From Health Consciousness to Promotion: Honoring Health Equity
By Michael Everett, MHS, EdD | October 14, 2021
It’s no secret that scholarly articles and community health-related research are often shared almost exclusively among the academics, never fully reaching or impacting the greater public. Even when accessible or intended for broader use, the jargon and specialized language creates barriers to access based on understandability and ease of comprehension. The average person’s ability to access, gather, and easily comprehend these resources in a meaningful way is almost impossible. If the average person cannot understand health information to make informed decisions based on science and peer reviews, they are likely to instead make health decisions based on the most accessible information, usually in the form of a social media meme.
So, what is the cause of the great Health Literacy divide and disconnect between academic research and the communities that are often times the focus of such research? As we recognize Health Literacy Month this year, let’s explore health equity through the journey from health consciousness to health promotion. As we seek out ways to improve the accessibility of research, resources, and ultimately our health messaging, we must also focus on centering our communities and challenging old paradigms that perpetuate narratives of shame over strength.
Health Equity is a Journey
Reading does not necessarily equate to understanding, but it must be accompanied by comprehension. Determining meaning is a journey that first starts with awareness and consciousness (reading text). The next step is determining the meaning of text within the scope of your hierarchy of needs (comprehension). There is the awareness of the “thing” and on a very basic level you might have determined if the “thing” is working for you (typically thought of as good) or not working for you (bad, or of no perceived value).
Recognizing health consciousness as a means to equity, one might have to first be aware of how one’s own health will be impacted or a have a perceived belief that something will promote or compromise the desired health result. In trying to better understand health equity as a journey, my dissertation research partly focused on outlining what that journey is and the opportunities to support greater health equity along with this spectrum.
Dissertation Research: Health Consciousness to Health Literacy
I received my doctorate in 2020, with much of my work inspired by years of overexposure to Black health narratives. The data and research has consistently highlighted the health disparities (i.e. heart disease, HIV, prison, unemployment, and incarceration) within the Black community. There are few narratives that offer a strength-based perspective when discussing the health disparities within the Black community. Providing a more comprehensive understanding of the opportunities and strengths within many Black families and communities with regard to navigating health is critical to building equitable health related systems.
In my research I chose to focus on the following health learning pathway:
Health consciousness—the awareness of a health threat or benefit. Moving into the health consciousness stage provides an opportunity for health literacy—consumption, comprehension and digestion of health-related information. Lastly, once there is a thorough understanding and value is assigned, there is motivation towards health efficacy—enough degree of confidence in skills to implement a positive health behavior, health promotion, and strategies for communicating health-related benefits or threats.
In qualitative interviews with 12 Black families (6 families with at least one member living with HIV, 6 families with unknown or negative status) about their self-protective health behaviors, it became apparent that it is equally important to study the intentions of Black people; otherwise, it is easy to overlook the strengths. The dominant narrative then becomes that Black is synonymous with risk, disease, poverty, and other challenging social determinants of health, which fails to fully capture the work Black people are doing to be and stay in good health. The other lesson was that health promotion can be the evidence of equity or lack thereof.
Examples of Opportunities to Better Understand the Health Equity Journey
- Consciousness to Support Awareness: Physical and mental wellness were important to these families, something to leverage when introducing new health consciousness. Educators and health support roles have been a valuable asset in Black families and help to advance or deepen the consciousness of a health threat or benefit in Black families. Discernment is the term that often came up to describe the skill of having an internal knowing of truth, so it may be helpful to explore cultural aspects of the use of discernment in Black communities.
- Literacy to Interpret: These Black families appeared to have a strong sense of collective agency around understanding complex health information via online resources and unpacking complex health information with knowledgeable family members. Literacy is interpreting text and deciding the value of a health information as something that can potentially work for or against best interest. The value of perceived benefit is determined by the analysis and comparison to one’s hierarchy of needs and is ranked on a spectrum of urgency.
- Efficacy to Implement: The Black families in my research helped me to better understand the role of influential and non-influential characteristics that work more naturally within Black families and Black communities for health efficacy. In addition, the high value for social relationships, family, and close connections to act on a sense of responsibility to protect young people from health threats that they may not know was also evidence of efficacy
- Promotion to Share: These Black families believed in sharing and promoting health information and personal experiences. I learned that, for some, information might be received and respected when coming from family who are generational peers.
- Understanding What Trust Looks Like Among Black Families: Continued understanding of the historical relationship between Black communities in America and medical mistrust & distrust to more specifically understand how it may impact Black health promotion is an opportunity worth investing in.
Equity-Structures that Create Pathways to Access in Alignment with Need
As we gear up for Health Literacy month, let us remember that literacy is a skill and health literacy seems to be a growing privilege excluding those who would benefit the most from access. Health equity is about the existence and the utilization of pathways and opportunities for all people to have access to tools that will help maximize health benefits. To do so, we must also create new narratives that all communities deserve to see the strength in themselves, not just the challenges.
The journey to health equity is filled with opportunities to more concretely understand, demonstrate, and evaluate protective health strategies, which leads to the understanding that most families strive for wellness and avoid threats. Let’s celebrate the strengths in each other and build the bridge of equity by honoring the journey of health literacy.
Michael Everett (He/Him They/Them) is the Chief of People & Culture at ETR. A proud father, Michael holds a master’s in human services and doctorate in education and has served in various capacities from consultant to a Senior Research Associate within ETR, and is currently invested in successfully supporting an agency culture that promotes wellness/wholeness, facilitates empowerment, and allows our staff to leave our organization better than they came in all the ways that we can professionally.
