inequities and health inequalities. Health inequities are systematic differences in the health status of different populations, owing to unjust and avoidable differences in the treatment of groups, defined socially, economically, demographically, or geographically (1). Specific examples include structural oppression and barriers based on socioeconomic status, ethnicity, or characteristics such as sex, ethnicity or disability [2]. Health inequity is measured by health inequalities, which are the uneven distribution of health or health information and resources as a result of health inequities. Health inequalities not only refer to the difference in health status and outcomes but also differences in the care people receive and the opportunities they have to live healthy lives [2]. Tackling health inequities requires broad systemic change to address its causes, which is why here we will be focusing on health inequalities, which we can start working to reduce through health communications programmes.

Examining health inequalities requires taking an intersectional view, understanding the ways that certain factors combine and interact with one another in creating health inequalities. These compounding factors will create a different set of implications for the health inequalities they are likely to experience.  Because of this, health inequalities, their causes, and their effects will differ by location, given the unique population being examined.

Health inequalities play a significant role in how people access and engage with healthcare information, as well as the actions that such information may prompt them to take.

Barriers to accessing health information

The barriers and challenges to accessing health information are numerous and varied. Like health inequalities, barriers are related to individuals’ specific sets of circumstances, often compounding one another. For example, an LGBTQ+ person living in a rural area may have greater difficulty in accessing affirming care or accurate and relevant information than an LGBTQ+ person living in a city.

Barriers to accessing health information further widen the health gap, preventing individuals from fully and accurately understanding their health and deterring them from seeking care in a timely manner. Learning to navigate and address these barriers in health communications is also integral to tackling the issue of health misinformation, with variables like health literacy, social exclusion trust, and topical emotions playing a role [3]. Here, we take a closer look at how health literacy, care access, distrust, and the digital divide impact communicating health information to people from deprived areas.

Health literacy

Health literacy relates to both an individual’s ability to understand and use information to make decisions about their health and care as well as reflecting the complexity of health information and challenges in the healthcare system [4]. Poor health literacy may result in individuals struggling to understand healthcare information, which may lead to some not accurately perceiving the risk or severity of certain conditions, the effectiveness of treatments and preventative care, causing them to not seek care. Research has shown that only 42% of UK working age adults understand everyday health information. When that information involves numeracy skills, it increases to 61% [5]. Further, it may contribute to lower health self-efficacy, hampering a person’s confidence in asking questions, advocating for themselves, and knowing when to seek care for themselves and others.

Access to quality care

Easily accessible and high-quality care and information are integral to reducing health inequalities but may be less readily available in areas of deprivation. Despite having a higher disease prevalence, more deprived areas tend to have fewer GPs per head and lower rates of admission to elective care than less deprived areas [6l]. In rural areas, there may be limited access to healthcare services; conversely, in more urban areas of deprivation, services may be overstretched. Inequitable access can lead to some receiving sub-optimal or inappropriate care, or less care relative to their needs, which may impact health outcomes or institutional trust [2]. Language can also present a challenge, not only for patients who do not have English as their native language, but as well as those from ethnic backgrounds or those from the LGBTQ+ community where information should be communicated in a sensitive way. Failing to do so may cause individuals to feel isolated or the thought of real or anticipated discrimination may deter individuals from seeking care.

Lack of trust

Distrust of healthcare providers can greatly impact the success of communications efforts. Distrust of healthcare providers can be rooted in both how marginalised groups have been treated historically or through negative experiences with healthcare providers, such as feeling dismissed, having their pain or experiences minimised, or feeling they are not being heard by healthcare providers [7]. Poor experiences with healthcare providers can lead to mistrust of healthcare information from traditional sources, and it may cause individuals to seek information and advice from alternative sources, such as peers, community centres, or the internet.

Digital divide

Despite seeing a higher increase in using mobile phones to access the internet during the pandemic, over one million people in the UK still don’t have access to internet, whether due to lack of infrastructure or costs [8]. While the internet can be a powerful tool for targeted health campaigns and conveying information, lack of access to internet for some means they are falling through the cracks. Beyond lack of internet access, limited digital skills can also hamper people’s ability to access and understand healthcare information, with those from low socioeconomic groups being more likely to use the internet for a smaller range of activities and have lower confidence in using the internet [9].

How can we reach people from deprived areas with health information?

To overcome these barriers, it’s important to use targeted communications that are rooted in empathy and that are accessible, understandable, and responsive to the unique needs of individuals in areas of deprivation. NHS England released a handy toolkit earlier this year that provides excellent guidance and consideration on communicating and engaging with those from socioeconomically deprived areas. Here, we look at how you can put these into action and start crafting communications programmes that make a difference.

Community outreach

It will come as no surprise that we advocate for some curiosity here, but getting curious about these communities can make a world of difference in devising health communications programmes that make a difference for those from deprived areas. Taking the time to engage with key community organisations, leaders, and other stakeholders can help to better understand the barriers and perceptions that exist in areas of deprivation, shining a light on pain points that might be unique to the population.

When engaging with these communities, lead with empathy and curiosity. Rather than seeing it as an opportunity to dictate, take the time to pump the brakes and learn from those living these experiences. How did we get here? How did it make you feel? What can be done? What does ‘better’ look like?

To take it a step further, some health communications programmes, such as those targeting adolescents and twenty-somethings, may benefit from social listening exercises to develop a more robust understanding of how the audience views a certain topic and what might be shaping this view.

Connecting with valued organisations and community leaders can also assist with raising awareness and getting healthcare information to those who need it most, particularly those who may lack trust in traditional healthcare institutions and place a greater value on the advice and support they receive from community organisations.

Co-creation

Developing materials and creating programmes that acknowledge and respond to the needs, feelings and existing perceptions of those from areas of deprivation can help improve the acceptance of health information. Adopting a ‘bottom-up’ approach and collaborating with people in these areas to co-create solutions and content helps to remove traditional power dynamics, allowing us to better listen and respond to their experiences and demonstrate. Through working with individuals from these backgrounds, we can better create campaigns and messages that people are able to see themselves in, helping to empower them, address their concerns, and build trust.

Transparency and relationship-building

Communications programmes that have a sense of transparency, authenticity, and seek to build relationships can help to develop trust in low-socioeconomic populations. By working to provide accurate and relevant information in an accessible way, those with low health literacy are better able to understand the benefits of treatment. Further, using channels and strategies that present information in a low-friction way can also help with capturing the attention of and building relationships with those from low socioeconomic backgrounds.

Addressing communications inequalities

Communication inequalities, such as low health literacy and language barriers, can be addressed through creating accessible materials. Using plain language and avoiding medical jargon and technical terms can improve understanding among those with low-health literacy, as can using visual aids such as infographics, diagrams, and videos to convey health information or demonstrate how treatments may be administered. The use of clear communications can help to improve understanding and trust among people from deprived areas, as well as building their sense of self-efficacy in accessing health information and advocating for themselves with healthcare professionals. In addition to this, communicating in a way that is sensitive to an individual’s circumstances, such as language barriers or an individual being LGBTQ+, can help ensure information is accessible and affirming, helping to reduce stigma and create trust. Further, training and supporting healthcare professionals at all levels to communicate in a similar way, as well as with empathy, can also help to improve with delivering healthcare information to those from deprived areas. Curious to learn more about accessible content? Check out our first blog in this series here.

Wrapping up

Designing health communications programmes to reach those from areas of deprivation requires a multi-faceted approach, going beyond the surface and involving communities to understand their concerns and identify solutions. By addressing these challenges, communications programmes can help to improve the health outcomes of people living in deprived areas and reduce health inequalities.

Curious about how you can help close the health gap and low socioeconomic groups? Team members at Curious Health have spent years designing and executing targeted, community-led programmes to effectively engage people from deprived areas. Get in touch with us for a chat by emailing st*********@***********th.io 

References: 

1. World Health Organization. Health Inequities and Health Inequalities: 21st Century Health Dynamics and Inequality. World Health Organization; n.d.

2. What are health inequalities? The King’s Fund 2023. https://www.kingsfund.org.uk/publications/what-are-health-inequalities.

3. Nan X, Wang Y, Thier K. Why do people believe health misinformation and who is at risk? A systematic review of individual differences in susceptibility to health misinformation. Social Science & Medicine 2022;115398. https://doi.org/10.1016/j.socscimed.2022.115398.

4. England N. NHS England » Enabling people to make informed health decisions n.d. https://www.england.nhs.uk/personalisedcare/health-literacy/.

5. Public Health England, UCL Institute of Health Equity. Local action on health inequalities: Improving health literacy to reduce health inequalities. Public Health England; 2015.

6. Barlow P, Mohan G, Nolan A, Lyons S. Area-level deprivation and geographic factors influencing utilisation of General Practitioner services. SSM – Population Health 2021;15:100870. https://doi.org/10.1016/j.ssmph.2021.100870.

7. Kapadia D, Zhang J, Salway S, Nazroo J, Booth A, Villarroel-Williams N, et al. Ethnic Inequalities in Healthcare: A Rapid Evidence Review. NHS Race & Health Observatory; 2022.

8. Internet access – households and individuals, Great Britain – Office for National Statistics. Internet Access – Households and Individuals, Great Britain – Office for National Statistics 2023. 

9. Ipsos. Communications and Engagement Toolkit for Socioeconomically Deprived Areas. London, United Kingdom: Patients Association, NHS England; 2023

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Kalyn Carpenter

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