Structure-Centered Approach

The structure-centered approach to health communication notes that structures play a crucial role in determining how people make sense of, or communicate about, health. The intersection between structures and an individual's or a collective's ability (agency) to make sense of the world—to communicate—has been discussed at length in the work of Anthony Giddens. The structure- agency duality taken into the realm of communication points to the notion that a society's rules and resources, in other words, structures, influence and are influenced by human communicative/sense-making patterns. When this conceptualization is transposed in the framework of health communication, the structure-centered approach to health communication situates health in the realm of the social structures that constitute it.

In his article on critical-cultural perspectives in health communication, Mohan Dutta-Bergman states that the aims of the structure-centered approach are most informed by studies examining how socioeconomic inequalities play a critical role in shaping the health and health communication patterns of communities.

Critical to this concept is the idea of structures, or what Giddens calls the rules and resources that both constrain and engender human behavior. Broadly defined, structures, in the structure-centered approach, refer to forms of social organizing that provide or limit access to resources. These resources script human behavior that guide culture and conduct. Structures that influence health include those at the microlevel, such as community medical services, community modes of transportation, channels of communication, and health-enhancing resources such as food, clean spaces, and spaces for exercising; meso-level resources such as points of policy implementation, avenues of civil society organizations, and media platforms; and macrolevel resources such as national and international political actors and points of policy formulation, and national and global health organizations. It is important to note that structures are embedded in material reality as well as in communicative practices, with one influencing the other. The emphasis in the structure-centered approach is to gain an understanding of those structures that limit the possibilities of health for members of a community.

For the homeless, for instance, structural barriers that impede access to use of health care facilities include material resources—pressure to find survival necessities such as food, clothing, shelter and safety; lack of money and health insurance; and lack of transportation; and/or communicative structures that stigmatize the homeless and paint them as lazy and incompetent. Or take the case of the Santals, an indigenous community that resides in multiple pockets in eastern India. Dutta-Bergman locates poverty as a barrier to this community's search for and articulations of health, noting that hunger is a key part of their lives and a primary obstacle to health. Subsequently, food, or the lack of it, and the overriding need to find food for the family takes precedence over accessing even the marginal health services available to the Santali communities. A similar experience is shared by tribals living in the Indian state of Jharkhand. Ambar Basu and Mohan Dutta note how these tribals living at the cusp of marginalization and modernity articulate concerns about not having access to the tropes of modern medicine. They talk about the government not being concerned about their health and their need to travel enormous distances to avail themselves of health care facilities.

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