When Malone Mukwende a medical student at St George’s, University of London created Mind the Gap, a first-of-its-kind handbook of clinical signs and symptoms in black and brown skin, including keloid scarring and chickenpox, he said: “I didn’t understand why we weren’t taught the full spectrum of people… I decided I needed to do something to challenge this issue myself.” Given how multicultural contemporary Britain is, you’d be forgiven for thinking Mukwende launched Mind the Gap decades ago. Remarkably, it was only published in 2020 and health information providers have since followed in its wake, including NHS Digital.
It may be unintentional, but ignoring certain groups of people from health advice has far-reaching consequences – it alienates, destroys trust and can compound health inequalities. But it’s also alarmingly common.
When content providers exclude at-risk groups
It’s even happened during the Covid-19 pandemic, one of the biggest health emergencies the world has ever faced, when clear and inclusive messaging is an absolute priority. At the start of the UK’s first lockdown, the government did not provide shielding letters in an accessible format, thereby disregarding blind and partially-sighted people and prompting the RNIB to launch its #InfoForAll campaign. And its failure to provide translated Covid-19 guidance was also criticised in a joint letter from 30 local authorities, public health leaders and charities – they told the government in no uncertain terms that they were jeopardising the safety of non-English speakers.
Covid-19 aside, there are countless other examples where the people most in need of accessible and coherent health advice are disregarded. MBRRACE-UK is a collaboration based at the University of Oxford that monitors and investigates the causes of maternal deaths, stillbirths and infant deaths. And it has repeatedly highlighted how pregnant women in the UK who have difficulty reading or speaking English are particularly vulnerable because they cannot easily access health information.
These stark examples illustrate how the format of content can directly exclude groups. But careless word choice can be alienating and stigmatising too. For example, relying on complicated medical jargon. Or labelling people with a health condition or using sensational, fear-based language, such as calling someone with a substance user disorder, a drug addict or abuser. Or using throwaway terms that are insensitive and equate certain characteristics to something negative: for example, ableist language such as “turning a blind eye” to a problem.
Good health content should be empathetic, put an arm around all audiences, be clear and encouraging. Poor language choices reduce the likelihood that messaging will get through and impact audiences positively.
Allowing natural biases to creep in
And there are even more subtle ways that health information can exclude.
We all have natural or unconscious biases – innate ideas and assumptions about certain groups of people. And these can seep into how we write and communicate, without us even realising it.
The World Obesity Federation has produced a set of guidelines – dos and don’ts for talking about obesity that highlights this very issue. To combat bias and assumptions that people who are overweight or obese are greedy, lack self-control and can’t follow recommendations and treatments, it has also created an image bank to “ensure accurate, non-biased, respectful images”. It wants to end the use of unflattering images of people with a high BMI eating junk food and looking lazy. Incidentally, studies show that the weight stigma created by natural biases can have dire consequences for those living with obesity, including increased depression and anxiety, disordered eating, and decreased self-esteem.
Studies also show that heteronormative language and imagery can also deter people who identify as LGBTQ+ from accessing health services. Tragically, this has contributed to disproportionately worse health outcomes and poorer healthcare experiences.
Embracing wider audiences
Inclusive content – encompassing sensitive language, imagery and format – builds trust and a connection with users. Messages cut through, users have more confidence in health professionals and in turn they’re more likely to reach out for help and adhere to treatment plans.
Alongside truly understanding the diversity of your audiences and getting them involved in content creation where possible, an important first step to producing inclusive content is to acknowledge that we are all affected by biases and stereotypes. And to be aware that language evolves quickly – for example in recent times, some disability advocates are moving towards language that explicitly identifies people by their disability. Meaning it’s not only important to stay up to date on the latest health advice, but how to communicate it sensitively too.
Antonia is the Managing Editor at Thrive. She is responsible for overseeing our team of editors and delivering engaging health content.
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