FREIMUTH AND QUINN RESPOND

Abstract

Eliminating racial and ethnic health disparities requires a multidisciplinary approach, including scholarship on the contribution of intelligence (IQ) to health outcomes as described by Batty and Deary. We agree with his conclusion that “proactive involvement of health care providers in the provider–client interaction . . . might reduce health differentials.” However, his reliance on IQ to make his claim places limits on our comprehensive health communication focus and minimizes important social determinants of health. Batty and Deary present evidence that IQ and health status are strongly correlated. While correlation is not causation, a potential relationship in some individuals is no surprise, given that both IQ measures and health status are dependent on social and cultural determinants. In fact, Neisser and colleagues state, “All social outcomes result from complex causal webs in which psychometric skills are only one factor.” 1(p96) This statement is consistent with a conclusion from Taylor et al.’s study on smoking cessation, also cited by Batty and Deary: “[O]ur data suggest that once variance in social class and deprivation was taken into account the effect of childhood IQ on smoking cessation was no longer significant.”2(p465) Populations suffering from disparities have been blamed for the lack of success of many interventions and labeled pejoratively as “hard to reach,” “obstinate,” “recalcitrant,” and “chronically uninformed.”3 The practice of negatively labeling groups with health disparities is counterproductive. If we focus on strengths rather than weaknesses and shift the responsibility for eliminating disparities from the individuals affected to the professionals with the responsibility of reaching them, we may make a greater contribution toward closing the gap. Over the years, we have raised awareness about the problem of low health literacy, and progress is being made in adapting health communication materials to populations with lower literacy levels. Information must be functional in people’s lives before we can expect them to value and use it. Furthermore, social determinants of health disparities extend beyond the individual level to include exposure to environmental hazards; socioeconomic factors, including education, income, and employment opportunities; discrimination; neighborhood conditions; access to health services; and lifestyle choices.4 These factors constitute the web of causation in which IQ may be but one thin thread. Therefore, health communication strategies must address multiple determinants in order to be effective in eliminating disparities.