This Wasn’t Written by a Bot

A seated doodle using ChatGPT on their laptop visibly suspicious

Here at We ❤️ Health Literacy HQ, we’ve been talking a lot about generative AI (short for artificial intelligence). By now, you’ve surely heard about — and maybe even tried — programs like ChatGPT or Bard. Generative AI uses source content, like a database or websites, to create new content based on a prompt or question you “ask” it. The results can be quite entertaining: Try asking ChatGPT to write a song about project management, for example. It’ll raise the roof at your next company party. (We speak from experience.)

Aside from being a fun diversion, generative AI has the potential to change the way we work and communicate with each other. For some, that’s great news. Others aren’t so sure: “Never trust anything that can think for itself if you can’t see where it keeps its brain,” as Arthur Weasley once said, probably in anticipation of 21st century AI.

It’s impossible to predict what impact generative AI will have over the coming years on things like, you know, our jobs as health writers and communicators. What we do know is that there are a few things to keep in mind if you’re going to use generative AI in health comm in 2023:

    • Don’t use generative AI as a replacement for audience research, plain language work, or translation. We can’t emphasize this enough: There’s no substitute for involving actual humans when it comes to the nuances of creating clear, trustworthy, and culturally appropriate health information.
    • Be transparent. If you’re using content that’s been generated by a generative AI program, say so — even if you put your own spin on it.
    • Check for accuracy. Remember that ChatGPT & Co. are only as good as the sources they draw from — which are vast in number and vary in quality. So as with any information you find online, check your facts by consulting other credible sources.
    • Watch out for bias. The source content for generative AI programs was created by humans. And as such, it carries over some of our biases, stereotypes, and misconceptions. Check your content carefully for non-inclusive language, harmful stereotypes, and the like.

Think of generative AI like that classmate in high school who let everyone copy their homework. Sure, it was easy. Especially if you spent the night before playing Sonic the Hedgehog instead of writing that paper on The Great Gatsby. But it also meant that you copied some of their mistakes — and besides, the work never quite felt like yours.

It’ll certainly be interesting to see what happens here in the long term — and how (if?) regulations will play a key role. If you’re anything like us, you’ve been thinking a lot about the types of policies that might have prevented some of the less savory implications of social media back in the day. Of course we all know what they say about hindsight…

If you have thoughts about generative AI and the future of health comm, dear readers, we want to hear them! As always, you can respond to this email or find us on LinkedIn or Twitter.   

The bottom line: Generative AI, like ChatGPT or Bard, can make some parts of our work easier. But remember that they’re just another tool for our communicator toolbox. 

Tweet about it: Read @CommunicateHlth’s take on generative AI and its impact on our work as #HealthComm professionals:

Announcing… Our New Playbook on Writing for LGBTQ+ Communities!

Three excited doodles presenting CommunicateHealth's new Inclusive Language Playbook: Writing for LGBTQ+ Communities resource. One of doodles is holding a progress pride flag.

As you probably know, dear readers, we recently released our Framework for Equity-Centered Health Communication. And we’re so excited to follow it up with another CommunicateHealth publication launching today: our Inclusive Language Playbook: Writing for LGBTQ+ Communities.

We’re very proud to be a company with LGBTQ+ leadership, and this is a topic that’s close to our collective ❤️. The timing is significant, too: Over the past few years, there’s been an upsetting trend of anti-LGBTQ+ legislation, including bans on gender-affirming health care for trans youth. This is exactly the type of thing that could lead to health disparities for LGBTQ+ communities in the future.

As public health communicators, it’s crucial that we do our part to help LGBTQ+ audiences feel seen, respected, and included. We acknowledge up front that there’s no one-size-fits-all guidance when it comes to writing for LGBTQ+ audiences, and we certainly don’t pretend to have all the “answers.” But we hope you’ll find the playbook useful — and that it might inspire some thoughts, ideas, and conversations.

Finally, as we noted with the equity-centered framework, we’d appreciate your feedback on this new resource. Feel free to reply to this email and tell us what you think!

The bottom line: Check out our latest resource on inclusive writing for LGBTQ+ communities and let us know what you think!

Tweet about it: NEW! @CommunicateHlth has just released a #HealthComm playbook on inclusive writing for #LGBTQ+ audiences. Check it out: #PublicHealth

Book Club: Demon Copperhead

A doodle gestures to a copy of Barbara Kingsolver's Demon Copperhead.In today’s edition of the We ❤️ Health Literacy Book Club, we’re highlighting a novel that we absolutely can’t stop thinking about: Demon Copperhead by Barbara Kingsolver. Set in rural Appalachia during the early days of the opioid epidemic, it’s a critique on the damaging effects of institutional poverty and a pharmaceutical company’s aggressive push to sell a new painkiller that it claimed wasn’t addictive.

Demon Copperhead is actually a modern retelling of Charles Dickens’ David Copperfield. But rather than an English boy born in the mid-19th century, the eponymous protagonist in Demon was born in the mountains of Virginia in the 1980s to a teenage mother living on her own and struggling with addiction. From the moment Demon enters the world, addiction is an overarching theme in his life, affecting nearly everyone he knows in one way or another.

The book is a heart-wrenching story told in Demon’s own voice — and you’d be hard-pressed not to love him. He’s full of sharp and often hilarious one-liners (“People love to believe in danger, as long as it’s you in harm’s way, and them saying bless your heart”), and he’s wise and insightful beyond his years (“The wonder is that you could start life with nothing, end with nothing, and lose so much in between.”)

One of our favorite parts about the book is how Kingsolver, herself from Appalachia, writes with unmistakable empathy — something we ❤️ to see as health communicators. Kingsolver builds connection with her characters, in large part by laying bare the many systemic barriers they’re up against — generational poverty, struggling schools, a broken foster care system, and limited access to high-quality health care among them.

She also calls out — and continually counteracts — a damaging stereotype (which is of course a key part of empathetic communication!). As Demon says: “This is what I would say if I could, to all the smart people of the world with their dumb hillbilly jokes. …We can actually hear you.”

Demon isn’t an easy read — it’s full of tragedy and loss and heartbreak. And of course it’s about a very real crisis that’s far from over. But it’s an important reminder of how the opioid crisis came to be and how profoundly it has harmed a population that many are quick to overlook. Kingsolver ends her author’s note by directly addressing real-life kids like Demon:

“For the kids who wake up hungry in those dark places every day, who’ve lost their families to poverty and pain pills, whose caseworkers keep losing their files, who feel invisible, or wish they were: this book is for you.”

The bottom line: Demon Copperhead is a heart-wrenching novel about the early days of the opioid epidemic in rural Appalachia. The subject matter is tough, but the author writes with empathy to build connection with her characters — and leave a lasting impression.

Tweet about it: The latest installment of @CommunicateHlth’s We ❤️ Health Literacy Book Club is all about Barbara Kingsolver’s #DemonCopperhead. Check it out, and be sure to pick up this super powerful read:

Reclaiming Our Time

Frazzled doodle on the phone, holding a pen among piles of paperwork

This week, we’re proud to offer our platform to Jennifer Sclar and Kathryn Wollan — Co-founders and CEOs of Clear Health Analytics, a women-owned small business built on the shared belief that everyone deserves access to clear, accurate, unbiased information about health insurance. And we certainly don’t have to tell you, dear readers, that health literacy is a hugely important part of that puzzle. You can see why we get along.

 With the COVID-19 pandemic as a backdrop, Jennifer and Kathryn wrote this op-ed on the disproportionate burden of health care-related administrative tasks on women. And as a women-owned small business ourselves, we wanted to help get this important message out there. We hope you’ll read and share!

In the United States, a novel virus places novel burdens on our complex, for-profit, health care system and creates novel challenges for those responsible for the health care-related administrative tasks of a household. Not surprisingly, women are responsible for 80% of household health care decisions, and the vast majority of the invisible, uncompensated hours spent interacting with the health care system falls to women.

During the COVID pandemic, millions of women in the United States spent millions of hours locating and scheduling COVID tests and vaccines — and managing the related logistics and paperwork. As many learned the hard way, not all facilities are created equal in terms of the cost of a “free” COVID PCR test, and not all health plans are created equal in terms of how to seek reimbursement for this “free” test. This is yet another example of the heavy toll that the health care system takes on women.

Complicated by Design
If you’ve ever seen a doctor in the United States, you know that reconciling the complicated, untimely, and often erroneous billing and insurance paperwork is tedious and time-consuming. Every single medical service results in at least one bill from the provider and at least one (but typically multiple) Explanation of Benefits (EOBs). These communications often arrive weeks after the service and weeks apart from one another. As family health care leaders, and patients themselves, this administrative burden falls disproportionately to women.

The complexity of our health care system is no accident — time consumption and consumer fatigue are the entire rationale for administrative complexity.The effort to “administrate into submission” has been wildly successful, as people routinely limit or forego health care for fear of out-of-pocket costs and coverage denials. And many people avoid appealing an insurer’s denial of care despite the fact that when they do, they often win.

A recent study published in the Annals of Internal Medicine details that the combined cost of health care administration to U.S. insurers and health care providers in 2017 was almost $2,500 per capita, or $812 billion. That’s nearly 35% of total health care spending and enough to cover health care for every American. And these numbers don’t begin to account for the cost of this administrative complexity to consumers. Not in dollars, not in time lost.

In his 2020 book Priced Out, late renowned health care economist Uwe Reinhardt meticulously recounts the costs of the health care administrative-industrial complex to private and public insurers, hospitals, and physicians. But when it comes to patients, he points out that no “…empirical estimates on administrative expense includes the value of the time American consumers devote to choosing health insurance products or, as patients, to process usually incomprehensible medical bills from the providers of health care or claims from health insurers.”

Women’s Work
Women bear the brunt of this growing burden in households of every type, regardless of their education or profession. And like most caretaking and household responsibilities, women’s contributions to their family’s health care administration are invisible and unpaid.

Reinhardt himself admitted that in his household, his wife handles the health insurance claims. “This goes beyond the capacity of a Ph.D. in economics,” he said. “So, she does it, and she tells me that claiming for health insurance is far more time intensive and complex than the income tax, which she also does.” (Reinhardt’s wife, Tsung Mei Cheng, is also a brilliant health policy researcher.)

This administrative morass devours our time and produces untold stress and anxiety, often with devastating effects on financial and physical well-being. So why is it allowed to continue? Because it’s women’s work.

It’s Our Time
It’s time to name and quantify the burden that health care administration puts on the resources of American women. Let’s advocate for changes to our health care system. Let’s make sure that our legislators recognize and address this crushing burden that threatens the physical and financial health of women and their families and steals untold hours from their lives. Women don’t have this kind of time to spare.

Let’s reclaim our time.

Jennifer Sclar and Kathryn Wollan are the Co-founders and CEOs of Clear Health Analytics.

Webinar: Centering Equity in Health Communication Design and Delivery

A doodle holds up a sign with the Society for Health Communication logo.

This week, dear readers, we’re so excited to invite you to a webinar all about one of our very favorite topics: equity-centered health communication. This event is hosted by the Society for Health Communication and sponsored by, well, us — and it’s happening on Wednesday, April 19, from 12 p.m. to 1:15 p.m. ET. We hope you’ll register to join!

Here’s an excerpt from the webinar description: As we continue to grapple with lessons learned from COVID-19, health communicators have an opportunity — and a responsibility — to approach our work through an equity lens. Even small shifts can go a long way toward rebuilding trust and disrupting power imbalances at the root of health care inequities. But what does centering equity in health communication look like in practice? What does inclusive and accessible public health guidance sound like? And what are the implications for communication research and evaluation?

To help answer these questions — and perhaps raise some new ones — CH President Stacy Robison will talk with Susan Laird, Training and Health Education Lead at CDC’s Division of Communication Science and Services. The conversation will be moderated by Ashani Johnson-Turbes, Vice President and Director of NORC’s Center on Equity Research at the University of Chicago.

We’re really looking forward to this event, and we hope to see many of you there. As Stacy wrote in the foreword of our newly released equity-centered health comm framework, the future of public health communication is ours to redesign.

Let’s get started.

The bottom line: Join us at the Society for Health Communication’s webinar on April 19 to talk about how to center equity in our health comm work.

Tweet about it: Join @healthcommsoc and @CommunicateHlth on 4/19 for a webinar all about centering #equity in #HealthComm work. You can learn more here:

Unpacking “Disabled,” Reclaiming Disability

2 doodles stand side by side. One holds a heart in their outstretched hand, saying, “I have a disability.” The other holds a heart close to their chest, saying, “I’m disabled.”

If you’re like us, you learned to say “people with disabilities” and not to say “disabled people.” This is an example of person-first language, which we typically learn is the most respectful approach to identity-related terminology. But we’ve noticed a shift in conversations about disability, with more people self-identifying as “disabled” and using the phrase “disabled people.” We’re paying close attention since we know that understanding how our audiences describe themselves — and why — helps us create inclusive materials that resonate.

Why are more people using “disabled”? Well, we certainly can’t speak for everyone — but for some, especially people who have experienced ableism or discrimination, embracing “disabled” is a way to reclaim disability as part of their identity. Although “people with disabilities” is often framed as the more inclusive approach, some disabled folks argue that it actually perpetuates stigma by separating them from their disability (you’d never say “person with womanhood” or “people with gayness”!) and making disability-related language in general feel like something not for use in polite society.

So in the same way that LGBTQ+ people have reclaimed the word “queer,” some people call themselves “disabled” to challenge that stigma — and many people find healing in the visibility that the term brings. This can be especially important for people who learned to hide their disability at an early age because trusted (and often well-meaning) adults taught them to assimilate into a world designed for non-disabled people. The unspoken lesson for those folks was that disability is a problem to be fixed.

The phrase “disabled people” also reminds us that, like health literacy, disability involves interactions between people and systems. Some advocates argue that ableist systems make people “disabled” by making it hard (or even impossible!) for them to access public spaces and participate in society. Of course, even in an ableism-free world, living with a disability would come with challenges. But as health communicators, we’re all about dismantling stigma and bias — and recognizing how ableism harms disabled folks is a good place to start.

What does all this mean for our health communication materials? As with many health comm challenges these days, there’s just no simple answer — the key is to get to know your audience and take your cue from them. People involved in disability activism, self-advocacy, or online disability communities are more likely to self-identify as disabled. So if you’re looking for it, you’ll probably see it pop up in conversations about equity and social justice. (We elected to use “disabled” in our Framework for Equity-Centered Health Communication, for example.)

We’d love to hear from you, dear readers, about how your organization handles this — especially if you write materials for disabled people. Drop us a line by responding to this email or tweeting @CommunicateHlth.

The bottom line: Many people have chosen to reclaim the word “disabled” for themselves. Understanding why can help us create materials that resonate with our audiences.

Tweet about it: This week, @CommunicateHlth explores why many people choose to reclaim the word “disabled”:

The American Gun Violence Epidemic Rages On

Group of somber doodles holding a banner that says, “enough is enough”

This week, we’re following the news coming out of Nashville as our nation grapples with yet another senseless loss of lives. We’re sad, frustrated, and angry. What we are not, unfortunately, is surprised. Though there isn’t a single agreed-upon definition of mass shootings, by the Gun Violence Archive’s measure (4 or more people injured or killed), there have been 130 mass shootings in the United States in 2023. It’s March. There are 9 more months left in 2023.

The unapologetic politicization of this public health issue is very literally killing children. On Monday, Tennessee Governor Bill Lee tweeted that he’s keeping a close eye on the “tragic situation” and asked people to join him in “praying for the school.” Last June, after the mass shooting in Uvalde, Governor Lee made it very clear that he’s against strengthening gun control laws in his state. “Criminals don’t follow the laws. Criminals break laws,” he said at the time. “We can’t control what we can’t control.”

Turns out Governor Lee has his own agenda for “protecting” children. Just a few weeks ago, he was busy signing 2 bills into law: one that criminalizes drag shows that take place where a child could potentially witness them and another banning gender-affirming health care for trans minors.

The hypocrisy and blatant disregard of facts is astonishing. Children are not collateral.

Here’s your reminder to:

We understand that this may feel like a hopeless battle at this point, but let’s try to help each other stay motivated. Fact is, firearms are now the leading cause of death for kids and teens in this country. That’s a public health issue, and we are public health professionals.

In solidarity,
The CommunicateHealth team

Tweet about it: Following the news out of Nashville this week, @CommunicateHlth shares thoughts for #PublicHealth professionals on the American #GunViolence epidemic:

Stack ‘Em Up

Doodle stacking blocks with healthy habits written on them, including" "wear SPF," prep healthy snacks," and "go for a walk"If you reflect on your daily life, dear readers, chances are you’ve acquired a few habits that you’re not so proud of — like leaving your socks on the floor. And if you’ve ever tried to break a not-so-great habit, you know it’s easier said than done.

The same is true for building new habits. Especially if they’re things you know you probably should be doing — like picking up those socks, putting them on your feet, sliding your feet into some sneakers, and going for a walk. As humans, we’re hardwired to follow established patterns. But here’s the good news for health communicators: If you’re trying to help your readers create a new habit, that hardwiring can actually be helpful — and that’s the idea behind a technique called habit stacking.

Originally coined by author S.J. Scott (or at least that’s the best info we could find), the term “habit stacking” basically means finding a behavior (the “habit” in this “stacking” scenario) that you already do and “stacking” a new one on top of it. Over time and with repetition, the new behavior becomes a habit, requiring less effort and focus.

So how can we apply this to our work as health communicators? Let’s say you’re encouraging your readers to prep healthy snacks for work in advance. You might suggest they think about something they already do every night — maybe eating dinner — and “stack” the new behavior on top. You could write: “After you eat dinner each night, cut up some fresh fruit to take to work the next day.”

And depending on the context of your material, then you might also explain the “why” behind the stacking: “If you connect a new behavior to something you already do anyway, it can be easier for your brain to make the new behavior a habit.”

Want more details about why this works? We’ll let James Clear, who covers habit stacking in his 2018 best-selling book Atomic Habits, speak to that: “Your brain builds a strong network of neurons to support your current behaviors. The more you do something, the stronger and more efficient the connection becomes,” he writes. (You can read more in this excerpt from Atomic Habits.)

By stacking a new behavior onto an old one, you’re leveraging those connections, making it easier for the new behavior to become a habit. And what health communicator doesn’t ❤️ a healthy habit?!

The bottom line: Habit stacking is a great tool for the health communicator’s behavior change toolbox.

Tweet about it: This week, @CommunicateHlth is reflecting on how habit stacking can help inspire behavior change in our #HealthComm materials:

Introducing Our Framework for Equity-Centered Health Communication

Three excited doodles presenting CommunicateHealth's new Framework for Equity-Centered Health Communication resource

Well, it’s an exciting day here at We ❤️ Health Literacy HQ because we’re rolling out our new Framework for Equity-Centered Health Communication! This is something we’ve been thinking about and working on for a long time — and we’re proud to share it with you here today, our dear readers. Check out the framework now.

Right off the bat, we want to emphasize that we’re really interested in your feedback on this resource. We certainly don’t expect to get everything right, and we want to hear from you — folks putting the framework to, well, work — about how we can improve it. We’ve created an email address for you to share comments and suggestions. So tell us your thoughts by writing to!

As to the “why” behind this framework, we’ll let CH President Stacy Robison’s foreword speak for itself. Below is a slightly abridged version.

The COVID-19 pandemic forced us to reckon with some hard truths. In response, pretty much everyone — including leadership at CDC — is calling for more emphasis on health equity, transparency, and clear health communication. At CommunicateHealth, we’re all for it.

But how does this work in practice? Unfortunately, guidance in this department is a bit thin, leaving many public health communicators with more questions than answers. What does centering equity in health communication look like? And how is it different than what we’ve been doing to date? What does clear, accessible public health guidance sound like?

We have some ideas.

At CommunicateHealth, we’ve been following an equity-centered health communication model for more than a decade. We started with the fundamentals of health communication, and over the years we added some adult learning theory, mashed it up with principles borrowed from human-centered design, and elevated one criterion for success above all others: Is the information easy to access, understand, and use?

The result is a health communication framework that prioritizes equitable access to basic health information and services. It’s by no means groundbreaking or even original. But it’s simple enough to follow, and we’ve used it to train hundreds of CommunicateHealth team members over the years.

Public health communication is at a crossroads. And we’re optimistic that, together, we’ll chart the right path forward. We hope, in some small way, this framework will help set us on that path — or at least get us asking the right questions. Fact is, health communication can worsen health inequities, or it can start to close gaps in access and understanding. And small shifts in our methods and mindsets can make all the difference.

The future of public health communication is ours to redesign.

The bottom line: Check out and share our new Framework for Equity-Centered Health Communication — and let us know what you think!

Tweet about it:
Heads up, #HealthComm colleagues! @CommunicateHlth has just launched a new framework for centering equity in the health communication process. Learn more: #HealthLiteracy #HealthEquity

Frequently Asked Question: How Can We Make Sure Language Is Inclusive and Clear?

Two doodles happily sitting on either end of a seesaw

Here at We ❤️ Health Literacy HQ, hearing from you, our dear readers, is one of our favorite things. And when we can, we ❤️ to feature real-life questions from our community — which is what we’ve got for you today.

It’s one we’re hearing from lots of folks in various contexts right now: With the current focus on using inclusive language in health comm… oh, and let’s pause to acknowledge how great it is that we can say there’s a current focus on inclusive language in health comm — hooray! Okay, back to the question: In today’s health communication landscape, how can we make sure our language is inclusive and clear?

There are a couple things to acknowledge right up front. First, language is evolving very quickly. This may be especially true for topics like sexuality, gender, and disability — things that shape who we are and how we experience the world. That means people may come to our materials with wildly different vocabularies and expectations. Some people may feel affirmed and validated when they see newer, more inclusive terms. But people who aren’t familiar with these terms may feel confused or even alienated by them. That’s the reality of our communication landscape at the moment, and it can make things tricky.

And on a related note, the answer to specific terminology questions in this context is almost always going to be… it depends. Of course that’s not actionable advice, but it feels important to “say out loud” nonetheless. There just isn’t generalizable guidance in this space, and that means we need to be really intentional and think through language nuances on a case-by-case basis. It’s our actual job!

That said, there’s plenty we can do. As a starting point, we can acknowledge these differences and approach our work with empathy for both groups of readers. And while there’s no one-size-fits-all approach, here are some ideas for how to balance inclusivity and plain language best practices:

  • Pair newer, more inclusive terms with more familiar terms. For example, one reader asked specifically if “chestfeeding” might confuse people used to seeing “breastfeeding.” In that case, you might want to use “chestfeeding (also called breastfeeding).” You can also ditch the parenthesis, as in “women and people with uteruses.” It may not always be the most elegant phrasing, but it can be quite effective.
  • Offer specific examples to contextualize newer terms. Never underestimate the power of examples! If you’re writing about mobility aids, consider adding some examples like this: “mobility aids — like wheelchairs, canes, or walkers.” Simple and clear for the win.
  • Segment your audienceThe more specific your audience, the more you can get to know them (see next tip) and the more informed your starting point will be. For example, if you’re creating a material that’s specifically for trans and nonbinary people, it’s pretty likely they’ll be familiar with newer terms and concepts related to gender.
  • Test, talk, and listen. If you’re wondering if we’ll ever get tired of plugging research with your priority audience, the answer is absolutely not! It’s always best to ask your audience about their language preferences (just don’t use “preferences” if you’re asking about pronouns). If you can’t do formal research, get a gut check from an audience member — or someone who might be more familiar with your audience than you. Ask your colleagues, family members, and friends. Talk about the issues that come up. Listen. We bet you’ll learn a lot.
  • Check out resources created by and for your audience. For example, if you’re creating materials about gender and sexuality for autistic adults, you might check out resources from the Autistic Women & Nonbinary Network to get a pulse on issues that are important to autistic LGBTQ+ people — and what language-related conversations might be going on at the moment.

The bottom line: It can be tricky to balance clear and inclusive language — but we can do it, and it’s really worth it.

Tweet about it: It can be tricky to balance clear and #InclusiveLanguage. But that’s part of our job as health communicators, says @CommunicateHlth: #HealthComm #HealthLiteracy