Course Overview
This course provides a global perspective on science and society by focusing on the relationship between culture and health communication. We will examine theoretical frameworks, case studies, and examples from health communication worldwide, exploring how culture and co-cultures is addressed in intercultural patient-physician communication, health messages, campaigns and interventions, health meanings, healthcare institutions, digital health, and the structural and social determinants of health. We will then review and synthesize the current health communication literature on how culture is defined and discussed in health communication theory and practice. The course will culminate with a collective discussion of theory- based applications of culture for achieving greater health equity globally within the context of health communication.
This class addresses the social construction of health and illness as well as social scientific theoretical perspectives used within the field of health communication, with a particular focus on interpersonal communication. As an international university, we will use the lenses of social change, structure, culture, and agency to explores the use of communication to transform global, national, and local structures of power that create and sustain oppressive conditions. This will all be grounded and focused in health communication. Using empirical evidence and case studies, we explore the ways through which those in power create conditions at the margins, and provides a theoretical base for discussing the ways in which these positions of power are resisted through communication processes, strategies, and tactics. The interplay of power and control with resistance is woven through each of the units.

The course will include a particular focus on provider-patient communication and interpersonal communication in healthcare and health/illness contexts. We will address the nature of clinician-patient relationships and the ways medical education provides opportunity for medical students to reflect on their communication. I expect that this experience will enable you to talk about ways in which research in health communication relates to patients’ health and well-being and to the health and well-being of society at large, how research in health communication advances our understanding of the process of human communication and relationships, and how contemporary societal developments such as communication as core competencies in medical education impacts research and health care delivery.

Our time will also be spent addressing issues in communication skills and training, disclosure issues, outcomes of health interactions, stigma, culture, and special populations, all from a cultural and global lens. I am also happy to work with you to conceptualize ways of looking at the interactions that allow for posing prospects for communication in community health, organizational issues, or health messages in the media depending on your interests. For example, if you are interested in community health you might explore broader social and community health concerns, including prevention, risk perceptions, disenfranchisement, community organizing, and social support networks and health. If you are interested in organizational issues, we might explore includes issues such as health care teams, social support for health care providers, the structure of health care organizations, and the rhetoric of health care organizations. If you are interested in health messages in the media, we might explore such topics as health information covered in the media, health campaigns, health PR, health literacy, health message strategies, or information technology issues.

Learning Outcomes
At the end of the course, students should be able to:
1) Describe the social construction of health and illness as well as social scientific theoretical perspectives used within the field of health communication;
2) Synthesize interpersonal communication and relationship science as a social scientific orientation that is also complimentary to the social construction of health/illness
3) Demonstrate an understanding of the role of applied research within the inter-disciplinary understanding of health communication;
4) Develop skills to promote the use of theory that bridges the gap between academic research and applied problems;
5) Understand core competencies and systems in medical education and healthcare education and the role of communication within these systems;
6) Demonstrate understanding of the vocabulary associated with modern health care, health care systems, medical education, relationships in health/illness and communication about health;
7) Apply health communication approaches to research, policy, advocacy, and education
8) Compare, contrast and synthesize the different theoretical foundations of cross-cultural
research with the aim of developing “new knowledge.”
9) Complete a group project that considers communication in healthcare or in an important area of health/illness.

Teaching Approach
This course will be a combination of lectures, readings, and discussions. Each class will begin with a lecture to introduce fundamental topics and concepts, particularly summarizing findings from a social science perspective. Next, students will discuss the assigned readings that explore the topic in greater depth and that offer an alternative perspective. To that end, you should come to class prepared to discuss the readings. Commitment to careful reading and engaged participation is required. During each session, students are encouraged to share your perspectives and to engage in critical thinking, analysis, and applications of the readings and course materials. I will facilitate discussion and application and provide additional context and examples and insight as needed. This course will also include opportunities for small group work and collaborative learning. For example, students will work in small groups to analyze and present a particular aspect of health communication from multiple perspectives including integrating the social construction of ideas as compared to the social scientific orientation, and how the orientations can co-inform each other.

Assessment
Assessment in this course will be based on a combination of participation in class discussions, three response papers, and your group project.

Digital resources
All readings for this class will be scanned and available to students digitally on the VIU digital library.

Overview of the Course

Overview of Health Communication across Cultures
Defining Health and Illness
What is Health Communication? Global Perspectives on Health Communication
Considering Culture in Health Communication
Theory and Application in the Global Context

PART 1: THEORETICAL FOUNDATIONS AND ASSUMPTIONS

(Re) Thinking Culture and the Global Context in Health Communication
How Patients, health professionals, and policymakers embody cultural constructs that impact health/illness and healthcare processes. What is culture? In this meeting, we explore different ways to think about culture and the implications of science and society.
READ: Hsieh, E., & Kramer, E.M. (2021). Rethinking Culture in Health Communication. An interdisciplinary overview of health communication using a cultural lens—uniquely focused on social interactions in health contexts. Chapter 1. pp 1-25.

Social Meanings of Health/Illness across Cultures
The emergence of the duality of “reality” in health/illness. Measuring symptoms of illness as compared to whole-person health. In this meeting, we discuss value orientations.
READ: Brody, H. (1994). “My story is broken; can you help me fix it?” Medical ethics and the joint construction of narrative.
Emotions in Health/Illness and Healthcare
Video: Empathy: The Human Connection to Patient Care.
In this session, we discuss the social construction of empathy and emotion. Example about ‘talking into depression.’ The ethics of emotions in health/illness and healthcare.

READ: TWO CHAPTERS from Feldman Barrett- How Emotions are Made.
Emotions are Constructed. Chapter 2
Emotion and Illness. Chapter 10.

Embodiment and Whole Person Attentiveness
While the way we live as humans has—for many of us—become less embodied, there is much the body can teach the mind. In this session, we consider scientific and humanistic understanding of embodiment, disembodiment, the role of the body in whole person attentiveness, and in the mind-body connection. We will consider global and cultural understanding of the body and embodiment.

READ: Duggan, A. (2019). Reconsidering Embodiment and Language for Illness. From Health and Illness in Close Relationships. Cambridge University Press.

Additional reading on the body from another culture. To be added.

Scientific Assumptions and the Emergence of Modern Medicine
In this session, we discuss the rational and empirical scientific basis of modern medicine in the Western World. We discuss evidence-based medicine as a paradigm shift in the early 1990s to address the tensions between rationalism and empiricism in medicine. We discuss the subsequent focus on the biopsychosocial model of medicine and changes in core competencies in medical school to include social sciences.

READ: Street, R.L., Makoul, G., Arora, N.K., & Epstein, R.M. (2009). How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Education and Counseling, 74, 295-301.

Perspectives on the Clinical Method and the Life World of the Patient
We compare with the necessary skills of the clinical method is an interpretive act which draws on narrative skills to integrate the overlapping stories told by patients, clinicians, and test results. The art of selecting the most appropriate medical maxim for a particular clinical decision is acquired largely through the accumulation of “case expertise” (the stories or “illness scripts” of patients and clinical anecdotes). We discuss the lived experience of patients as experts in their own lives and conditions.

We consider the critical narrative of navigating cultural differences in medicine and life, and how communication can drastically impact a patient's care.
WATCH interview with the author of “The spirit catches you and you fall down.”
(see link. One hour video.)
OPTIONAL TO READ THE BOOK: Fadiman, A. (2012).The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. Macmillan.

PART 2: METHODS AND MEASUREMENT AND SYSTEMIC INTERCONNECTIONS

Social Determinants, Structural Factors, and Health inequities.
The social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems. ---We also examine the systemic intersections of culture, ethics, and institutional policies. To that end, we shift our focus away from individual- or group-based health interventions, and investigate how health policies and structural barriers shape the complex relationships between individuals’ everyday lives and a society’s management of resources. Recent investigations of health disparities have highlighted several important issues in conceptualizing structural barriers. Rather than providing a blanket criticism against structural barriers, our goal is to explore the complex and nuanced interrelationship between structural barriers, social policies, and health disparities. We discuss global and cultural examples of social determinants and systemic interconnections.

READ: WHO Social Determinants of Health

The Culture-Centered Approach to Health Communication Research and Innovation
Health communication in defining stakeholders within society, communication and the ethics of science and medicine, communication and healthcare competencies. Social scientific and critical cultural integration of communication in shaping science and society.

READ: Dutta, M.J. (2023). Culture-centered approach to Communicating Health. Chapter 12 from Communication Theory: Racially Diverse and Inclusive Perspectives. Jasmine T. Austin, Mark P. Orbe, and Jeanetta D. Sims, Eds. Cognella.

Measuring Health and Well-Being
We consider science and innovation from the practical challenges in measuring health and well-being, particularly with respect to the influence of cultural factors on well-being and well-being measurement. We consider the WHO report on the impact of culture on health and well-being, and how to communicate findings from well-being data across such a culturally diverse region as Europe.

READ: Beyond bias: Exploring the cultural contexts of health and well-being measurement.
WHO report from regional office in Europe.

Insights from Humanities: Locating the “subjective” in subjective well-being
How can insights from the humanities contribute to our understanding of the cultural dynamics of subjective well-being? Are alternative sources of data, such as the historical or cultural record, valid in constructing narratives of national and regional subjective well-being?

READ: Greenhalgh. Narrative based medicine in an evidence-based world.

Culture and Health Behaviors
In previous class sessions, we have explored how fundamental differences in cultural understanding can lead to significant differences in our worldviews, values, and the realities we live in. We will now explore how these cultural perspectives can bring insights into our understanding of health behaviors.
We review two theories of behavior change including the Health Belief Model and the Theory of Reasoned Action (TRA)/Theory of Planned Behavior (TPB) that are common in health campaigns to change health behavior. We will then analyze the underlying assumptions held by the theories. We will then explore how certain common values that are prevalent and fundamental to medicine and healthcare delivery in the West (e.g., informed consent, patient autonomy, and self-determinism) are also cultural products, which may create tensions and ethical dilemmas when patients and providers do not share the same cultural values.

Health practices are cultural practices. As we make sense of our everyday life, our understanding of information, behaviors, and motivations are embedded in cultural contexts. So are our theories that are developed to explain health behaviors. In this session we unpack the underlying assumptions.

READ: Simkulet, W. (2018). Nudging, informed consent and bullshit. Journal of Medical Ethics, 44(8), 536–542.

PART 3: INNOVATIONS AND APPLICATIONS

Transformative Technologies including AI
We will explore the interconnection between technology and healthcare and health/illness from two perspectives. First we will explore technology as a tool for health communication and health intervention including medicine as interconnected with technological innovation. We will examine how generative AI shapes and is shaped by innovation. Second, we will ask how technology as a cultural phenomenon shapes our experiences and understanding of medicine, of the body, and of health and illness. We examine the relationships between science, technology, and ethics. We will consider how technologies shape our understanding of realities.

Positive Deviance and Positive Disruptors in Health Communication
In this class session, we explore tools of health communication that involve creativity.
READ: Pennebaker, J.W. & Chung, C.K. (2007). Expressive writing, emotional upheavals, and health. In Friedman, H. & Silver, R. (eds.) Handbook of health psychology. New York: Oxford University Press.
Go to http://www.positivedeviance.org. Examine the site’s materials, presentations, publications, and other features.
Go to https://thebiggerpicture.youthspeaks.org/. Examine the site’s examples of using art and community engagement to change the conversation on health.
Assignment. You will take five images of things (other than yourself) that affirm or reinforce your health/wellbeing, and five images of things that threaten or undermine your health/wellbeing. You will caption these images. You will share your images and captions and be prepared to discuss how self- expressive experiences have been used, and might be used even more imaginatively, to improve people’s health. What domains/ areas can self-expressive images be helpful for health or well-being?
Communicating Social Support: Understanding Supportive Relationships through Cultural Perspectives and Co-Cultures
In this class meeting, we consider the literature on social support, highlighting its multi-dimensional meanings as situated in interpersonal and social contexts. By situating the meanings of social support in cultural contexts, we acknowledge that social support is a cultural phenomenon that needs to be understood, interpreted, and enacted through its cultural norms. By adopting a normative approach to individuals’ interpretation and evaluation of social support, we will explore the challenges to identity management and illness management faced by patients and their supportive others in offering different forms of social support.

We will look at Carey Candrian’s “Eye to Eye” photos of older queer women which showcases intimate portraits of nearly three dozen LGBTQ women aged 59 to 85.
We will also look at other cultural perspectives on communicating social support.

PART 4: Global and Cultural Contexts in Health Communication: Special Topics

Venice and Healthcare
We will explore Venice and healthcare including the historical challenges and health communication. This section will include two out of class activities. We will visit the ‘Ospedale Civile’ which is the general hospital located adjacent to the Church of San Giovanni e Paolo in the Castello district of Venice. This large, modern hospital provides care for the lagoon population of Venice from the cradle to the grave. We will also celebrate the November Festa della Salute.
Out of Classroom Activities as a Class:
---We will visit the hospital and medical museum in Venice.
---We will celebrate November Venice celebrates the Festa della Salute –this commemorates survival from the plague. This will include an out-of-class visit to Santa Maria Della Salute and learning about what that means for Venice historically and currently.
---Celebration of Venice group meal at Professor Duggan’s apartment.

Global and Cultural Considerations for Disability and Health Communication
World Health Organization Overview: Disability is part of being human and is integral to the human experience. It results from the interaction between health conditions such as dementia, blindness or spinal cord injury, and a range of environmental and personal factors. An estimated 1.3 billion people – or 16% of the global population – experience a significant disability today. This number is growing because of an increase in noncommunicable diseases and people living longer. Persons with disabilities are a diverse group, and factors such as sex, age, gender identity, sexual orientation, religion, race, ethnicity and their economic situation affect their experiences in life and their health needs. Persons with disabilities die earlier, have poorer health, and experience more limitations in everyday functioning than others.

In this session, we focus in particular on support for people with disabilities in Italy.
READ:
https://www.oecd.org/en/publications/2023/11/disability-work-and-inclusion-in-italy_6f463b9c.html

Health Communication for Happiness and Well-Being: Global and Cultural Considerations
In this class meeting, we focus on a positive aspect of health and well-being: Happiness. We use the World Happiness Report and describe implications from the perspectives we have discussed so far in class. We discuss happiness and age, happiness and culture(s), global trends in child and adolescent well-being, supporting the well-being of an aging global population, and differences in life satisfaction among older adults.

READ (or SKIM): World Happiness Report

Aging and Health Communication: Global and Cultural Considerations
I will introduce you to Life span perspectives on aging and health communication. We will learn about one theory in particular--- Communication Accommodation Theory (CAT) in the context of Aging. We will look at positive and negative aspect of communication accommodation and aging. We will analyze the #oldlivesmatter initiative affiliated with VIU from the perspective of CAT.

READ: European Interdisciplinary Council on Ageing report

We will focus in particular on thriving and aging. Pending getting access which I am working on……. We will watch the Film “In Life” a documentary about three people living longer in different cultures, thriving in life, and who are exemplars of positive age beliefs. Support for the film came through a grant from the Law Stroud Foundation. Produced by Persistent Productions, the film: “In Life consists of three video portraits of artists creating original work in their later years. Featuring writer Betsy Cox, painter Goh Beng Kwan, and pianist Leeanne Rees, the film captures their artistic vantage points and offers perspectives into their processes for their most recent works. The films show us that aging can be fuel for artistic production and hitting one’s stride creatively speaking. Viewers will also discover mentors, guides and ideas that inspired perseverance.”

Last updated: January 29, 2025