How we communicate about health is just as important as what we communicate

How we communicate about health is just as important as what we communicate

The manner in which we advocate and discuss health topics in our conversations with others plays a significant role in the difference we make. A few weeks ago, I was listening to an episode of one of my favorite podcasts, Plant Proof by Simon Hill, featuring a convicting conversation with Harvard-educated psychologist Dr. Melanie Joy. Dr. Joy is a vegan activist who specializes in relationships, social transformation, and communication. Though her discussion focused on veganism, she unpacked a lot of important lessons that are easily transferable to the ways we discuss matters of public health.

During the episode, Dr. Joy noted the transformative power of communication, pointing out that “people respond to the process more than the content […] We need to be careful to not allow the content to override a healthy relational process. Talking about social justice doesn’t give us license to communicate any way we want.” She points to the dangers of having a toxic attitude of moral superiority that aims to elicit shame, a destructive human emotion she labels the “Achilles heel of human functioning”. Eliciting shame with attitudes of moral superiority damages connection, causes the receiver of our communication to reflexively build defensive walls, and ultimately inhibits change or productive results.

Instead, Dr. Joy challenges us to “honor the dignity of others” and compassionately “[respect] intrinsic worth” in our activism, clarifying that she is not endorsing pacifism or neutrality but rather encouraging that we actively “hold people accountable without [also] damaging their dignity.”

This is not intended to support the avoidance of any discomfort. Without discomfort, there is no press for change. However, this is about making an effort to recognize the multiple systemic mechanisms and ego defense mechanisms behind people’s choices and beliefs rather than tying those choices and beliefs to their intrinsic worth as fellow human beings. This is about supporting change that stems from constructive levels of guilt, rather than shame.

Differences between guilt and shame, including their implications, are widely studied in the world of psychology. Guilt is cited as a psychological discomfort rising from the belief that we have done something wrong or acted against our values. Shame is cited as a painful and humiliating feeling arising from the belief that we are inherently flawed and unworthy. Guilt can be constructive, as the wrongness is tied to one’s actions rather than their inherent worth, thus carrying the potential to motivate change. Conversely, shame is incredibly destructive, as the wrongness is tied to one’s core value and worth, thus leading to defensive responses that reinforce current behaviors rather than inspire change. In fact, a 2014 study published in Psychological Science (Tangney, et al) demonstrated this by showing former inmates who expressed feelings of guilt had lower rates of recidivism (re-offense) than those who expressed feelings of shame. Similar concepts stand behind the success of motivational interviewing and the (very necessary) shift away from patriarchal approaches to practicing medicine.

As advocates of public health, HOW we advocate – not simply what we advocate – is unquestionably important in our ability to achieve change. Our careers are unique in that our actions and words have consequences on human lives, human wellbeing, and human health. And if we enter discussions with others who hold beliefs antithetical to our public health efforts with an air of moral superiority, aiming to shame and label the other person rather than trying to compassionately engage in constructive conversation, then we are failing. If shame prevents change and causes others to defensively become locked in their beliefs, why are we using this tactic? We are doing a public health disservice by partaking in communication behaviors that remove any chance of inspiring change.

This past year has been full of public health crises. As activists, advocates, and professionals in public health, it is difficult and exhausting and disheartening to witness and listen to others who hold beliefs that go against our public health efforts. When a front-liner who experiences the worst horrors of this pandemic daily sees others who believe or act like the pandemic is fake, it can feel incredibly hurtful. As health experts, it can be hurtful, offensive, and frustrating for people to invalidate or nullify your expertise. It is natural for public health professionals to feel anger, sadness, moral injury, burnout, and even contempt when others – especially loved ones – are engaging in practices that contradict your public health efforts. So how do we go about making this change?

1. Invest time in self-awareness. Examine your own human emotions before engaging in any form of health communication. How do you feel in the moment? How might these feelings affect your manner of communication? How might these feelings affect how your message is received? Do you need to take time to allow potentially destructive emotions to resolve before engaging in constructive communication?

2. LISTEN. Listening is such a huge part of communication, especially in communication efforts you are hoping will inspire change. Why does this person hold these beliefs? What are their beliefs regarding your side of things? Try to identify any systemic reasons this person may be so ingrained in their beliefs rather than jumping to the conclusion they are simply a horrible person.

3. Think about your words. Think about how your words, especially if engaging in virtual communication, are going to be interpreted. This is not about the content of your message, but rather the tone of your message. Do you have the time and bandwidth to ensure your communication is as constructive as possible right now? If not, refrain from engaging in-the-moment and schedule a future time to allow for fruitful conversation.

4. Avoid labeling. Labeling people as corrupt, rather than their actions or behavior, is frequently correlated with feelings of shame. It also gives the impression that you are “inherently superior”, which again, is destructive and elicits feelings of inadequacy. This is not to condemn calling out dangerous, wrong, destructive, or corrupt behavior. However, labeling others in a personal way that threatens their inherent virtue is more likely to build those defensive and stubborn walls than productively eliciting feelings of guilt which lead to reparative behavioral change (i.e. I did wrong, not I am bad).

5. Aim to have more REAL conversations. The more conversations we have, the more opportunities to engage in healthy communication and make a habit of it. These days, we are so quick to leave a comment on a social media post we disagree with, which opens the door for fruitless communication (refer to point 3) that only stirs up anger and perpetuates divisive walls. It removes any demand for one to truly listen to the other party (refer to point 2); and further, only about 7% of communication is verbal (i.e. what you say), with the other 93% made up of non-verbal components like tone and body language. Virtual communication can be constructive, but one must commit to ensuring it is done properly. Let us otherwise make a goal to have more intentional and real conversations with others. Though face-to-face discussions may be few and far between in a pandemic world, phone calls and video calls can be more constructive than hiding behind a façade of text.

At the end of the day, the reality remains: some people will never change, no matter how “correctly” you communicate. But as public health professionals, advocates, and activists, we can at least do a better job at increasing our odds of change by intentionally improving the way we communicate.

Interested in learning more about the role of communication in public health? We at BMGC are beyond thrilled to announce the theme of our inaugural virtual conference – Health Communication: Why it Matters and How We Can Improve. More information to come soon. If not already, sign up for our mailing list and follow our Facebook, Instagram, and Twitter to receive conference-related announcements and updates!

We want to hear from you! BMGC would love to hear your thoughts about this topic in the comments section. Here are some discussion questions to get you started:

1. What are some of the biggest communication challenges you have encountered in your public health efforts?

2. What are some other barriers to effective communication? What systemic challenges prevent change in beliefs and behavior? What are some ways we, as public health professionals, can effectively address these?

3. How does the information from this article apply to issues of social justice and ethics/humanities? Are shame tactics and labeling acceptable when addressing things like racism, white supremacy, etc.? For example, when addressing a racist comment made by a family member: what are the pros and cons of saying “what you said was racist and harmful” versus “you are a racist”?