The past three decades have seen an ever-increasing interest in the relationship between language and health. Whereas the earlier studies, such as Mishler's (Reference Mishler1984) seminal work on the dialectics of medical interviews, focussed more on the language of the medical encounter, more recently the scope has broadened to include all discourse about health. From written information about various conditions given out to patients and carers to patient-to-patient exchanges in online support groups, from the language used to instruct medical students to that of clinical incident reporting, the language of health communication has been receiving ever-increasing attention.
Studies on language and health communication have emerged from different disciplines. Among them are psychology, medical anthropology, the medical humanities, narrative studies, sociology, and, of course, linguistics. This variety of provenance has resulted in a rich and diverse scholarly output. It has also meant, however, that inter- and cross-disciplinary conversations have not always been as productive as many would have wished. This is only one of the reasons why The Routledge handbook of language and health communication is likely to be welcomed in many quarters.
The Handbook is at once a textbook, an introductory text, and a catalogue of current research and possible future developments. Its intended audience includes ‘undergraduate and graduate students in applied linguistics and social sciences broadly conceived; linguists who are interested in learning about their fields as it relates to health contexts and issues; health communication scholars who are eager to engage with linguistic theories and methodologies; medical school educators; and practicing health professionals and medical researchers who would like to learn more about the role of language in their own areas of experience and expertise’ (p. 1). It is precisely in its broad appeal and in the heterogeneous disciplinary provenance of its contributors that the strength and, in part, the weakness of the volume derive.
The Handbook is divided into three parts: (i) ‘Individuals’ everyday health communication’, (ii) ‘Health professionals’ communicative practices’, and (iii) ‘Patient-provider communication in interaction’. The editors envisaged this tripartite structure to reflect the disciplinary affiliations of early research on language and medicine in medical anthropology, institutional discourse analysis, and interactional sociolinguistics. Such early research gave rise to the concept of crosstalk, which refers to the different interpretations, and thus miscommunication, that can arise among interactants owing to ethnic, linguistic, and cultural backgrounds. Crucially, this mismatch can also be the result of differences in professional perspectives (e.g. between physicians and nurses or social workers), levels of education, or familiarity with certain institutional discourses and practices.
Part 1 of the Handbook focuses on precisely the differences that can give rise to such crosstalk. The first four chapters, under the heading ‘Perceptions and understandings about health’, deal with the different backgrounds with which actors in any health communication scenario operate.
Chapter 1, by Nancy J. Burke & Judith C. Barker, offers a very good start by introducing the concept of ‘noise’ in health communication. This refers to the wider social, environmental, and cultural environments that the different interactants bring to health, or indeed any, type of communication. The authors clearly illustrate the challenges posed by ‘noise’ but, crucially, they also highlight the possibilities that it offers to enhance communication and understanding. In chapter 2, Mark R. Luborsky explores the puzzle of self-appraised health reports, where a reply of ‘poor’ is three times more likely to result in the appraiser's death. The author stresses the importance of selecting an appropriate elicitation technique and of focussing on not only language but, crucially, attempting to understand language and communication issues. Erika Waters, Amy McQueen, & Linda C. Cameron address the complexity of health and risk communication in chapter 3 with reference, for example, to public health campaigns. They highlight the importance of addressing personal and societal differences in the perception of risk and advocate greater involvement of language scholars in this field. In chapter 4, Christina Zarcardoolas & Wendy Vaughon address the importance of numeracy skills in parsing health communication and they show how a better understanding of semiotics and linguistics can be used to better appreciate numerical data on health matters.
The second part of Part 1, ‘Linguistic constructions of health’, opens with a very informative chapter by Paul Crawford, Brian Brown, & Kevin Harvey on the use of Corpus Linguistics (CL) for evidence-based health communication. Very usefully, the authors offer a critical overview of the state of play of CL in health care. This section will be appreciated by medical educators and health practitioners alike and does indeed contain recommendations for practice, which make it a wonderful resource in a variety of settings. In chapter 6, Ulla Connor & Kathryn Lauten present a very insightful analysis of diabetes patients' talk. They skilfully utilise Martin & White's (Reference Martin and White2005) framework for the linguistic analysis of appraisal, itself couched in Hallidayan Systemic Functional Grammar, to assist practitioners in evaluating patients' likelihood of adhering to treatment. The chapter is of great interest to the linguist and also the physician and health worker. Rodney H. Jones, in chapter 7, is another good example of the potential for practical uses of research on health communication, its author investigating the possible reasons for the apparent failure of campaigns on HIV prevention by using mediated discourse analysis to investigate risky behaviour. Vaidehi Ramanathan, in chapter 8, looks at narratives of patients with cancer who undergo chemotherapy. The discussion is insightful although the claim (p. 123) that breast cancer is surrounded by a silence that is more ‘palpable’ than is the case with other conditions is questionable. In chapter 9, Peter Lichtenberg & Mark Luborsky look at the ethical consequences of Alzheimer's diagnosis.
The third part of Part 1 focuses on ‘Health interactions’ and includes four chapters. These address topics such as the use of applied linguistics as a resource for advancing health literacy; the role of health in researching health disparities; health communication in the era of Web 2.0; and interactions in online support groups. This is a particularly interesting and strong section in the volume. Word limitations do not allow for a very detailed discussion of the contributions but, in my opinion, the chapters on the role of applied linguistics and on online communication are particularly worthy of notice. Donald Rubin, in his chapter on the uses of applied linguistics, makes very important observations on the issues faced by speakers of minority languages, as well as of those faced by speakers of majority languages who are, nonetheless, ethnic minorities. He raises crucial points on the inequalities arising from ineffective communication and discusses methods for assessing health literacy. The topic is especially relevant in this age of mass migration and brings to mind the work of Tove Skutnabb-Kangas (see e.g. Skutnabb-Kangas & Phillipson Reference Skutnabb-Kangas and Phillipson1995, inter alia), one of the most prolific authors on linguistic rights.
In chapter 12, Abby Prestin & Wen-ying Sylvia Chou provide an insightful analysis of the ways in which Web 2.0 has had an impact on health communication. Of particular interest for its topicality is the section on peer-to-peer health communication, which the authors note, as well as offering advantages, is potentially perilous too. Particularly useful are the suggestions they offer for multidisciplinary research.
Part 2, on ‘Health professionals’ communicative practices’, opens with a contribution by Rita Charon, the leading figure behind ‘narrative medicine’. In her characteristically pithy way, Charon clearly demonstrates how reflexive writing by medical students, when ‘treated not as report but as discovery [can help them] harvest tremendously powerful insights’ (p. 255). Charon's chapter is followed by contributions on patient-centredness, transforming medical school culture, communicative skills for physicians, and the interactions between people with dementia in assisted residence and their visitors.
Inter-professional communication is the focus of the next section in Part 2. This is particularly welcome because, in the past, the focus has often been on doctor-patient interactions, as if intra-professional communication in health were less interesting or problematic.
Part 3 takes the reader to the area of patient-provider communication, with contributions that address not only the linguistic aspects but also those to do with morality and, more generally, the illness experience. This section is followed by the one on the management of linguistic and cultural diversity, which is especially relevant in these times that, as mentioned above, see large movements of people across countries and continents.
The volume concludes with five chapters on an essential component of any work on health and health communication—ethics in action. The contributors to this closing section have done a very good job of clearly showing the ethical implications and dimensions of communication in health and healthcare settings. Clinical trials, the solicitation of organ donations, and communication in palliative care are only some of the issued that are skilfully and informatively addressed here.
To conclude, it is worth stating that a review of this size cannot really do justice to the Handbook. Its coverage is vast and brings the reader up-to-date with the latest research and research trends. The editors are to be complimented for commissioning contributions that will undoubtedly appeal to such a diverse readership and for finally giving us, all in one place, a resource of this magnitude, which is likely to inspire and inform researchers for years to come. The diversity of the contributors to the volume may explain some of the weaknesses of the collection. Linguists will, I presume, sometimes be frustrated by some contributors’ loose grasping of all of the intricacies of the various subfields of linguistics within which they operate. These are minor weaknesses, however, that are easily compensated by the vast appeal of this volume and the research that it will inspire. Lecturers, students, patients, carers, and medical professionals will certainly benefit from the insights that the research presented here offers.
