The fault lines in healthcare equity in the United States grew to seismic craters during the COVID-19 pandemic. The last two years have underscored just how critical identity is in calculating the impact of diseases on specific communities.
For instance, PBS found that inconsistent data reporting minimized the devastating impact of COVID-19 on Native Hawaiians and Pacific Islanders. This fact was largely hidden because this community was lumped into the Asian category, the “Other” category or not included at all. As Stephanie Sy, a correspondent for PBS NewsHour, noted, “Grouping [Native Hawaiians and Pacific Islanders] in a broad category with Asians, a much larger population, hides their uniquely high rates.”
Instead of relying on old frameworks, healthcare communicators must embrace a new model that will keep up. If we ground our communications in identity, we’re better able to create intentional, multidimensional messaging to help bridge the gaps and form new pathways to nurture healthier communities.
Today’s tools and tactics fall short
Our broad tools for tracking disease state epidemiology do not reveal how specific communities fall through the cracks. If we do not know who is impacted by diseases, then we don’t know how our communications—especially our digital-first strategies—should be shaped. Because of that, people who might desperately need information and support continue to be overlooked.
|This article is featured in O'Dwyer's Oct. '22 Healthcare & Medical PR Magazine
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Digital platforms are usually the first touchpoint for reaching people on critical health issues like preventative testing, clinical trials or vaccine access. That’s why it’s essential to integrate identity—beyond traditional modes of gender and race—into our strategies. Central to the idea of identity is the concept of intersectionality. First introduced by Kimberlé Crenshaw, a Black feminist legal scholar, intersectionality describes our overlapping and intersecting social identities—gender, race, social class, ethnicity, nationality, sexual orientation, religion, age and disability status. As poet, essayist and writer Audre Lorde posited, “There is no such thing as a single-issue struggle because we do not lead single-issue lives.”
We all have overlapping social identities that impact how we experience the world. These identities also influence how we approach our health and experience and talk about and seek out information on specific diseases. Everyone’s entry point into the doctor’s office will not be the same. The future of effective digital health communications lies in embedding intersectionality and centering identity into our processes so that lived experiences, cultural nuances, language, etc., are pulled through in the narrative. When we move identity from the margins to the center, we are more likely to speak to people authentically and to reach their hearts—which is key to influencing behaviors.
More companies are expanding their communications strategies to connect with diverse communities. However, the current tools and methods to build these campaigns lack the framework to ensure cultural relevance, particularly around deeply personal healthcare behaviors. Social listening and audience measurement tools—limited to one-dimensional markers like age or gender—do not adequately capture the realities of our intersectional lives.
We can imagine that a Gen Z woman with eczema would talk about her healthcare journey differently than a Baby Boomer woman. Likewise, we can surmise that Black gay men might use different digital platforms to discuss sexual health compared to Black lesbians. But what are we doing about that? Missing these critical distinctions in the data means we miss communicating effectively with these important groups.
Insights are found at the intersection
To fill this void and give healthcare communications practitioners an approach to embedding identity into their digital communications, I worked with my colleagues to help develop a new model grounded in identity: Identity Experience. IX represents an evolution of the communications models we all learned about—pre-TikTok—and the path to inserting intersectionality into our tactics.
The purpose of IX is to give our industry a roadmap that:
- Aggregates disease state epidemiology, intersectional data and digital media behavior.
- Considers how the data influence intended messaging for a key audience.
- Shapes the narrative that will reach key audiences along their healthcare journeys.
We also know that while data are the cornerstone of our strategies, messaging is the framework for how the home is built. At GCI Health, we have developed a model that ensures, among other things, we acknowledge the bias, historical drivers and language that impact a person’s healthcare journey. This framework ensures that sub-narratives are pulled through based on key cultural insights for each audience and that we are creating digital campaigns that are fully dimensional and effective.
Leveraging identity for authentic narratives
To integrate identity into our communications strategies, it’s essential to:
Examine disease state epidemiology to identify the most impacted communities. For example, with the outbreak of monkeypox, the statistics signaled that the condition was impacting gay men but, more specifically, Black gay and queer men. Understanding this could ground digital communicators on what channels to use and which voices to leverage to discuss vaccine access. Additionally, in-person activations like vaccination drives could target where Black gay and queer men live, work and socialize. Starting with the most marginalized groups opens the floor to scale across other groups versus trickle-down approaches.
Remove our assumptions and dig deeper. No one group is monolithic, and when we assume a broad brush will paint the picture, that’s when we need to course correct. There are nearly 170 million women in the U.S. To assume that they all think, feel and act the same regarding healthcare or to lean on a white-straight-Christian-cisgender model will not yield the message resonance that we are after.
Put analog communications back into the mix. Social media listening tools have changed the game for understanding and measuring what audiences are talking about across platforms. But what is often missing is the “who,” especially from an intersectional lens. Yes, women might talk about contraception more on social media, but what generation do they fall into? What is their religion? What’s their country of origin? Do they have access to a gynecologist to discuss birth control? While we can lean on social media listening tools to understand the breadth of healthcare topics, we must re-engage with qualitative methods like focus groups, surveys and interviews to understand a topic’s depth.
Develop a channel mix—organic and paid—that makes sense for each audience and touchpoint. Touchpoints that layer in unique disease journeys can achieve messaging reach, relevance and resonance. For example, to reach specific communities around mental health, we might lean on Facebook for white Baby Boomers, but a Meta platform like WhatsApp is more effective for reaching second-generation Mexican Americans. So, flip the adage “If you build it, they will come” to “If we go to them, they will engage.” Beyond social media platforms, there are an array of digital platforms that are led by marginalized communities ripe for sponsored content from healthcare. For example, the Black Effect podcast is a collection of Black voices covering various topics, from finances to sports, all under the iHeartPodcasts umbrella. A sponsored podcast with Charlamagne tha God focused on colon cancer screenings might reach millions of people, particularly Black men who are over the age of 45.
Incorporate visuals and audio that support compelling storytelling. From the details of reflecting secular identities to picking up the lilt in scripted conversations, representative creative rounds out how we bring data and cultural nuances to life, leading to greater segmentation. A non-healthcare brand that does this well is Disney, especially in their recent representation of Hispanic/Latino stories in “Coco” and “Encanto.” While there are similarities across Latino communities, their traditions, physical characteristics and world views vary. Coco is a distinct story centered on a Mexican boy while Encanto follows a Colombian teenager. Getting the cultural notes right helped create depth for each community. This sort of identity centralization is not about excluding others. It is about elevating those universal experiences that everyone can feel.
As health communicators, we have an opportunity and responsibility to contribute to improved health outcomes for everyone. We can do that by creating better narratives that are influenced by who people are versus what we want them to do. If we continue to focus on our targets’ actions rather than their layered identities, we may not fill these craters or get treatments and interventions for those who will benefit the most.
Kianta Key is Senior Vice President, Digital, at GCI Health.