Western medicine often presents itself as an exact science — objective and free from biased values or politics. Over its history, health communication scholarship has typically affirmed this perception, working to identify communicative strategies to persuade the public to engage in behaviors and pursue health goals that are determined, in advance, by the findings of scientific medical research. While there is little question that Western medicine has made extraordinary contributions to saving lives and improving the quality of life for many people, today a growing number of scholars dedicate their research to challenging the notion that the Western model is objective or apolitical, stressing that its dominance has also produced its own harms, especially for marginalized groups.
Scholars who adopt critical perspectives in health communication attend to the relationship between power and health in a variety of contexts, including national and international health policy, medical discourses, health campaigns, and organizational communication in medical institutions. They are interested in the power structures that are unique to medical communication, like the relationships between doctors and nurses, or patients and healthcare practitioners. They are critically engaged with the ways that health contexts and their communication dynamics reflect the power hierarchies of the cultural, social, political, and economic contexts in which they are situated, like those organized around class oppression, racism, sexism, heteronormativity, and cis-normativity.
This article introduces critical perspectives in health communication, intended to be useful for prospective graduate students in the field. After providing a brief history of critical health communication scholarship, the following sections discuss how critical health communication problematizes the Western biomedical model of health, and how the field analyzes power and politics in applied health contexts. It also discusses how critical health scholars critique the medical sciences, as well as health communication research itself, for participating in the marginalization of oppressed social groups. The article concludes by discussing the current state of critical health communication research.
Spotlight on Scholarship: Featured Scholars in Critical Perspectives on Health Communication
Explore the research of scholars currently doing critical work in health communication, from studies of health activism and environmental health to politically engaged critiques of the reproductive injustices suffered by migrant women at the U.S.-Mexico border.
Dr. Mohan J. Dutta is Dean’s Chair Professor of Communication at Massey University in New Zealand, where he also serves as Director of the Center for Culture-Centered Approach to Research and Evaluation. A leading voice in many areas of communication studies, Dr. Dutta’s research in health communication involves working alongside marginalized groups and activists in conducting research that aims to bolster community health while resisting dominant, exclusionary medical frameworks. Dr. Dutta’s scholarship has been recognized with a number of awards, among them the 2016 International Communication Association (ICA) Applied/Public Policy Communication Research Award, and the 2018 Outstanding Health Communication Scholar Award. His applied community health initiatives have been supported by a number of grants. Most recently, the Agency for HealthCare Research & Quality funded a culture-centric communication project dedicated to reducing heart disease among African Americans in Indiana. Dr. Dutta’s books include Communicating Health: A Culture-centered Approach and Voices of Resistance: Communication and Social Change.
Dr. Leandra Hernández is Associate Professor and Director of Graduate Studies in the Department of Communication at The University of Utah. Dr. Hernandez’ research focuses on reproductive justice, with a special focus on Latino/a/x health. Her articles have appeared in leading communication journals such as Health Communication, Frontiers of Communication, and Women’s Studies in Communication. With Sarah De Los Santos Upton, Dr. Hernández co-authored the book Challenging Reproductive Control and Gendered Violence in the Américas: Intersectionality, Power, and Struggles for Rights), which received the 2018 Bonnie Ritter Book Award from the National Communication Association’s (NCA) Feminist and Gender Studies Division. She has received numerous awards for her scholarship, teaching, and service, including the 2024 NCA Women's Caucus Francine Merritt Award for her advocacy for women in the field of communication.
Dr. Alexandra Murphy is Professor and Dean in the Department of Communication at DePaul University. Dr. Murphy’s research applies critical perspectives in organizational communication to health contexts and is especially interested in the way that power and communication impact emergency situations. Dr. Murphy’s essays have appeared in publications like Annals of Emergency Medicine, Journal of Applied Communication Research, Journal of Contemporary Ethnography, and Communication Monographs, as well as chapters in edited volumes, which include “The Medium is the Message: Communication and Power in Sign-outs,” and “Coaching to the Craft: Understanding Knowledge in Health Care Organization.” Dr. Murphy also applies her expertise in work on HIV/AIDs education initiatives in Africa.
Dr. Jennifer Vardeman is Associate Professor andDirector of the Jack J. Valenti School of Communication at the University of Houston, where she is also affiliate faculty in the Women’s, Gender and Sexuality Studies Program. Dr. Vardeman’s research explores the contact points between public relations, media research, and public health, with a focus on the contexts that influence how women make medical decisions and the role racial and gender equality play in that process. Her critical research in health communication has been published in articles such as, “The Framing of Women and Health Disparities: A Critical Look at Race, Gender, and Class from the Perspectives of Grassroots Health Communicators,” published in Health Communication and “Issues of Representation, Reflexivity, and Research-Participant Relationships: Doing Feminist Cultural Studies to Improve Health Campaigns,” published in Public Relations Inquiry.
Dr. Heather M. Zoller is Professor in the Department of Communication at the University of Cincinnati. Dr. Zoller’s award winning research focuses on health communication and organizational communication, with an emphasis on the politics of public health organizations, discourses, and policies. She is co-editor of the volume, Emerging Issues and Perspectives in Health Communication: Meaning, Culture, and Power with Dr. Mohan Dutta as well as the author of a number of important articles on critical health communication including “Interpretive and Critical Contributions to Health Communication Theory” (co-authored with Kimberly Klein) and “The Narrative Politics of Health, Risk and Illness in Environmental Campaigns.” Dr. Zoller serves as Editor-in-Chief of The Journal of Applied Communication Research.
A Brief History of Critical Perspectives in Health Communication
The field of health communication has been predominately made up of post-positivist, social scientific research. As Mohan Dutta and Heather Zoller argue, this research typically employs quantitative research, sometimes alongside the use of other empirical methods like qualitative interviews, with the aim of describing, predicting, and controlling health related outcomes. While contemporary scholarship in health communication displays greater diversity in perspectives and methods, this general orientation remains the norm in a great deal of research. Critical perspectives in health communication encompass a diverse body of literature, but are united in critiquing the assumptions of positivist research of health.
The term “critical” can be ambiguous in its academic usage. As discussed in the Introductory Guide to Critical / Cultural Studies, in communication scholarship the term most commonly describes research that explores the relationship between communication and power. In the context of health communication, critical scholars consider how power manifests itself in a diversity of health contexts, from doctor-patient communication to health campaigns. Critical health communication research also attends to the way in which medical discourses, institutions, practices, and practitioners can contribute to sociopolitical disparities and perpetuate the marginalization of certain communities and cultural groups. In doing so, they draw from a diverse body of intellectual influences, including cultural studies, critical scholarship on race, poststructuralist philosophy, Marxism’s post- and anti-colonial thought, and feminist criticism.
Some critical scholarship on public health traces its foundations to Western philosophical texts like Michel Foucault’s The Birth of the Clinic and Madness and Civilization, which y map the genealogy of Western medical and psychiatric institutions, respectively, to illustrate how medical knowledge has been produced over time in relation to dominant formations of power. Critical perspectives on race, Indigeneity, and colonialism, gender, and sexuality provide equally important precedent for this work and have seen increasing, if still limited, influence over the field in recent years.
For example, Gayatri Spivak’s work on the possibility of the oppressed obtaining representation in colonial contexts, Frantz Fanon’s work on colonialism, race, and psychology, and Black feminisms, including Kimberlé Crenshaw and Patricia Hill Collins’ work on intersectionality, have greatly influenced critical scholarship on health communication. Queer theory, from analyses of the exclusionary nature of responses to the HIV/AIDS pandemic to Judith Butler’s work on gender performativity and the social construction of sex, have also been an essential voice in the field.
Early examples of the critical treatment of health in communication research include Martha Solomon’s 1985 essay, “The Rhetoric of Dehumanization: An Analysis of Medical Reports of the Tuskegee Syphilis Project,” which investigates the relationship between medicine, power and race. In it, Solomon draws on the tools of rhetorical criticism to analyze the role of medical discourses in creating and sustaining an environment where medical practitioners abused and killed Black patients in the name of scientific progress for decades without intervention, even as they documented their practices in medical journals. Paula Treichler’s 1987 publication in Cultural Studies, “AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification” is another touchstone.
Despite these precedents for critical engagements with scientific health paradigms, critical scholarship has gained traction in health communication research more slowly than in some other areas of communication studies. Deborah Lupton’s essay, “Toward the Development of a Critical Health Communication Praxis,” is one of the earliest critical essays to appear in Health Communication, one of the field’s leading journals (Dutta 2010). Indeed, as Nicole Hudak (2020) argues, the publication of critical research can still present a challenge in the current academic context. That being said, today critical health communication is a growing area of scholarship, which invaluably expands research in the field by challenging its limitations and grappling with the pressing social, political, and cultural dynamics involved in healthcare and health communication.
Critiquing Western Biomedicine
Western biomedicine is grounded in empirical science, and as such often presents its recommendations as objective truths that apply across situational, political, and sociocultural contexts. Beginning from this assumption, traditional approaches in health communication often take the goals and methods of biomedicine at face value and similarly rely on universalist social scientific models of communication to understand how to motivate people to follow the directives of Western medicine.
By considering the relationship between medical knowledge and power, critical scholarship on health and health communication challenges the assumptions of universality, effectivity, and innovativeness of dominant, Western scientific health paradigms (Dutta 2010). The critique of the dominance of the Western biomedical model found in critical health communication research complicates the assumption that biomedicine is necessarily altruistic and objective. It emphasizes the ways in which health communication often works in the service of power, which ultimately prevents it from accomplishing its ultimate goal of promoting public health. Health campaign messaging and media representations of health issues, for example, often assume the universal applicability of their communicative strategies, glossing over important sociopolitical, cultural, and contextual factors that impact their efficacy.
The universality of the biomedical model also marginalizes alternative medical knowledge and practices. Patricia Geist-Martin et al. (2008), for instance, argue that holistic and non-Western healing practices’ focus on spiritual and bodily elements of health, emphasizing enhanced patient-provider communication and a willingness to “delve into areas of physical and psychic pain downplayed or ignored in biomedicine and generally not addressed in health communication research.” Elsewhere, Geist-Martin criticizes health communication for often engaging in an unreflective paternalism that erases the importance of context and cultural identity. Dutta similarly argues that health campaigns and health communication programs often fail to work with the communities they target to develop their goals and strategies, and can, as a result of their affiliations with corporations and governmental organizations, act as instruments of cultural colonization and capitalist exploitation.
In reacting to these problematics, critical health communication scholars move beyond the social science methods typical of health communication research. They adopt interpretive and qualitative methods and work closely with activists and members of marginalized communities to produce more equitable approaches to public health and health communication. At the same time, these critical challenges to the Western medical paradigm importantly do not reject medical science in its entirety. Critical health scholars critique the medical sciences so that scholars might be sensitive to their biases and engage in reflexive scholarly practice that aims to avoid perpetuating structural inequalities and violent practices that are symptoms of the worst tendencies in the Western medical tradition. They aim to build a more inclusive approach to medical communication that includes marginalized and activist perspectives in conversations about public health. Both of these objectives serve the ultimate goal of reducing health disparities and promoting community health.
Indeed, understanding relations of power is treated as crucial to identifying and overcoming obstacles to care, including breakdowns in emergency medicine caused by organizational hierarchies and racial and gendered disparities in mental health care treatment. While some scholars seek more radical alternatives to existing medical and health communication paradigms, critical health scholars maintain a common commitment to addressing structural health inequalities and promoting community health.
Power and Politics in Health Communication
Critical health communication scholars investigate the relationship between power and the knowledge, discourses, practices, and institutions surrounding health and medicine. They have documented the relevance of power to health care from the highest levels — the production of Western medical knowledge and national and international health policy — to the most everyday interactions, like communications between doctors and patients.
In practice, individual health behaviors, access to care, and quality of care are mediated by the organizational power structures of medical institutions, the interpersonal power relations between health practitioners and patients, and the broader cultural context in which health needs emerge. For example, Murphy et al. (2008) attend to the ways in which organizational power structures in emergency medicine can have adverse effects on patient health because of the communication problems they generate. The power disparity between medical practitioners and between patients and providers can impact quality of care for similar reasons, diminishing the quality of patient-provider communication in ways that often disproportionately affect members of socioeconomically disadvantaged groups (Ellington 2008).
But larger power structures are also central to determining the politics of health initiatives. Some of the contextual dynamics relevant to health are related to governmental and economic power. Heather Zoller’s (2008) research, for example, explores the way that global economic policy sustains discourses on health that turn health into a matter of individual responsibility, and which discourage state-based health care solutions in favor of corporate ones. Dutta (2010) similarly argues that health campaigns often serve the economic agendas of global corporations like pharmaceutical companies while treating the local communities where health interventions take place as “passive target audiences.”
Biomedical interventions and health communication can also perpetuate inequalities pertaining to cultural identity. Many critical scholars today examine how medical discourses, public health policies, health campaigns, and medical institutions perpetuate power structures that subjugate groups on the basis of race, gender, and sexual orientation. (The next section investigates these criticisms in more detail.) In response to these inequities perpetuated by dominant approaches to public health, critical scholars have worked to develop models of health communication that are more inclusive and participatory in nature — arguing for the value of working alongside health care activists and the communities affected by health interventions to develop approaches to public health that are empowering and inclusive, as opposed to exclusionary, colonizing, and paternalistic.
Identity and Cultural Politics in Critical Health Communication
One of the most vital areas of critical health communication today is scholarship dedicated to understanding how dominant practices in biomedicine and health communication have participated in the marginalization and oppression of certain cultural groups and identities, and envisioning critical and culturally competent health communication practices that promote racial and social justice (Goins and Pye 2013). Often obscured by biomedical claims to objectivity, universality and progress, medical institutions and practitioners have been responsible for grave acts of violence against members of minority groups, from forced sterilization of Indigenous, Black, and Latina/o/x women, to the murder, through deprivation of treatment, of Black men suffering from syphilis, all in the name of medical science (Hernández and De Los Santos Upton 2019; Solomon 1985).
In other instances, governmental policies directly impact the welfare of members of subjugated communities. For example, Leandra Hernández and Sarah De Los Santos Upton (2019) observe that migrants at the U.S.-Mexico border are routinely denied access to reproductive health care, and, as a consequence, these policies are an example of “reproductive feminicide”: a form of gendered violence against women “spanning from a structural limitation of reproductive options to the murdering of women because of their reproductive capabilities.” In this context, they argue for the important role that critical health communication praxis can serve in witnessing and resisting reproductive injustice and health injustices in militarized spaces like national borders.
The oppressive nature of the biomedical paradigm and dominant approaches to health communication is not always so explicit as violence and medical neglect. Racial, ethnic, and identity-based discrimination in health care is a trenchant issue on a number of different levels. Critical health scholars have identified the ways that power hierarchies related to cultural identity operate in medical knowledge, normative health practices, patient-provider communication, structural access to and quality of care, and approaches to public health and health campaigns. Scholars in this field have also argued that disparities in all of these areas reflect and intensify the oppression of marginalized groups (for example, see: Goins and Pye 2013, Slaughter-Acey 2020, Vardeman-Winter 2016).
In light of this, critical scholars have directed their efforts to developing more inclusive practices of communication scholarship that respect and center the experiences of oppressed communities and encourage researchers to be self-conscious about the limitations of their own perspectives and the possible harm generated by unreflective medical interventions.
Critical Perspectives in Health Communication Today
The critical perspectives on health communication discussed in this article constitute the cutting edge of research in the field. While the institutionalization of critical theory into mainstream health communication research is still an ongoing effort, critical health communication scholarship has demonstrated that attention to power in medical contexts is an essential step toward understanding and addressing health disparities and the larger sociocultural inequalities they represent.
However, in a time when the politicization of public health initiatives has led to unnecessary deaths (for example, during the COVID-19 pandemic) and suffering and scientific authority over public health comes under threat in other areas, it is important to stress that the critiques of the Western biomedical model and its influence on health communication advocated by critical communication scholars do not cast doubt on the efficacy of scientific innovations like vaccines. On the contrary, critical health scholars have sought to formulate strategies for intervening in these new cultural struggles, and are best equipped to do so because their research theorizes the relationship between power, culture and health (Sastry and Badu 2021). Contemporary health scholars continue to value promoting public health while they push to make healthcare and health communication more just.
Sources and Further Resources
Critical perspectives in health communication is still a developing and growing influence in the field. To keep up with critical health communication research, check out the journals: Health Communication, Frontiers in Communication, Critical Public Health, and the following resources.
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- Hernández, Leandra H. and Sarah De Los Santos Upton. 2018. Challenging Reproductive Control and Gendered Violence in the Américas: Intersectionality, Power, and Struggles for Rights. Lexington Studies in Health Communication.
- Hernández, Leandra H. and Sarah De Los Santos Upton. 2019. “Feminist Approaches to Border Studies and Gender Violence: Family Separation as Reproductive Injustice.” Frontiers in Communication, 4: 44.
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- Hite, Adele H., and Andrew Carter. 2019. “Examining Assumptions in Science-Based Policy: Critical Health Communication, Stasis Theory, and Public Health Nutrition Guidance.” Rhetoric of Health & Medicine, 2(2): 147-175.
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- Zoller, Heather M. 2008. “Technologies of Neoliberal Governmentality: The Discursive Influence of Global Economic Policies on Public Health.” In Emerging Perspectives in Health Communication: Meaning, Culture, and Power. Heather M. Zoller and Mohan J. Dutta, eds. Routledge: 390-410.
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- Zoller, Heather M. 2019. “Critical Health Communication Methods: Challenges in Researching Transformative Social Change.” Frontiers in Communication, 4: 41.
- Zoller, Heather M. and Mohan J. Dutta. 2008. “Emerging Agendas in Health Communication and the Challenge of Multiple Perspectives.” In Emerging Perspectives in Health Communication: Meaning, Culture, and Power. Heather M. Zoller and Mohan J. Dutta, eds. Routledge: 449-463.
Additional Topics on Research in Health Communication
This guide details the central theories governing health communication research, including social cognitive theory and the theory of planned behavior, while examining the different types of health communication such as patient-provider discussions and health campaigns.
Explore health communication research on health campaigns, including the history of health campaigns, leading theoretical perspectives in campaign research, major approaches to designing and evaluating health campaigns, and the state of campaign research today.
Explore Social Cognitive Theory and its applications in health communication. Learn about the theory’s history and key constructs, as well as its applications in health campaigns and health promotion initiatives, and the current state of research using the SCT.
Explore the definition and history of the Health Belief Model, its application in health communication research and public health initiatives, and its limitations, as well as contemporary research on the Health Belief Model and its effects.
Learn about the Theory of Planned Behavior in health communication research. Explore the history of the Theory of Planned Behavior, its key constructs, the model’s applications in health campaigns and health education, and the state of contemporary research in the field.
