He has spent three decades pushing for better health communication, and he is not stopping now.
When Prof Scott Ratzan first encountered patients affected by HIV in Los Angeles hospitals in the 1980s, medicine alone was not the biggest challenge. Fear was.
Doctors hesitated to approach patients. Communities were consumed by stigma. Governments struggled to speak openly about prevention. Public health campaigns avoided even saying the word “condom” on television. At the centre of the crisis was not only a virus, but a communication failure.
For Prof Ratzan, that moment became a turning point that would define a career spanning three decades at the intersection of medicine, communication and public health.
Today, he is regarded as one of the world’s leading voices on health communication and health literacy. A physician by training, he serves as a faculty member at the CUNY Graduate School of Public Health and Health Policy and has spent 30 years as Editor-in-Chief of the Journal of Health Communication. His work focuses on how people receive, understand and use health information, and why communication itself is a determinant of health.
Prof Ratzan told Willow Health Media’s Whitecoat Diaries that modern healthcare cannot succeed without quality communication. “How do we communicate about health that is necessary for ourselves, for our family, and for society?” he asked. That question has become increasingly urgent in a world shaped by pandemics, misinformation, digital media and widening distrust in institutions.
One doctor could treat 2,000 or 3,000 families, but communication multiplies that
Prof Ratzan’s path into health communication was not straightforward. Raised by an obstetrician-gynaecologist father, he initially followed the traditional medical path. Yet while studying medicine in the United States, he realised that healthcare outcomes were influenced by more than clinical treatment.
Before medical school, he studied political communication. Later, during a year at the Harvard Kennedy School, he combined health policy studies with communication training. That intersection shaped the rest of his career. “One doctor could treat 2,000 or 3,000 families,” he explained. “But communication multiplies that. Add a couple of zeros.”
The insight reflects a growing understanding within public health that communication influences whether people vaccinate their children, seek medical care, adhere to treatment, trust science or adopt healthier behaviours.
The importance of communication became starkly visible during the HIV/AIDS crisis. Fear and misinformation spread rapidly. Many patients experienced discrimination not only from the public but also from healthcare workers. Governments were often reluctant to discuss prevention openly.
Prof Ratzan responded by editing one of his earliest books, AIDS: Effective Health Communication for the 90s, which examined how public messaging around HIV could be improved and why political and social communication mattered as much as biomedical advances. “It was the political communication side that made the difference,” he said. “Not necessarily the medical side that made the difference early on.”
Health systems blame communities for not understanding medical information
Those lessons would later reappear during other health crises, including Ebola, COVID-19 and vaccine hesitancy campaigns.
Central to Prof Ratzan’s work is the concept of health literacy. Together with colleague Ruth Parker, he helped define the term at a time when few institutions were discussing it formally. Their definition would eventually influence policy and become incorporated into the United States’ Affordable Care Act, commonly known as Obamacare.
Health literacy, he explained, is the ability of people to “obtain, process, understand and use health information and services to make appropriate health decisions.”
But he insists the responsibility does not rest solely on individuals. Too often, health systems blame communities for not understanding medical information while ignoring how inaccessible or confusing healthcare itself can be. “It’s not just about educating people,” he said. “It’s the system as well.”
Health information must be understandable, culturally relevant and adapted to local realities. A message that works in New York may not work in Nairobi or rural Bangladesh. The word “appropriate” in the health literacy definition, he noted, was deliberately chosen. “We have to be localised to the community.”
Family planning, child survival and infectious disease campaigns function separately despite affecting same populations
Over the years, Prof Ratzan shifted his focus toward community-centred communication strategies. While working with the United States Agency for International Development (USAID), he helped develop global health communication strategies at a time when many health programmes operated in silos, with family planning, child survival and infectious disease campaigns often functioning separately despite affecting the same populations.
He argued for integrated approaches that engaged communities directly. “You need to get it local,” he said. “We need to empower community workers and people in the community to make better health decisions.”
That philosophy shaped some of the earliest mobile health communication initiatives, including Text4Baby, a United States-based programme that sent pregnant women tailored maternal health messages through mobile phones. The initiative later inspired a broader global programme called the Mobile Alliance for Maternal Action, or MAMA.
Transferring digital health ideas across countries was not straightforward. In Bangladesh, many women did not own phones, men often controlled access to devices, and literacy and language barriers affected implementation. These challenges highlighted a critical lesson: technology alone is insufficient. Social realities determine whether information actually reaches people.
One of the programme’s strongest successes emerged in South Africa through MomConnect, which rapidly expanded nationwide. Within two years, the platform reportedly reached 63 per cent of pregnant women, while 97 per cent of health facilities were providing information through the system.
False claims about vaccines, treatments and Covid-19 virus spread rapidly online, distrust of institutions intensified
If communication challenges existed during HIV and earlier public health campaigns, the digital age has made them significantly more complex. Today, the challenge is no longer merely access to information. It is the overwhelming abundance of it, including misinformation, rumours and manipulated content.
The COVID-19 pandemic exposed these vulnerabilities globally. False claims about vaccines, treatments and the virus spread rapidly online. Distrust of institutions intensified. “We saw during COVID people died because they couldn’t get a vaccine or refused a vaccine,” he said.
Before COVID-19 was officially declared a pandemic, Prof Ratzan and colleagues had already published a call for a coordinated and trusted source of public health information, drawing lessons from Ebola and previous outbreaks. Many of those concerns later materialised.
Today, Prof Ratzan believes one of the biggest challenges is restoring trust in health information ecosystems. “We have to lift quality information rather than just worry about false information,” he said. The issue involves ensuring that trustworthy information is ethical, evidence-based, understandable and engaging.
At the centre of health communication lies trust. Without it, communities may reject vaccines, ignore health guidance or become vulnerable to conspiracy theories and harmful myths.
Prof Ratzan argues that trust cannot be built solely through government directives or institutional authority. It must also come from community leaders, healthcare workers, journalists, educators and ordinary citizens. “What is our duty as a citizen?” he asked.
Institutions prioritised anatomy, pharmacology and neuroscience assuming communication skills were naturally acquired
He notes that people do not make decisions based purely on science. Faith, politics, culture, education and economic realities all influence health behaviour. “You don’t get all those areas in medicine alone,” he said. That recognition has reinforced his support for multidisciplinary approaches combining medicine with communication, sociology, public policy and community engagement.
Despite decades of advocacy, Prof Ratzan admits it was difficult to integrate health communication formally into medical education. Many institutions prioritised anatomy, pharmacology and neuroscience while assuming communication skills were naturally acquired. “But that’s not the same as communication,” he said.
For journalists and communicators, his message carries particular significance. Health communication now extends far beyond ministries of health or academic journals. Podcasts, TikTok videos, WhatsApp groups, radio stations and multimedia storytelling shape public understanding of health issues daily. “We need people to buy into the space of health communication,” he said.
Prof Ratzan reflected on a fellowship project he once called Getting Past Sisyphus, a reference to the figure from Greek mythology condemned to endlessly push a rock uphill only to watch it roll back down. The metaphor captures the recurring nature of public health challenges. “We could have learned from Ebola, we could have learned from HIV,” he said when discussing COVID-19.
Still, he remains optimistic. “The rock is getting bigger, and the hill is getting steeper,” he admitted. Yet he continues pushing.
His message is ultimately a reminder that healthcare is not confined to hospitals or laboratories. In a world flooded with information, communication itself has become a form of healthcare.
