By Michelle Hutchinson, DMD, MPH, CPH, health communication specialist/health literacy lead, Office of Communication Science, Office of the Associate Director for Communication (OADC), Centers for Disease Control and Prevention (CDC), and Sara R. Bedrosian, public affairs specialist, Health Equity Working Group, Division of Public Affairs, OADC, CDC
October is Health Literacy Month, a time for public health and health care organizations to recommit to making sure all audiences can find, understand, and use our information and services to make the best health-related decisions for themselves and others.
The U.S. Department of Health and Human Services includes health literacy in one of its overarching Healthy People 2030 goals: “Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.” With that goal in mind, CDC chose “Health Literacy and Health Equity: Advancing Diversity, Accessibility, and Inclusion” as its 2021 Health Literacy Month theme.
The Connection Between Health Literacy and Health Equity
Health literacy and health equity are related concepts. Equity sits at the center of the 10 Essential Public Health Services, and effective communication is the 3rd essential service. Effective communication uses health literacy principles to inform and educate the public. Putting health literacy principles into action advances health equity: the attainment of the highest level of health for all people. These principles include testing materials with intended audiences, providing translation services for people with limited English proficiency, using plain language, and designing websites so they’re accessible to people who use assistive technology. When people can access and understand our information, they can act on it, but this may not be enough to spur action.
People are more likely to embrace information that incorporates health equity principles because that information is more likely to meet each audience’s specific cultural, linguistic, environmental, and historical needs and priorities. People are more likely to accept messages that don’t blame them for their adverse circumstances.
Health literacy principles make information clearer. Health equity principles make it more inclusive. Organizations that carefully consider both when designing and developing communication products will more easily realize their communication objectives and achieve success in their public health interventions.
A New Resource
To help CDC’s workforce and partners address all people inclusively, accurately, and with respect, the agency launched Health Equity Guiding Principles for Inclusive Communication in August 2021 on CDC’s Gateway to Health Communication. It outlines inclusive communication principles such as:
- Using a health equity lens
- Using person-first language
- Avoiding unintentional blaming
- Using preferred terms for populations of focus while recognizing that preferred terms may differ
- Looking for ways to be more inclusive in text and images
- Exploring other resources related to health equity communications
Guiding Principles also provides suggestions and rationale for language that may increase message adoption by the intended audience. For example, “communities with limited access to [specific service]” might be more accepted than “hard-to-reach communities” because the latter implies that a condition is inherent to the group, while the former focuses on causal factors. These are not authoritative rules; they are recommendations.
Additionally, Guiding Principles recommends the use of plain language principles along with the use of health equity concepts and the language necessary to accurately and equitably represent all people. For example, the phrase “people who are incarcerated” is wordier but more representative and equitable than the term “inmates.” The former humanizes individuals by referring to them as people first — people who are currently incarcerated — while the latter reduces those same people solely to their imprisonment status. Though it may seem that we’re sacrificing brevity for the sake of inclusivity, we’re not. Rather, we’re using plain language with equity principles to accurately and justly represent people with whom we communicate. After all, the first rule of plain language is “write for your audience.”
Development of Guiding Principles
Guiding Principles grew out of an earlier effort to create an internal COVID-19 Response Health Equity Style Guide. That guide was developed when it became clear that long-standing systemic health and social inequities — including some that had been introduced or exacerbated by federal, state, and local policies — had put some population groups at increased risk of getting COVID-19 and having poorer outcomes when they did get sick. These groups included but were not limited to:
- Black, Hispanic, American Indian, and Pacific Islander persons
- LGBTQ+ persons
- People with self-care disabilities
- People experiencing homelessness
- People in detention facilities
This resource was so well-received that senior CDC leadership felt it should be adapted for public use beyond the scope of COVID-19 and expanded into a set of guiding principles instead of a style guide.
CDC strives to apply best public health practices to all its work. This includes using inclusive, accurate, and accessible language that shows respect for all audiences. People do not have the same frame of reference. Communicating with people in the way they prefer is essential to public health interventions and the health of our nation.
Michelle Bonds, director of CDC’s Division of Public Affairs, led the Health Equity Working Group. Under her leadership, people aligned with the mission from across CDC joined to develop the Guiding Principles along with multiple CDC and external validators from the fields of public health, academia, health care, communication, and policy.
Guiding Principles is not a style guide, and it’s not meant to be prescriptive — not every suggestion will suit the needs of every community or population of focus. Instead, we encourage organizations to use it as a resource for having conversations about messaging and for engaging with their communities and partners to build a shared vocabulary.
CDC encourages public health professionals and partners at the federal, state, and local level to apply these Guiding Principles across their public health communication work, including when they’re creating information resources and presentations or developing and reviewing external or internal communication materials.
Guiding Principles is a living resource. It will be updated annually to keep pace with changes in language and cultural norms. Read it, share it, and join the conversation by emailing HEGuidingPrinciples@cdc.gov.
Connecting the dots between health equity and health literacy is key to enhancing public health — they are complementary concepts. Adopting a comprehensive approach in our practice that reflects this conceptual synergy will improve health and well-being for all.