When I was trained as a health communication scholar, much of my learning was based on the model of individual behavior change, defining communication as messages directed at raising awareness, changing attitudes, and promoting healthy behaviors. This line of health communication scholarship has had a long history, having been applied to create and strategically disseminate health messages to target populations.
My ongoing journey in collaborating with communities at the margins taught me that the problem of health inequalities that I was grappling with were much more to do with existing structural inequalities that constitute health than to do with the absence of knowledge, attitudes, and individual behaviors. Although communication as message could indeed be directed at target populations, such a narrow framework of communication did not really address the larger structural inequalities, the inequality in income distribution, the absence of structural resources, the poverty of neighborhoods, the racist stigmas that constituted how those at the margins experienced health.
Health inequalities I came to understand are inequalities in the distribution of economic resources; access to basic resources such as housing, food, and unemployment; and access to everyday services for health. Health inequalities I also learned are communicative inequalities, the absence of communicative opportunities for recognition and representation among the marginalized.
I came to learn that health inequalities are perpetuated by undemocratic structures that devalue the poor, treat the poor as passive targets, and systematically erase opportunities for the poor to participate in decision-making that shapes the nature of solutions being developed. The devaluing of the poor is rooted in undemocratic processes that undermine the capacity of the poor to develop meaningful solutions.
The journey of the CCA thus became one of collaborating with communities at the margins to co-create democratic spaces of participation that are grounded in the everyday rationalities of the poor. These democratic infrastructures enable the articulation of solutions from designing educational resources to advocating for just pay to building community hospitals through the participation of the poor in creation of the solutions. Health inequalities are thus addressed by acknowledging the deep seated communicative disenfranchisements that the poor experience and by seeking to transform these disenfranchisements through community advocacy.