why is health important speech

Speech on Health and Fitness for Students and Children

Speech on health and fitness.

Hello everyone. I am here to present a speech on health and fitness. The very known two terms to us are the word ‘health’ and ‘fitness’. Many times we tell or use these words whenever we say phrases like ‘health is wealth’ and ‘fitness is the key’. What does the word health really mean? It implies the idea of ‘being well’. A healthy and fit person is the one when he/she can function well physically as well as mentally. Proper health and fitness do not depend on our own but also on our physical environment and the quality of food intake.

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Health and fitness is the most important aspect of our life.  There is nothing more important than health for any human being.  When we are healthy and fit we are able to enjoy our life well. We can talk to our near and dear one, we can laugh, smile, travel, enjoy food, and sleep well.

But when our health and fitness is not up to the mark, we are unable to do anything properly and stay behind. We cannot enjoy eating, watching sports or movies.  Our mood always remains negative and we are unable to talk nicely with our near and dear or even sleep properly.

Our health and fitness are more valued than our wealth.  In fact, our elders were always been focused on the health and fitness part. They treasure it like wealth. To maintain good health and fitness at its best all the time, we need to take care of hygiene and sanitation around us.

We must eat a healthy and complete diet.  We must eat vegetables, milk, egg, etc. Everyone should make a diet chart and ensure that we take a sufficient amount of carbohydrates, proteins, minerals, and vitamins.  Apart from eating we must maintain cleanliness in our room, house and nearby surroundings.

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Roots Affecting Health and Fitness

Well, there are many factors that are responsible for the staggering health and fitness graph. But the major reason is the personal habit and living style of people. A human body requires 20 gm fat per day. The consumption of just a regular pizza adds 10 grams of fat to the human body; a whopper burger blesses you with 13 gm fat and 100 gm French fries promote 15 gm fat to your body.

All the junk foods are destroying people’s health and fitness these days. Due to the fast-paced life, people are concerned about filling their stomachs rather than considering what they are eating and its effect on their health and body.

Health and Fitness tips

As we know that health and fitness play an important role in our overall wellbeing so we should try for a good balance between mind, body, and soul. I have some suggested activities to maintain proper health and fitness. One can start playing games and sports. An active body can metabolize well and so keep us in good shape.

Yoga has got a lot of health and fitness benefits such as flexibility, burn calories, increase blood flow, boosts immunity. Proper food selection leads to eating healthy. The intake of vitamins found in vegetables and fruits, proteins found in whole grains and lean meat keeps us healthy. Eat foods that have less oil are good to control cholesterol levels.

Avoid smoking and drinking as they affect our sleep which is important for the body to remain healthy and in good shape. Exercising improves the general health of the body. One must take at least thirty minutes a day to do some exercises or walk.

As told by Dalai Lama “Happiness is the highest form of health”. Happiness will come only when we will be healthy and fit. But today we live in a world where we value things more than people, work more than family, food more than health and status more than life.

We rush after money and social status and we forget about our health. What’s the value of life if we don’t live healthy and fit. This absurd attitude has ruined our lives and it will continue to do so unless we open up our eyes and see the reality.

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Speech On Health | Health Speech for Students and Children in English  

February 8, 2024 by Prasanna

Speech On Health: Health is considered to be a person’s physical and mental condition. A person requires both good physical health and mental health to survive in this world.

If a person is suffering from any of the problems related to physical or mental health conditions, then it is that person’s responsibility to get it checked. For checking physical health, physicians are required and for checking mental health psychologists or psychiatrists are required.

Both conditions should be kept on regular checks to sustain good health. A person is said to be healthy when he or she is both physically and mentally stable.

Students can also find more  English Speech Writing  about Welcome Speeches, Farewell Speeches, etc

Long And Short Speeches On Health for Kids And Students in English

A long speech on the health of 500 words and a short speech on the health of 150 words is provided to the students so that they can prepare a speech on health. Ten lines on this topic are also provided to the students so that they can form an idea on this topic.

A Long Speech On Health is helpful to students of classes 7, 8, 9, 10, 11 and 12. A Short Speech On Health is helpful to students of classes 1, 2, 3, 4, 5 and 6.

Long Speech On Health 500 Words In English

A very good morning to my teachers and to the special guests who have come today; I would like to present a speech on health.

Health is a condition which determines a person’s well being. Health not only includes physical health but also mental health. Some group of people used to think and still think that looking after physical health is fine.

But when it comes to mental health, these people become uncomfortable. They avoid those people who go for regular mental check up. These people should understand that it is important to keep a regular check on both physical and mental health.

People should not look down upon those people who go for regular mental check up. A person is considered to be healthy if he is both physically and mentally stable.

To be physically healthy, a person needs to feed himself with healthy food which provides the body with the nutrients that the body needs to survive. The people also need to avoid food that is unhealthy for the human body.

A visit to the doctor on a regular basis helps in checking one’s physical health. A person does not become ill if he feeds himself with nutrition rich food and if he exercises on a regular basis.

To be mentally healthy, a person needs to stay away from all kinds of negativities, get a good amount of sleep every day, try to stay happy, try to manage stressful situations tactfully, talk to the close friends or relatives, etc.

It is advised to go for a regular mental check up without getting embarrassed thinking about what the people would say or think about him. It is one’s responsibility to be physically and mentally healthy.

One should know that if a person is mentally healthy, then he can be physically healthy as it is our mind which controls everything. One needs to think positively on any situation so that he can improve his thoughts and he can be healthy in every way.

One healthy person can inspire many others who are trying to get better. It is a duty of everyone to help himself and the other people who are in his surrounding healthy and happy.

Many of us like to have oily fried foods which are tasty but they are very unhealthy for our bodies. So we should try to stay healthy for most of the times so that we can afford to eat our favourite food sometimes, without harming our body.

Similarly, we should keep our thoughts positive and get a good amount of sleep, and fulfill all the requirements for staying in peace so that we can handle sudden shocks or stress in a manageable way.

People can manage to survive without money but they can’t manage without a stable health. One should lead a very disciplined life to lead a stable life with good physical and mental health. A healthy person lives a longer and happy life.

Short Speech On Health 150 Words In English

Good morning to my teachers and friends. I would like to present a speech on health.

Leading a peaceful and a healthy lifestyle is a wish of everyone. But to lead this lifestyle, one has to become disciplined both physically and mentally to achieve that.

It is important to be both physically and mentally healthy. One needs to consume healthy and non-toxic food to keep the body healthy, and one has to get some good sleep and keep positive thoughts in mind to keep the mind healthy.

To keep the mind and body healthy, the people need to take care of every detail around him and notice what the things that seems to keep him happy are and what the things that disturb him are.

By keeping a check on these things helps a person to rectify on these things and lead a healthy life. These are the necessary things that a person should check to be both physically and mentally healthy.

10 Lines On Health Speech In English

• Being healthy not only means to be physically healthy and fit. One should be mentally healthy also.
• One’s domestic atmosphere helps to detect a person’s physical and mental health. If the people around them in their house are healthy then the person is also considered to be healthy.
• The people should have food with proper amount of nutrients. The nutrients help the person to be physically healthy.
• One needs to make his immune system strong by consuming all nutritious food. With the vitamins and minerals, the immune system is going to get strong so that it can fight with the toxins that deteriorate our health.
• We need to feed our brain with good thoughts, positive vibes and peaceful things that help us in maintaining a healthy mind.
• We should keep ourselves so much healthy that even if we consume toxic foods or we come across toxic thoughts, it could not harm our physical and mental health.
• The people should try to balance his life according to his schedule. If he manages to do that, it will then help him to keep himself healthy.
• One should have a regular check-up for his physical health and mental health check-up at the physician’s and therapist’s advice respectively.
• Both physical and mental health check-ups should be given an equal amount of importance.
• Healthy food and healthy thoughts are important for a person’s well being. A person leads a longer life if he is healthy.

FAQ’s On Health Speech

Question 1. How do people maintain physical health?

Answer: A person needs to exercise regularly, consume nutrition-rich food, and maintain proper hygiene to maintain physical health.

Question 2. How do people maintain mental health?

Answer: A person needs to get good long sleep, think positively, talk to people and meditate to maintain mental health.

Question 3. How can people tackle physical health problems?

Answer: When someone is going through physical health problems, he should consult a physician and consume medicines prescribed by him.

Question 4. How can people tackle mental health problems?

Answer: When someone is going through mental health problems, he should consult a therapist and follow what he advises.

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Speech on Health

Most of us have heard the age-old proverb ‘health is wealth’, but has anyone ever wondered why health is considered wealth? This speech will help students give an effective short speech on health. It will include all the important aspects necessary to cover in a speech about health.

Table of Contents

What is health, how should one take care of their health, precautions to be taken during the pandemic.

• FAQs on Speech on Health

When we say the word ‘health’, what do we mean by it? As per the WHO (World Health Organisation), health is referred to the state of full mental, social and physical well-being and not just the absence of mental or physical weakness or illness. When a person doesn’t have any physical ailments and isn’t mentally disturbed, then they can be said to be in their best health. People usually try to stay healthy but, due to the recent pandemic, it’s becoming difficult to maintain one’s health.

The spread of the corona virus over the past two years has made it difficult for everyone to maintain their health. Though this is the case, one should try to follow some simple ways that will help them keep their bodies and minds healthy. Let’s look at some ways that anyone can follow:

• Try including some physical exercises/yoga in your routine. They not only prove to be beneficial for the body but also for the mind. For the past two years, offices, as well as schools and colleges, have been functioning online. As a result, many students and young people have developed backaches and posture problems. Adding at least half an hour of yoga/exercise to your daily routine will help you overcome these problems.
• In today’s world, everybody is engrossed in their mobiles or laptops, and there’s very little time they spend without it. Sometimes, it is necessary to take a break from all these electronic and smart devices. This will help us maintain proper physical and mental health.
• A good night’s sleep is an easy and effortless way to maintain your health. Your body works to repair all the cells and make sure that your body functions properly the next day in the time that you rest. A minimum of 8 hours of sleep is necessary for any adult being.
• Try to avoid processed or fried foods and make sure that your plates include enough vegetables and fruits. A healthy platter does wonders for one’s health.
• If you are feeling disturbed or upset about something, talk to your near and dear ones; you can also consult a specialist if you need. Just like physical health, mental health is also something that is to be considered important. When we fall ill, we have medicines; similarly, if someone is feeling mentally unwell, they should consult a specialist.

With the COVID19 pandemic going on for the past two years, one should take the following precautions to avoid getting affected by the virus. Here are some simple steps one can follow:

• Always put on a mask whenever you step out of your houses. This is applicable to people of all ages.
• Everyone should avoid going to crowded places as there is a high risk of getting affected.
• If you feel you are affected by the virus, seclude yourself from the rest of your family members and keep in touch with your doctors so that everything is monitored and you stay out of danger.
• Try to eat healthy food and fruits that’ll help you develop immunity.

Frequently Asked Questions on Speech on Health

What is health.

As per the WHO (World Health Organisation), health is referred to the state of full mental, social and physical well being and not just the absence of mental or physical weakness or illness.

What should one do if they feel they are affected by the virus?

If one gets affected by the virus, it’s advised to isolate oneself from the rest of the family members and be in constant contact with doctors.

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How should we talk about mental health?

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Mental health suffers from a major image problem. One in every four people experiences mental health issues — yet more than 40 percent of countries worldwide have no mental health policy. Across the board it seems like we have no idea how to talk about it respectfully and responsibly.

Stigma and discrimination are the two biggest obstacles to a productive public dialogue about mental health; indeed, the problem seems to be largely one of communication. So we asked seven mental health experts: How should we talk about mental health? How can informed and sensitive people do it right – and how can the media do it responsibly?

End the stigma

Easier said than done, of course. Says journalist  Andrew Solomon : “People still think that it’s shameful if they have a mental illness. They think it shows personal weakness. They think it shows a failing. If it’s their children who have mental illness, they think it reflects their failure as parents.” This self-inflicted stigma can make it difficult for people to speak about even their own mental health problems. According to neuroscientist  Sarah Caddick , this is because when someone points to his wrist to tell you it’s broken, you can easily understand the problem, but that’s not the case when the issue is with the three-pound mass hidden inside someone’s skull. “The minute you start talking about your mind, people get very anxious, because we associate that with being who we are, fundamentally with ‘us’ — us as a person, us as an individual, our thoughts, our fears, our hopes, our aspirations, our everything.” Says mental health care advocate  Vikram Patel , “Feeling miserable could in fact be seen as part of you or an extension of your social world, and applying a biomedical label is not always something that everyone with depression, for example, is comfortable with.” Banishing the stigma attached to mental health issues can go a long way to facilitating genuinely useful conversations.

Avoid correlations between criminality and mental illness

People are too quick to dole out judgments on people who experience mental health problems, grouping them together when isolated incidents of violence or crime occur. Says  Caddick , “You get a major incident like Columbine or Virginia Tech and then the media asks, ‘Why didn’t people know that he was bipolar?’ ‘Was he schizophrenic?’ From there, some people think, ‘Well, everybody with bipolar disease is likely to go out and shoot down a whole bunch of people in a school,’ or, ‘People who are schizophrenics shouldn’t be out on the street.’”  Solomon  agrees that this correlation works against a productive conversation about mental health: “The tendency to connect people’s crimes to mental illness diagnoses that are not in fact associated with criminality needs to go away. ‘This person murdered everyone because he was depressed.’ You think, yes, you could sort of indicate here this person was depressed and he murdered everyone, but most people who are depressed do not murder everyone.”

But do correlate more between mental illness and suicide

According to the National Institute for Mental Health (NIMH), 90 percent of people who die by suicide have depression or other mental disorders, or substance-abuse disorders in conjunction with other mental disorders. Yet we don’t give this link its due. Says  Solomon , “Just as the association between mental illness and crime is too strong, the connection between mental illness and suicide is too weak. So I feel like what I constantly read in the articles is that ‘so-and-so killed himself because his business had gone bankrupt and his wife had left him.’ And I think, okay, those were the triggering circumstances, but he killed himself because he suffered from a mental illness that drove him to kill himself. He was terribly depressed.”

Avoid words like “crazy” or “psycho”

Not surprisingly, nearly all the mental health experts we consulted were quick to decry playground slang like “mental,” “schizo,” “crazy,” “loonie,” or “nutter,” stigmatizing words that become embedded in people’s minds from a young age. NIMH Director  Thomas Insel  takes that one step further — he doesn’t like the category of “mental health problems” in general. He says, “Should we call cancer a ‘cell cycle problem’? Calling serious mental illness a ‘behavioral health problem’ is like calling cancer a ‘pain problem.’” Comedian  Ruby Wax , however, has a different point of view: “I call people that are mentally disturbed, you know, I say they’re crazy. I think in the right tone, that’s not the problem. Let’s not get caught in the minutiae of it.”

If you feel comfortable talking about your own experience with mental health, by all means, do so

Self-advocacy can be very powerful. It reaches people who are going through similar experiences as well as the general public.  Solomon  believes that people equipped to share their experiences should do so: “The most moving letter I ever received in a way was one that was only a sentence long, and it came from someone who didn’t sign his name. He just wrote me a postcard and said, ‘I was going to kill myself, but I read your book and changed my mind.’ And really, I thought, okay, if nobody else ever reads anything I’ve written, I’ve done some good in the world. It’s very important just to keep writing about these things, because I think there’s a trickle-down effect, and that the vocabulary that goes into serious books actually makes its way into the common experience — at least a little bit of it does — and makes it easier to talk about all of these things.”  Solomon ,  Wax , as well as  Temple Grandin , below, have all become public figures for mental health advocacy through sharing their own experiences.

Don’t define a person by his/her mental illnesses

Just as a tumor need not define a person, the same goes for mental illness. Although the line between mental health and the “rest” of a person is somewhat blurry, experts say the distinction is necessary. Says  Insel : “We need to talk about mental disorders the way we talk about other medical disorders. We generally don’t let having a medical illness define a person’s identity, yet we are very cautious about revealing mental illness because it will somehow define a person’s competence or even suggest dangerousness.”  Caddick  agrees: “There’s a lot of things that go on in the brain, and just because one thing goes wrong doesn’t mean that everything’s going wrong.”

Separate the person from the problem

Continuing from the last,  Insel  and  Patel  both recommend avoiding language that identifies people only by their mental health problems. Says  Insel , speak of “someone with schizophrenia,” not “the schizophrenic.” (Although, he points out, people with autism do often ask to be referred to as “autistic.”) Making this distinction clear, says  Patel , honors and respects the individual. “What you’re really saying is, this is something that’s not part of a person; it’s something the person is suffering from or is living with, and it’s a different thing from the person.”

Sometimes the problem isn’t that we’re using the wrong words, but that we’re not talking at all

Sometimes it just starts with speaking up. In  Solomon’s  words: “Wittgenstein said, ‘All I know is what I have words for.’ And I think that if you don’t have the words for it, you can’t explain to somebody else what your need is. To some degree, you can’t even explain to yourself what your need is. And so you can’t get better.” But, as suicide prevention advocate  Chris Le  knows well, there are challenges to talking about suicide and depression. Organizations aiming to raise awareness about depression and suicide have to wrangle with suicide contagion, or copycat suicides that can be sparked by media attention, especially in young people. Le, though, feels strongly that promoting dialogue ultimately helps. One simple solution, he says, is to keep it personal: “Reach out to your friends. If you’re down, talk to somebody, because remember that one time that your friend was down, and you talked to them, and they felt a little better? So reach out, support people, talk about your emotions and get comfortable with them.”

Recognize the amazing contributions of people with mental health differences

Says autism activist  Temple Grandin : “If it weren’t for a little bit of autism, we wouldn’t have any phones to talk on.” She describes the tech community as filled with autistic pioneers. “Einstein definitely was; he had no language until age three. How about Steve Jobs? I’ll only mention the dead ones by name. The live ones, you’ll have to look them up on the Internet.” Of depression, Grandin says: “The organizations involved with depression need to be emphasizing how many really creative people, people whose books we love, whose movies we love, their arts, have had a lot of problems with depression. See, a little bit of those genetics makes you sensitive, makes you emotional, makes you sensitive — and that makes you creative in a certain way.”

Humor helps

Humor, some say, is the best medicine for your brain. Says comedian  Wax : “If you surround [your message] with comedy, you have an entrée into their psyche. People love novelty, so for me it’s sort of foreplay: I’m softening them up, and then you can deliver as dark as you want. But if you whine, if you whine about being a woman or being black, good luck. Everybody smells it. But it’s true. People are liberated by laughing at themselves.”

Featured illustration via iStockphoto.

About the author

Thu-Huong Ha is a freelance writer. Previously she was the books and culture reporter for Quartz and the context editor at TED. Her writing has also appeared on Slate and in The New York Times Book Review. Her debut novel, Hail Caesar, was published in 2007 by PUSH, a YA imprint of Scholastic, and was named an NYPL Book for the Teen Age. Follow her at twitter.com/thu

• Andrew Solomon
• Editor's picks
• How should we talk about?
• mental health
• mental illness
• questions worth asking
• Sarah Caddick
• Temple Grandin
• Thomas Insel
• Vikram Patel

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Why the world needs global health initiatives

Honourable Mayor of Venice, honourable President of the Veneto Region, honourable ministers, colleagues from the United Nations system, representatives of global health initiatives, researchers and academics, civil society, ladies and gentlemen,

First, let me thank the city of Venice for hosting this event, and thank the government of Italy for its support. Let me thank the many contributors from around the world who have so generously given their time, their findings, and their thoughtful insights.

I think we can now let a long-standing and divisive debate die down. This is the debate that pits single-disease initiatives against the agenda for strengthening health systems.

As I have stated since taking office, the two approaches are not mutually exclusive. They are not in conflict. They do not represent a set of either-or options. It is the opposite. They can and should be mutually reinforcing. We need both.

This is one of the jobs, I believe, of this high-level dialogue: to craft policies and best practice that help the two approaches work together, in harmony, in ways that reduce waste and duplication, and improve efficiency.

We need them to work together to facilitate what I believe we all agree is the most important goal: to save lives and improve health outcomes. The Positive Synergies report has its limitations, which the co-authors readily admit. But it does give us the most solid ground yet for taking stock of where we stand today and establishing informed policies for the future.

Ladies and gentlemen,

Global health initiatives were established with a strong sense of purpose and great ambition. They set out to save lives, on an emergency basis, even though not everything was known at the start about everything that needed to be done, or the best way to do it.

There were risks, and there were missed opportunities, which better planning might have prevented. But there was also courage, or to use words from the report, “an invigorating sense of ambition and purpose.”

And there was a clear moral imperative to act. The AIDS epidemic demonstrated the relevance of equity and universal access in a substantial way. With the advent of antiretroviral therapy, an ability to access medicines and services became equivalent to an ability to survive for many millions of people.

This is the essence of the equity argument: people should not be denied access to life-saving interventions for unfair reasons, including an inability to pay.

These global health initiatives have gathered knowledge along the way, and in so doing, they have shed light on a cause of much ill health in this world: weak and inequitable health systems.

Weak health systems are wasteful. They waste money, and dilute the return on investments. They waste money when regulatory systems fail to control the price and quality of medicine.

They waste training when workers are lured away by better working conditions or better pay. They waste efficiency when needless procedures are performed, or when essential procedures are precluded by interruptions in the supply chain.

They waste opportunities for poverty reduction when poor people are driven even deeper into poverty by the costs of care or by the failure of preventive services.

Above all, weak health systems waste lives.

Weak health systems are almost certainly the greatest impediment to better health in the world today. They are the central obstacle that blunts the power of global health initiatives.

The tuberculosis community clearly states the problem. The emergence of drug-resistant TB represents not just a failure of the control programme, but a failure of the entire health system in which that control programme operates.

In looking for ways to get beyond this impasse, we can take lessons not just from the evidence set out in the report, but also from history.

One reason for the success of smallpox eradication was a constant use of research to guide increasingly refined strategic operations. The smallpox campaign had a built-in capacity to respond, adapt, and shift gears as new evidence emerged.

The campaign to eradicate malaria did not. Of the many reasons put forward for the failure of this campaign, one is particularly relevant to today’s high-level dialogue. It is this: even the best-funded and managed initiatives will fail in the absence of basic infrastructures and services needed to sustain routine case detection and treatment.

The history of the onchocerciasis control programme provides another instructive example. At its start, this was the most vertical control programme imaginable: helicopters dropping insecticides from the sky.

As the burden of disease came down, the programme evolved. It brought us the strategy of community-directed distribution of a broadened range of interventions. This strategy is now an important tool for extending primary health care.

It is time to start listening to the evidence, and not to anecdotal reports or to praises or criticisms founded on ideology rather than on evidence. Let me highlight four points that I personally find important.

First, these initiatives have unquestionably done great good. They have saved or prolonged millions of lives. This was the overarching purpose. I do not need to say more.

Second, it is wrong to conclude, categorically, that these initiatives have weakened health systems. They were launched at a time when health systems were already weak, sometimes on the verge of collapse, following decades of neglect. The global initiatives may have exacerbated some specific pre-existing weaknesses, but they did not cause them.

The report identifies some problems. Better planning could have prevented the establishment of parallel systems for information and for the procurement and distribution of supplies. As we know, these parallel systems have contributed to duplication, higher costs, and the undermining of national capacities.

The mixed picture revealed by the report is often a function of differences in the capacity of health systems. Stronger health systems have been better positioned to maximize gains from support by these initiatives and to counteract potentially negative effects.

In reality, the momentum and drive of these initiatives have made specific weaknesses in health systems much more visible. This, in turn, has allowed a more precise definition of problems and a more targeted approach to solutions.

My third point is closely related. For me, some of the best news from the report is evidence that global health initiatives can be flexible and responsive.

Part of their “invigorating sense of ambition and purpose” is an ability to solve problems, often in highly innovative ways.

In their drive for results, they are devising solutions to the very problems they have revealed. As the report states quite simply: they are constantly adapting and improving.

My fourth point is a straightforward request to you. The report cites abundant examples of deliberate and successful innovations.

These innovations are helping to bring health staff to rural areas and keep them there, to change legislation so that nurses can prescribe drugs, and to fully engage community health workers and civil society organizations. They are reducing drug prices, rationalizing the switch to second-line treatments, and exploiting advances in information and communication technologies with a speed and efficiency that have defied the sceptics.

Pay close attention to these innovations. They have unquestionably streamlined operations, saved money, and led to great efficiency gains.

They have also improved the quality of care for patients. And this has been a distinctive shared feature of these initiatives: they have upgraded the quality of care with quality-assured interventions and standardized treatment protocols, setting a new benchmark for global health.

We are meeting at a time when the world faces multiple crises on multiple fronts. Global crises like the economic downturn and climate change will hit developing countries the hardest.

As these countries have the greatest vulnerability, they will bear the brunt of the consequences. As these countries have the least resilience, they will take the longest to recover.

As announced earlier this month, the world is at the start of the 2009 influenza pandemic. I firmly believe that this pandemic will reveal, in a highly visible, measurable, and tragic way, exactly what it means, in life-and-death terms, when health needs and health systems have been neglected, for decades, in large parts of the world.

The gaps and inequalities that we are all trying so hard to address are likely to grow even greater. The price of failure will keep getting higher.

We simply cannot afford to be distracted from our central purpose. We cannot let the momentum, the drive, stumble for a moment. We must pursue every possible opportunity to improve efficiency and reduce waste. We are learning as we keep moving on, with an appropriate sense of urgency.

We faced some challenges early on, but we are moving forward, learning, adapting, pulling together, saving lives.

WHO values all its partners in global health, and values their clear contributions to better health. I am proud of these partnerships, and greatly encouraged by the attention being given to health systems.

This is not easy work. This is not glamorous work. But it absolutely must be done.

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• Universal Health Care

The Importance of Universal Health Care in Improving Our Nation’s Response to Pandemics and Health Disparities

• Policy Statements and Advocacy
• Policy Statement Database
• Development Process
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• Proposed Policy Statements
• Date: Oct 24 2020
• Policy Number: LB20-06

Key Words: Health Insurance, Health Care, Health Equity

Abstract The COVID pandemic adds a new sense of urgency to establish a universal health care system in the United States. Our current system is inequitable, does not adequately cover vulnerable groups, is cost prohibitive, and lacks the flexibility to respond to periods of economic and health downturns. During economic declines, our employer-supported insurance system results in millions of Americans losing access to care. While the Affordable Care Act significantly increased Americans’ coverage, it remains expensive and is under constant legal threat, making it an unreliable conduit of care. Relying on Medicaid as a safety net is untenable because, although enrollment has increased, states are making significant Medicaid cuts to balance budgets. During the COVID-19 pandemic, countries with universal health care leveraged their systems to mobilize resources and ensure testing and care for their residents. In addition, research shows that expanding health coverage decreases health disparities and supports vulnerable populations’ access to care. This policy statement advocates for universal health care as adopted by the United Nations General Assembly in October 2019. The statement promotes the overall goal of achieving a system that cares for everyone. It refrains from supporting one particular system, as the substantial topic of payment models deserves singular attention and is beyond the present scope.

Relationship to Existing APHA Policy Statements We propose that this statement replace APHA Policy Statement 20007 (Support for a New Campaign for Universal Health Care), which is set to be archived in 2020. The following policy statements support the purpose of this statement by advocating for health reform:

• APHA Policy Statement Statement 200911: Public Health’s Critical Role in Health Reform in the United States
• APHA Policy Statement 201415: Support for Social Determinants of Behavioral Health and Pathways for Integrated and Better Public Health

In addition, this statement is consistent with the following APHA policies that reference public health’s role in disaster response:

• APHA Policy Statement 20198: Public Health Support for Long-Term Responses in High-Impact, Postdisaster Settings
• APHA Policy Statement 6211(PP): The Role of State and Local Health Departments in Planning for Community Health Emergencies
• APHA Policy Statement 9116: Health Professionals and Disaster Preparedness
• APHA Policy Statement 20069: Response to Disasters: Protection of Rescue and Recovery Workers, Volunteers, and Residents Responding to Disasters

Problem Statement Discussions around universal health care in the United States started in the 1910s and have resurfaced periodically.[1] President Franklin D. Roosevelt attempted twice in the 1940s to establish universal health care and failed both times.[1] Eventually, the U.S. Congress passed Medicare and Medicaid in the 1960s. Universal health care more recently gained attention during debates on and eventual passage of the Affordable Care Act (ACA).[2]

To date, the U.S. government remains the largest payer of health care in the United States, covering nearly 90 million Americans through Medicare, Medicaid, TRICARE, and the Children’s Health Insurance Program (CHIP).[3] However, this coverage is not universal, and many Americans were uninsured[4] or underinsured[5] before the COVID-19 pandemic.

The COVID-19 pandemic has exacerbated underlying issues in our current health care system and highlighted the urgent need for universal health care for all Americans.

Health care is inaccessible for many individuals in the United States: For many Americans, accessing health care is cost prohibitive.[6] Coverage under employer-based insurance is vulnerable to fluctuations in the economy. Due to the COVID-19 pandemic, an estimated 10 million Americans may lose their employer-sponsored health insurance by December 2020 as a result of job loss.[7] When uninsured or underinsured people refrain from seeking care secondary to cost issues, this leads to delayed diagnosis and treatment, promotes the spread of COVID-19, and may increase overall health care system costs.

The ACA reformed health care by, for instance, eliminating exclusions for preexisting conditions, requiring coverage of 10 standardized essential health care services, capping out-of-pocket expenses, and significantly increasing the number of insured Americans. However, many benefits remain uncovered, and out-of-pocket costs can vary considerably. For example, an ACA average deductible ($3,064) is twice the rate of a private health plan ($1,478).[4] Those living with a disability or chronic illness are likely to use more health services and pay more. A recent survey conducted during the COVID-19 pandemic revealed that 38.2% of working adults and 59.6% of adults receiving unemployment benefits from the Coronavirus Aid, Relief, and Economic Security (CARES) Act could not afford a $400 expense, highlighting that the COVID-19 pandemic has exacerbated lack of access to health care because of high out-of-pocket expenses.[8] In addition, the ACA did not cover optometry or dental services for adults, thereby inhibiting access to care even among the insured population.[9]

Our current health care system cannot adequately respond to the pandemic and supply the care it demands: As in other economic downturns wherein people lost their employer-based insurance, more people enrolled in Medicaid during the pandemic. States’ efforts to cover their population, such as expanding eligibility, allowing self-attestation of eligibility criteria, and simplifying the application process, also increased Medicaid enrollment numbers.[10] The federal “maintenance of eligibility” requirements further increased the number of people on Medicaid by postponing eligibility redeterminations. While resuming eligibility redeterminations will cause some to lose coverage, many will remain eligible because their incomes continue to fall below Medicaid income thresholds.[10]

An urgent need for coverage during the pandemic exists. Virginia’s enrollment has increased by 20% since March 2020. In Arizona, 78,000 people enrolled in Medicaid and CHIP in 2 months.[11] In New Mexico, where 42% of the population was already enrolled in Medicaid, 10,000 more people signed up in the first 2 weeks of April than expected before the pandemic.[11] Nearly 17 million people who lost their jobs during the pandemic could be eligible for Medicaid by January 2021.[12]

While increasing Medicaid enrollment can cover individuals who otherwise cannot afford care, it further strains state budgets.[11] Medicaid spending represents a significant portion of states’ budgets, making it a prime target for cuts. Ohio announced $210 million in cuts to Medicaid, a significant part of Colorado’s $229 million in spending cuts came from Medicaid, Alaska cut $31 million in Medicaid, and Georgia anticipates 14% reductions overall.[11]

While Congress has authorized a 6.2% increase in federal Medicaid matching, this increase is set to expire at the end of the public health emergency declaration (currently set for October 23, 2020)[13] and is unlikely to sufficiently make up the gap caused by increased spending and decreased revenue.[14] Given the severity and projected longevity of the pandemic’s economic consequences, many people will remain enrolled in Medicaid throughout state and federal funding cuts. This piecemeal funding strategy is unsustainable and will strain Medicaid, making accessibility even more difficult for patients.

Our health care system is inequitable: Racial disparities are embedded in our health care system and lead to worse COVID-19 health outcomes in minority groups. The first federal health care program, the medical division of the Freedmen’s Bureau, was established arguably out of Congress’s desire for newly emancipated slaves to return to working plantations in the midst of a smallpox outbreak in their community rather than out of concern for their well-being.[15] An effort in 1945 to expand the nation’s health care system actually reinforced segregation of hospitals.[15] Moreover, similar to today, health insurance was employer based, making it difficult for Black Americans to obtain.

Although the 1964 Civil Rights Act outlawed segregation of health care facilities receiving federal funding and the 2010 ACA significantly benefited people of color, racial and sexual minority disparities persist today in our health care system. For example, under a distribution formula set by the U.S. Department of Health and Human Services (DHHS), hospitals reimbursed mostly by Medicaid and Medicare received far less federal funding from the March 2020 CARES Act and the Paycheck Protection Program and Health Care Enhancement Act than hospitals mostly reimbursed by private insurance.[16] Hospitals in the bottom 10% based on private insurance revenue received less than half of what hospitals in the top 10% received. Medicare reimburses hospitals, on average, at half the rate of private insurers. Therefore, hospitals that primarily serve low-income patients received a disproportionately smaller share of total federal funding.[16]

Additional barriers for these communities include fewer and more distant testing sites, longer wait times,[17] prohibitive costs, and lack of a usual source of care.[18] Black Americans diagnosed with COVID-19 are more likely than their White counterparts to live in lower-income zip codes, to receive tests in the emergency department or as inpatients, and to be hospitalized and require care in an intensive care unit.[19] Nationally, only 20% of U.S. counties are disproportionately Black, but these counties account for 52% of COVID-19 diagnoses and 58% of deaths.[20] The pre-pandemic racial gaps in health care catalyzed pandemic disparities and will continue to widen them in the future.

Our health care system insufficiently covers vulnerable groups: About 14 million U.S. adults needed long-term care in 2018.[21] Medicare, employer-based insurance, and the ACA do not cover home- and community-based long-term care. Only private long-term care insurance and patchwork systems for Medicaid-eligible recipients cover such assistance. For those paying out of pocket, estimated home care services average $51,480 to $52,624 per year, with adult day services at more than $19,500 per year.[22]

Our current health care system also inadequately supports individuals with mental illness. APHA officially recognized this issue in 2014, stating that we have “lacked an adequate and consistent public health response [to behavioral health disorders] for several reasons” and that the “treatment of mental health and substance use disorders in the United States has been provided in segregated, fragmented, and underfunded care settings.”[23]

The COVID-19 pandemic has brought urgency to the universal health care discussion in the United States. This is an unprecedented time, and the pandemic has exacerbated many of the existing problems in our current patchwork health care system. The COVID-19 pandemic is a watershed moment where we can reconstruct a fractured health insurance system into a system of universal health care.

Evidence-Based Strategies to Address the Problem We advocate for the definition of universal health care outlined in the 2019 resolution adopted by the United Nations General Assembly, which member nations signed on to, including the United States. According to this resolution, “universal health coverage implies that all people have access, without discrimination, to nationally determined sets of the needed promotive, preventive, curative, rehabilitative and palliative essential health services, and essential, safe, affordable, effective and quality medicines and vaccines, while ensuring that the use of these services does not expose the users to financial hardship, with a special emphasis on the poor, vulnerable and marginalized segments of the population.”[24]

Our current system is inaccessible, inflexible, and inequitable, and it insufficiently covers vulnerable populations. Here we present supporting evidence that universal health care can help address these issues.

Universal health care can increase accessibility to care: Evidence supporting universal health care is mostly limited to natural experiments and examples from other countries. Although countries with universal health care systems also struggle in containing the COVID-19 pandemic, their response and mortality outcomes are better owing to their robust universal systems.[25]

While individuals in the United States lost health care coverage during the pandemic, individuals in countries with universal health care were able to maintain access to care.[26–28] Some European and East Asian countries continue to offer comprehensive, continuous care to their citizens during the pandemic.

Taiwan’s single-payer national health insurance covers more than 99% of the country’s population, allowing easy access to care with copayments of $14 for physician visits and $7 for prescriptions. On average, people in Taiwan see their physician 15 times per year.[27] Also, coronavirus tests are provided free of charge, and there are sufficient hospital isolation rooms for confirmed and suspected cases of COVID-19.[28]

Thai epidemiologists credit their universal health care system with controlling the COVID-19 pandemic.[29] They have described how their first patient, a taxi driver, sought medical attention unencumbered by doubts about paying for his care. They benefit from one of the lowest caseloads in the world.[29]

Universal health care is a more cohesive system that can better respond to health care demands during the pandemic and in future routine care: Leveraging its universal health care system, Norway began aggressively tracking and testing known contacts of individuals infected with COVID-19 as early as February 2020. Public health officials identified community spread and quickly shut down areas of contagion. By April 30, Norway had administered 172,586 tests and recorded 7,667 positive cases of COVID-19. Experts attribute Norway’s success, in part, to its universal health care system.[26] Norway’s early comprehensive response and relentless testing and tracing benefited the country’s case counts and mortality outcomes.

Once China released the genetic sequence of COVID-19, Taiwan’s Centers for Disease Control laboratory rapidly developed a test kit and expanded capacity via the national laboratory diagnostic network, engaging 37 laboratories that can perform 3,900 tests per day.[28] Taiwan quickly mobilized approaches for case identification, distribution of face masks, containment, and resource allocation by leveraging its national health insurance database and integrating it with the country’s customs and immigration database daily.[28] Taiwan’s system proved to be flexible in meeting disaster response needs.

Although these countries’ success in containing COVID-19 varied, their universal health care systems allowed comprehensive responses.

Universal health care can help decrease disparities and inequities in health: Several factors point to decreased racial and ethnic disparities under a universal health care model. CHIP’s creation in 1997 covered children in low-income families who did not qualify for Medicaid; this coverage is associated with increased access to care and reduced racial disparities.[30] Similarly, differences in diabetes and cardiovascular disease outcomes by race, ethnicity, and socioeconomic status decline among previously uninsured adults once they become eligible for Medicare coverage.[31] While universal access to medical care can reduce health disparities, it does not eliminate them; health inequity is a much larger systemic issue that society needs to address.

Universal health care better supports the needs of vulnerable groups: The United States can adopt strategies from existing models in other countries with long-term care policies already in place. For example, Germany offers mandatory long-term disability and illness coverage as part of its national social insurance system, operated since 2014 by 131 nonprofit sickness funds. German citizens can receive an array of subsidized long-term care services without age restrictions.[32] In France, citizens 60 years and older receive long-term care support through an income-adjusted universal program.[33]

Universal health care can also decrease health disparities among individuals with mental illness. For instance, the ACA Medicaid expansion helped individuals with mental health concerns by improving access to care and effective mental health treatment.[34]

Opposing Arguments/Evidence Universal health care is more expensive: Government spending on Medicare, Medicaid, and CHIP has been increasing and is projected to grow 6.3% on average annually between 2018 and 2028.[35] In 1968, spending on major health care programs represented 0.7% of the gross domestic product (GDP); in 2018 it represented 5.2% of the GDP, and it is projected to represent 6.8% in 2028.[35] These estimates do not account for universal health care, which, by some estimates, may add $32.6 trillion to the federal budget during the first 10 years and equal 10% of the GDP in 2022.[36]

Counterpoint: Some models of single-payer universal health care systems estimate savings of $450 billion annually.[37] Others estimate $1.8 trillion in savings over a 10-year period.[38] In 2019, 17% of the U.S. GDP was spent on health care; comparable countries with universal health care spent, on average, only 8.8%.[39]

Counterpoint: Health care services in the United States are more expensive than in other economically comparable countries. For example, per capita spending on inpatient and outpatient care (the biggest driver of health care costs in the United States) is more than two times greater even with shorter hospital stays and fewer physician visits.[40] Overall, the United States spends over $5,000 more per person in health costs than countries of similar size and wealth.[40]

Counterpoint: Administrative costs are lower in countries with universal health care. The United States spends four times more per capita on administrative costs than similar countries with universal health care.[41] Nine percent of U.S. health care spending goes toward administrative costs, while other countries average only 3.6%. In addition, the United States has the highest growth rate in administrative costs (5.4%), a rate that is currently double that of other countries.[41]

Universal health care will lead to rationing of medical services, increase wait times, and result in care that is inferior to that currently offered by the U.S. health care system. Opponents of universal health care point to the longer wait times of Medicaid beneficiaries and other countries as a sign of worse care. It has been shown that 9.4% of Medicaid beneficiaries have trouble accessing care due to long wait times, as compared with 4.2% of privately insured patients.[42] Patients in some countries with universal health care, such as Canada and the United Kingdom, experience longer wait times to see their physicians than patients in the United States.[43] In addition, some point to lower cancer death rates in the United States than in countries with universal health care as a sign of a superior system.[44]

Another concern is rationing of medical services due to increased demands from newly insured individuals. Countries with universal health care use methods such as price setting, service restriction, controlled distribution, budgeting, and cost-benefit analysis to ration services.[45]

Counterpoint: The Unites States already rations health care services by excluding patients who are unable to pay for care. This entrenched rationing leads to widening health disparities. It also increases the prevalence of chronic conditions in low-income and minority groups and, in turn, predisposes these groups to disproportionately worse outcomes during the pandemic. Allocation of resources should not be determined by what patients can and cannot afford. This policy statement calls for high-value, evidence-based health care, which will reduce waste and decrease rationing.

Counterpoint: Opponents of universal health care note that Medicaid patients endure longer wait times to obtain care than privately insured patients[42] and that countries with universal health care have longer wait times than the United States.[43] Although the United States enjoys shorter wait times, this does not translate into better health outcomes. For instance, the United States has higher respiratory disease, maternal mortality, and premature death rates and carries a higher disease burden than comparable wealthy countries.[46]

Counterpoint: A review of more than 100 countries’ health care systems suggests that broader coverage increases access to care and improves population health.

Counterpoint: While it is reasonable to assume that eliminating financial barriers to care will lead to a rise in health care utilization because use will increase in groups that previously could not afford care, a review of the implementation of universal health care in 13 capitalist countries revealed no or only small (less than 10%) post-implementation increases in overall health care use.[47] This finding was likely related to some diseases being treated earlier, when less intense utilization was required, as well as a shift in use of care from the wealthy to the poorest.[47]

Alternative Strategies States and the federal government can implement several alternative strategies to increase access to health care. However, these strategies are piecemeal responses, face legal challenges, and offer unreliable assurance for coverage. Importantly, these alternative strategies also do not necessarily or explicitly acknowledge health as a right.

State strategies: The remaining 14 states can adopt the Medicaid expansions in the ACA, and states that previously expanded can open new enrollment periods for their ACA marketplaces to encourage enrollment.[48] While this is a strategy to extend coverage to many of those left behind, frequent legal challenges to the ACA and Medicaid cuts make it an unreliable source of coverage in the future. In addition, although many people gained insurance, access to care remained challenging due to prohibitively priced premiums and direct costs.

Before the pandemic, the New York state legislature began exploring universal single-payer coverage, and the New Mexico legislature started considering a Medicaid buy-in option.[49] These systems would cover only residents of a particular state, and they remain susceptible to fluctuations in Medicaid cuts, state revenues, and business decisions of private contractors in the marketplace.

Federal government strategies: Congress can continue to pass legislation in the vein of the Families First Coronavirus Response Act and the CARES Act. These acts required all private insurers, Medicare, and Medicaid to cover COVID-19 testing, eliminate cost sharing, and set funds to cover testing for uninsured individuals. They fell short in requiring assistance with COVID-19 treatment. A strategy of incremental legislation to address the pandemic is highly susceptible to the political climate, is unreliable, and does not address non-COVID-19 health outcomes. Most importantly, this system perpetuates a fragmented response to the COVID-19 pandemic.

An additional option for the federal government is to cover the full costs of Medicaid expansion in the 14 states yet to expand coverage. If states increased expansion and enforced existing ACA regulations, nearly all Americans could gain health insurance.[50] This alternative is risky, however, due to frequent legal challenges to the ACA. Furthermore, high costs to access care would continue to exist.

Action Steps This statement reaffirms APHA’s support of the right to health through universal health care. Therefore, APHA:

• Urges Congress and the president to recognize universal health care as a right.
• Urges Congress to fund and design and the president to enact and implement a comprehensive universal health care system that is accessible and affordable for all residents; that ensures access to rural populations, people experiencing homelessness, sexual minority groups, those with disabilities, and marginalized populations; that is not dependent on employment, medical or mental health status, immigration status, or income; that emphasizes high-value, evidence-based care; that includes automatic and mandatory enrollment; and that minimizes administrative burden.
• Urges Congress and states to use the COVID-19 pandemic as a catalyst to develop an inclusive and comprehensive health care system that is resilient, equitable, and accessible.
• Urges the DHHS, the Agency for Healthcare Research and Quality, the Institute of Medicine, the National Institutes of Health, academic institutions, researchers, and think tanks to examine equitable access to health care, including provision of mental health care, long-term care, dental care, and vision care.
• Urges Congress, national health care leaders, academic institutions, hospitals, and each person living in the United States to recognize the harms caused by institutionalized racism in our health care system and collaborate to build a system that is equitable and just.
• Urges Congress to mandate the Federal Register Standards for Accessible Medical Diagnostic Equipment to meet the everyday health care physical access challenges of children and adults with disabilities.
• Urges national health care leaders to design a transition and implementation strategy that communicates the impact of a proposed universal health care system on individuals, hospitals, health care companies, health care workers, and communities.
• Urges Congress, the Centers for Disease Control and Prevention, the DHHS, and other public health partners, in light of the COVID-19 pandemic, to recognize the need for and supply adequate funding for a robust public health system. This public health system will prepare for, prevent, and respond to both imminent and long-term threats to public health, as previously supported in APHA Policy Statement 200911.

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Health Aff (Millwood). 2020;39(7):1253–1262. 20. Millett GA, Jones AT, Benkeser D, et al. Assessing differential impacts of COVID-19 on black communities. Ann Epidemiol. 2020;47:37–44. 21. Hado E, Komisar H. Long-term services and supports. Available at: https://www.aarp.org/ppi/info-2017/long-term-services-and-supports.html. Accessed September 1, 2020. 22. GenWorth Financial. Cost of care survey. Available at: https://www.genworth.com/aging-and-you/finances/cost-of-care.html. Accessed September 1, 2020. 23. American Public Health Association. Policy statement 201415: support for social determinants of behavioral health and pathways for integrated and better public health. Available at: https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/01/28/14/58/support-for-social-determinants-of-behavioral-health. Accessed September 1, 2020. 24. UN General Assembly. Resolution adopted by the General Assembly on 10 October 2019—political declaration of the high-level meeting on universal health coverage. Available at: https://www.un.org/pga/73/wp-content/uploads/sites/53/2019/07/FINAL-draft-UHC-Political-Declaration.pdf. Accessed September 30, 2020. 25. Sommers BD, Baicker K, Epstein AM. Mortality and access to care among adults after state Medicaid expansions. N Engl J Med. 2012;367(11):1025–1034. 26. Jones A. I left Norway’s lockdown for the US: the difference is shocking. Available at: https://www.thenation.com/article/world/coronavirus-norway-lockdown/. Accessed September 1, 2020. 27. Maizland L. Comparing six health-care systems in a pandemic. Available at: https://www.cfr.org/backgrounder/comparing-six-health-care-systems-pandemicX. Accessed August 20, 2020. 28. Wang CJ, Ng CY, Brook RH. Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing. JAMA. 2020;323(14):1341–1342. 29. Gharib M. Universal health care supports Thailand’s coronavirus strategy. Available at: https://www.npr.org/2020/06/28/884458999/universal-health-care-supports-thailands-coronavirus-strategy. Accessed August 30, 2020. 30. Shone LP, Dick AW, Klein JD, Zwanziger J, Szilagyi PG. Reduction in racial and ethnic disparities after enrollment in the State Children’s Health Insurance Program. Pediatrics. 2005;115(6):e697–e705. 31. McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. Health of previously uninsured adults after acquiring Medicare coverage. JAMA. 2007;298(24):2886–2894. 32. Rhee JC, Done N, Anderson GF. Considering long-term care insurance for middle-income countries: comparing South Korea with Japan and Germany. Health Policy. 2015;119(10):1319–1329. 33. Doty P, Nadash P, Racco N. Long-term care financing: lessons from France. Milbank Q. 2015;93(2):359–391. 34. Wen H, Druss BG, Cummings JR. Effect of Medicaid expansions on health insurance coverage and access to care among low-income adults with behavioral health conditions. Health Serv Res. 2015;50(6):1787–1809. 35. Congressional Budget Office. Projections of federal spending on major health care programs. Available at: https://www.cbo.gov/system/files/115th-congress-2017-2018/presentation/53887-presentation.pdf. Accessed October 12, 2020. 36. Blahous C. The costs of a national single-payer healthcare system. Available at: https://www.mercatus.org/publications/government-spending/costs-national-single-payer-healthcare-system. Accessed October 10, 2020. 37. Galvani AP, Parpia AS, Foster EM, Singer BH, Fitzpatrick MC. Improving the prognosis of health care in the USA. Lancet. 2020;395(10223):524–533. 38. Friedman G. Funding HR 676: the Expanded and Improved Medicare for All Act. How we can afford a national single-payer health plan. 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Accessed August 30, 2020. 43. How Canada Compares: Results from the Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries. Ottawa, Ontario, Canada: Canadian Institute for Health Information; 2017. 44. Organisation for Economic Co-operation and Development. Deaths from cancer: total, per 100,000 persons, 2018 or latest available. Available at: https://data.oecd.org/healthstat/deaths-from-cancer.htm. Accessed October 12, 2020. 45. Hoffman B. Health Care for Some: Rights and Rationing in the United States since 1930. Chicago, IL: University of Chicago Press; 2012. 46. Kurani N, McDermott D, Shanosky N. How does the quality of the U.S. healthcare system compare to other countries? Available at: https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-start. Accessed September 20, 2020. 47. Gaffney A, Woolhandler S, Himmelstein D. The effect of large-scale health coverage expansions in wealthy nations on society-wide healthcare utilization. J Gen Intern Med. 2020;35(8):2406–2417. 48. King JS. COVID-19 and the need for health care reform. N Engl J Med. 2020;382(26):e104. 49. Hughes M. COVID-19 proves that we need universal health care. States are exploring their options. Available at: https://rooseveltinstitute.org/2020/06/25/covid-19-proves-that-we-need-universal-health-care-states-are-exploring-their-options/. Accessed September 1, 2020. 50. Blumenthal D, Fowler EJ, Abrams M, Collins SR. COVID-19—implications for the health care system. N Engl J Med. 2020;383(15):1483–1488.

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Remarks by President   Biden on Expanding Access to Mental Health   Care

3:22 P.M. EDT THE PRESIDENT:  Please, have a seat.  Richele, thank you for that introduction and the courage it takes to stand up on national television in front of all these people and tell your story.  But your story is the story of millions of people all across the country.  And, you know, one of the things that the pandemic demonstrated is the need for a lot more help.  Over a million people dead from COVID.  And that’s estimated to mean 8 million people left behind who were close to them. How many mornings people get up or show up for dinner and there’s an empty chair?  The impact on people’s lives is profound.  But — and you were paying insurance every month.  You know, you shouldn’t be your own — well, you shouldn’t have to do what you had to do, going through one of the hardest things in life. And, by the way, Debbie, Debbie, Debbie — God love you.  (Laughter.)  You’re the best, Debbie.  You really are.  We wouldn’t be here were it not for Debbie, and that’s not a — that’s not an exaggeration.  (Applause.)  We served together for a long time in the Senate, and I’ve never known you not to be a significant advocate for this very issue. And I want to thank Acting Secretary Su and everyone at the Department of Labor and HHS and Treasury for working to improve insurance coverage for mental health care in America. And, folks, you know, I don’t know what the difference between breaking your arm and having a mental breakdown is.  It’s health.  There is no distinction.  It’s health.  Vivek Murthy, who is our Surgeon General, and I talk about this issue a lot.  You know, in the last two State of the Union Addresses, I’ve laid out what I call the Unity Agenda.  It is made up of four big things to — that we’re going to do together as a nation. One of the things I’m always asked is: You know, why — why Americans have sort of lost faith for a while on being — being able to do big things.  “If you could do anything at all, Joe, what would you do?”  I said, “I’d cure cancer.”  And they looked at me like, “Why cancer?”  Because no one thinks we can.  That’s why.  And we can.  We can end cancer as we know it.  Deliver on our sacred obligations to veterans is the second thing I think is critically important. Thirdly was beat the opioid epidemic, which we’re still fighting very hard.  And fourth was to tackle the mental health crisis, which is why we’re here today. You know, we can all agree mental health care is healthcare.  It is healthcare.  It’s essential to people’s wellbeing and their ability to lead a full and productive life, to find joy, to find purpose, to take care of themselves and their loved ones.  It’s about dignity.  Think about this.  My dad used to have an expression: Everyone is entitled to be treated with dignity.  Imagine being a parent looking at your beautiful child you adore needing help and know you can’t do a damn thing about it because you don’t have the wherewithal.  You can’t — talk about stripping a parent of their dignity — their inability to help their child or their husband or their wife or their mother or their father or someone they adore. But, right now, for millions of Americans, mental health care and treatment for substance abuse is out of reach.  It’s out of reach. In 2020, less than half — less than half of all adults with mental illness diagnosis received care for it.  Less than half. For children the numbers are even worse.  Nearly 70 percent of our kids who seek me- — care for mental health or addiction cannot get it.  Seventy percent.  Talk to parents and teachers.  Talk to the school nurses and counselors.  Talk to young people.  They’ll tell you there’s a serious youth mental health crisis happening right now in this country.  We must fulfill the promise of true mental health parity for all Americans now.  Now.  (Applause.)   And I might note, parenthetically: If we do, it saves the country billions of dollars.  The idea that it — (applause) — it saves.  Here is what it means.  Almost 15 years ago, the bipartisan Mental Health Parity and Addiction Equity Act became law.  It called for health insurance companies to cover mental healthcare and treatment for substance abuse at the same levels of physical healthcare.  Because just like when you break your bone — a bone or have a heart attack, when you’re having a mental health crisis, you should be able to get help — medical help, professional help.   

During the Obama-Biden administration, we worked hard to put a law — this law into effect.  And the result, by some important measures: There is greater parity — not nearly enough — greater parity today than in the past.  Look, there’s lower co-pays for mental health care, getting rid of some arbitrary limits on the number of times you can see your therapist each year.  Plus, for the first time ever, the Affordable Care Act made mental health care an essential service, which means many health plans must cover it. 

But there were many important — these were important steps, but they weren’t enough.  We’re still not where we need to be.  We’re still not there. Insurers still make it far too difficult to get mental health care.  Their networks of providers are badly inadequate, with far fewer psychiatrists, therapists, and other mental health professionals compared to all other mental — all other medical specialties.   And as a result, even with private insurance, patients are often forced to seek out-of-network care at significantly higher costs, if they can find it.  Seeing a therapist can cost 200 bucks a visit or more.  That’s $800 a month if you have a session every week, which is often what patients need.  Many families — a significant number of families — cannot afford that.  And, by the way, think about — parenthetically, think — think about just how difficult it is to begin with, to say, “I need help.” You break your arm, you have no trouble going to the emergency and — “I need help.”  You’re having a mental crisis, it’s hard.  It’s hard to say “I need help.”  “I need help.”  “My child needs help.”  And this is happening to millions of people. People with insurance are twice as likely to have to go out-of-network for mental health care compared to physical healthcare.  And that gap has only gotten wider.  As a result, folks with depression, anxiety, post-traumatic stress, bipolar disorders, eating disorders, addiction, and other illnesses often go without care.  Period.  And you know how that ends, many times.  They try to power through and hope that they can manage on their own.  Or they pay whatever it takes, spending down their savings, racking up credit card bills, or taking out second or third mortgages to get the care for themselves or their children.  Folks, it shouldn’t be this way.  It doesn’t need to be this way.  I’ve heard from mental health professionals across the country describing a system that’s falling short.  One therapist wrote to me who primarily treats teenagers, including some who are having suicidal thoughts.  And he said when his patients need to be hospitalized to save their lives, insurance companies often deny the claims — often deny the claims.  Another clinical psychologist wrote me and described getting calls from desperate people who have called 20 different therapists looking for help but can’t find it.  This therapist says, and I quote, “I try to create time that I don’t have to see more patients.”  End of quote.  “I’m often the only person,” he went on to say, “who is able to call them back.”  They never even get calls, most of the time. And I’ve personally received letters from family members whose loved ones are suffering from mental illness, who describe how difficult it can be to help.  One woman wrote and went on to say — about her mother, a retired teacher who has a bipolar disorder.  Her daughter wrote, quote, “Too often, insurance companies dictate the standard of care when it actually needs to be care providers and family members who have more to say.”  And she went on to say, “Please advocate hard for the most vulnerable among us.”  Well, that’s exactly what my administration is trying to do. Today, my administration is announcing new steps to dramatically expand access to mental health care in America.  Our plans would require health insurance plans to identify the gaps in the mental health care that they provide.  For example, they’d need to measure how many mental health providers are in their networks, how much they are paying these providers, how difficult it is for someone to join their network, how often doctors have to get the so-called prior authorization before they can treat a patient.  Some of you have dealt with this more than once.  You get referrals to see mental health specialists.  But when you make the appointment, they say, “I can’t see you until your doctor submits the paperwork and gets special permission from the insurance company.”  Give me a break.  (Laughter and applause.)  It’s ridiculous.  It really is.  It’s ridiculous.  And it prevents people from getting the care they need.  Now insurance companies — now insurers are going to measure how often they require prior authorization and how often they deny those requests.  Right now, many health plans don’t collect data.  Under my administration’s new plan, they would be required to collect that data.  (Applause.) And under the existing law, when facts reveal that mental health care is not being treated on par with physical healthcare, they would be required by law to fix it.  Fix it, fix it, fix it.  (Applause.) And here’s something else we’re announcing today.  When Men- — when the Mental Health Parity Act was passed 15 years ago, there was a loophole.  Health plans that are offered to state and local government employees did not have to comply with the Mental Health Parity Act.  More than 200 health plans nationwide were left out.  Now we’re making it clear they have to follow the law as well.  (Applause.)  They must follow the law as well. This builds on the work we’ve done over the past two years with the expanded Certified Community Behavioral Health Clinics.  And I want to thank Debbie again, who for years worked to get this program up and running.  She made sure it was funded in the Bipartisan Safer Communities Act, which I was proud to sign into law — the largest investment in mental health ever, ever, ever, ever.  Thank you, Debbie.  (Applause.)    These clinics provide a range of services, including crisis support available 24 hours a day and 7 days a week.  And they serve anyone who needs care regardless of their ability to pay.  There are now 500 of these clinics in 46 states.  We’ve added more than 140 during my administration.  And we’re going to keep increasing the number because you need more than the 500. We’ve also launched a nationwide crisis hotline: 8- — excuse me — 988.  Let me say that again: The crisis hotline is 988, where you can connect with a trained crisis counselor 24 hours a day, 7 days a week.  Over 5 million people have called that hotline since I launched it a year ago — 5 million.  (Applause.)  And we say we don’t have a problem? We’ve invested $1 billion to help schools hire, train — and train 14,000 new mental health counselors in schools across the country.  And we’re taking steps to address the harm of social media is doing to our young people.  And it is doing harm.  (Applause.)   We’ve got to hold — we’ve got to hold these platforms accountable for the national experiment they’re conducting on — on our children for profit.  Later this week, senators will debate legislation to protect kids’ privacy online, which I’ve been calling for for two years.  It matters.  Pass it, pass it, pass it, pass it, pass it.  (Laughter.)  I really mean it.  Think about it.  Do you ever get a chance to look at what your kids are looking at online? Folks, the actions we’re announcing today represent a real step forward to help millions of people get mental health care they need and their insurance should be — and — and the insurance should be provided — should be provided.  But there’s still so much more to do.  Improving our mental health system means addressing the three Cs: coverage, care, and causes.  Today, we took a big step on coverage.  Now we need to keep expanding care — for example, by increasing access to telemedicine; expanding our mental health workshop — workforce — doctors, therapists, and counselors.  Expanding it.  We need to address prevention and the root cause of the pain and trauma that a lot of people are feeling, like loneliness and isolation, social media and online bullying, gun violence.  And there’s still — we’re still feeling the profound loss of the pandemic.  As I mentioned, we have over 100 [1 million] people dead.  That’s 100 [1 million] empty chairs around the kitchen table.  Every single loss, there are so many people left behind and broken-hearted.  Folks, this mental health crisis is something we need to face together as a country.  We have a moral obligation, in my view, to be there for each other, to reach out — reach to our neighbors in grief and stress and trauma and despair.  Reach out to them to offer help or just a listening ear; to have the courage to ask for help when we need it.  And it’s hard, because we know that even when it feels as dark as it can get, we aren’t alone.  It’s important for people to realize they’re not alone.  That’s what I want everyone — that’s what I want for everyone in America: not to feel isolated and alone, to know their country has their back and their President has their back. Let me close with this.  Many people will have to seek mental health care at some point in their lives.  Whether you’re in a red state, a blue state, it doesn’t matter.  Mental health care can be life-changing and even lifesaving.  For all those brave enough and strong enough to seek help — and I mean that — brave enough and strong enough to seek help, we have to do better.  Together, I know we will.  We just have to remember who we are, for God’s sake.  We’re the United States of America.  Think — we’re the United — there is nothing beyond our capacity — nothing — nothing beyond our capacity when we do it together.  So, God bless you all.  And may God protect our troops.  Thank you so very much.  (Applause.) 3:38 P.M. EDT

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Spreading the word: why we need to talk about mental health

By HealthSherpa

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May is Mental Health Awareness Month, but it’s important to talk about mental health all year round. In large part, this is connected to the societal stigma that has plagued mental illnesses. But this topic is about more than just disorders. Here’s what else it covers and why it’s important to talk about mental health.

What is mental health?

Mental health is a state of well-being that encompasses the emotional, psychological, and social aspects of our lives. If you have positive mental health, you’re able to realize your own potential, work productively, manage the normal stresses of life, have healthy relationships, and make a contribution to your community. Conversely, if you experience mental health problems, it could impact how you think, feel, and act, and this could adversely impact other areas of your life.

Why is it important to talk about mental health?

Mental health is a crucial part of overall health, yet it is often a hushed topic of discussion — if it’s even discussed at all. This is largely due to the stigma that has long surrounded mental illnesses. Mental disorders are actually quite common and there is treatment to help with recovery. The stigma, however, often prevents people from seeking treatment, which can isolate them even more and worsen their conditions. Talking about mental health helps improve our communities by making it more acceptable for those suffering from mental illnesses to seek help, learn to cope, and get on the road to recovery. In addition, mental health isn’t just about mental illnesses. It’s also about maintaining a positive state of wellbeing. Talking about mental health helps improve our communities by helping members maintain positive mental health, and a community of people in good mental health creates a more productive and collaborative environment.

Whom do mental illnesses impact?

Mental illnesses are common and widespread and can affect anyone. Nearly one-fifth of the U.S. adult population lives with some sort of mental disorder, according to the American Psychiatric Association. Approximately four percent live with a serious mental illness. The statistics are similar for children and adolescents. The CDC estimates that approximately 13-20 percent of minors in the U.S. experience a mental disorder in any given year. In fact, 75 percent of mental illnesses manifest before age 24, with 50% showing the first signs before age 14. When you add in the family members and friends who are supporting those living with a mental illness, the number of Americans impacted is significant.

What are some of the most common mental illnesses in the United States?

Anxiety disorders are the most common, with nearly one-fifth of the adult population in the U.S. living with this type of mental illness. Many people with anxiety disorders also suffer from depression. In the United States, nearly seven percent of the adult population live with major depression. Bipolar disorder and schizophrenia are also more common in the U.S. than you might think at 2.6 percent and 1.1 percent of the adult population, respectively.

What are the signs and symptoms of the most common mental illnesses?

Each mental illness is different, though some have overlapping symptoms. There are, however, some warning signs that could indicate a need to see a medical or mental health professional. These early warning signs include:

• Eating or sleeping too much or too little
• Abusing alcohol, drugs, or tobacco
• Fighting more with friends and family
• Considering harming yourself or others
• Feeling fatigued with low or no energy
• Feeling apathetic
• Feeling hopeless or helpless
• Feeling sad or irritable for long periods of time
• Experiencing excessive amounts of anger, anxiety, confusion, fear, forgetfulness, and worry
• Experiencing extreme mood swings that negatively impact relationships
• Experiencing unexplained physical pain
• Hearing voices or having delusional thoughts
• Withdrawing from other people and social activities
• Being unable to do your daily tasks

What should I do if I think I have a mental health issue?

Find and talk with a mental health professional if you think you may be living with a mental illness so you can get the appropriate treatment. This is important for both your mental and physical health. In addition to impacting your day-to-day life and potentially causing financial distress due to lost earnings, serious mental illnesses also increase your risk of having chronic medical conditions. You can also take screening tests for some mental disorders, but only a mental health professional can formally diagnose you and get you on the road to recovery.

How can I help a friend or family member who has or may have a mental health issue?

Learning the signs and symptoms of depression, anxiety, and other common mental health illnesses can help you spot potential mental health issues. If you’re concerned, talk to your loved one and encourage him or her to speak with a mental health professional. If you think your friend or family member may hurt him or herself, encourage them to call the National Suicide Prevention Lifeline at 1-800-273-TALK to chat with a trained crisis worker. Online chat is also available.

Is mental health coverage included under the Affordable Care Act?

Yes! Mental health services are one of the essential health benefits that are mandated by the ACA . Coverage includes behavioral health treatments such as counseling and psychotherapy, inpatient services for mental and behavioral health, and treatment for substance abuse. The exact mental health benefits you have will depend on your health insurance plan. In addition, most plans also include preventive mental health services such as depression screenings.

How can I maintain positive mental health?

Being mentally healthy allows you to realize your own potential and help with that of your community’s. Proactive ways to maintain positive mental health include exercising, getting adequate sleep, learning how to cope with life’s stresses , connecting with other people, and speaking with a mental health professional when you need it.

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nice information, Thanks for sharing.

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The Importance of Mental Health

It's not just a buzzword

Westend61 / Getty Images

Risk Factors for Poor Mental Health

Signs of mental health problems, benefits of good mental health, how to maintain mental health and well-being.

Your mental health is an important part of your well-being. This aspect of your welfare determines how you’re able to operate psychologically, emotionally, and socially among others.

Considering how much of a role your mental health plays in each aspect of your life, it's important to guard and improve psychological wellness using appropriate measures.

Because different circumstances can affect your mental health, we’ll be highlighting risk factors and signs that may indicate mental distress. But most importantly, we’ll dive into why mental health is so important.

Mental health is described as a state of well-being where a person is able to cope with the normal stresses of life. This state permits productive work output and allows for meaningful contributions to society.

However, different circumstances exist that may affect the ability to handle life’s curveballs. These factors may also disrupt daily activities, and the capacity to manage these changes. That's only one reason why mental health is so important.

The following factors, listed below, may affect mental well-being and could increase the risk of developing psychological disorders .

Childhood Abuse

Childhood physical assault, sexual violence, emotional abuse, or neglect can lead to severe mental and emotional distress. Abuse increases the risk of developing mental disorders like depression, anxiety, post-traumatic stress disorder, or personality disorders.

Children who have been abused may eventually deal with alcohol and substance use issues. But beyond mental health challenges, child abuse may also lead to medical complications such as diabetes, stroke, and other forms of heart disease.

The Environment

A strong contributor to mental well-being is the state of a person’s usual environment . Adverse environmental circumstances can cause negative effects on psychological wellness.

For instance, weather conditions may influence an increase in suicide cases. Likewise, experiencing natural disasters firsthand can increase the chances of developing PTSD. In certain cases, air pollution may produce negative effects on depression symptoms.  

In contrast, living in a positive social environment can provide protection against mental challenges.

Your biological makeup could determine the state of your well-being. A number of mental health disorders have been found to run in families and may be passed down to members.

These include conditions such as autism , attention deficit hyperactivity disorder , bipolar disorder , depression , and schizophrenia .

Your lifestyle can also impact your mental health. Smoking, a poor diet , alcohol consumption , substance use , and risky sexual behavior may cause psychological harm. These behaviors have been linked to depression.

When mental health is compromised, it isn’t always apparent to the individual or those around them. However, there are certain warning signs to look out for, that may signify negative changes for the well-being. These include:

• A switch in eating habits, whether over or undereating
• A noticeable reduction in energy levels
• Being more reclusive and shying away from others
• Feeling persistent despair
• Indulging in alcohol, tobacco, or other substances more than usual
• Experiencing unexplained confusion, anger, guilt, or worry
• Severe mood swings
• Picking fights with family and friends
• Hearing voices with no identifiable source
• Thinking of self-harm or causing harm to others
• Being unable to perform daily tasks with ease

Whether young or old, the importance of mental health for total well-being cannot be overstated. When psychological wellness is affected, it can cause negative behaviors that may not only affect personal health but can also compromise relationships with others. 

Below are some of the benefits of good mental health.

A Stronger Ability to Cope With Life’s Stressors

When mental and emotional states are at peak levels, the challenges of life can be easier to overcome.

Where alcohol/drugs, isolation, tantrums, or fighting may have been adopted to manage relationship disputes, financial woes, work challenges, and other life issues—a stable mental state can encourage healthier coping mechanisms.

A Positive Self-Image

Mental health greatly correlates with personal feelings about oneself. Overall mental wellness plays a part in your self-esteem . Confidence can often be a good indicator of a healthy mental state.

A person whose mental health is flourishing is more likely to focus on the good in themselves. They will hone in on these qualities, and will generally have ambitions that strive for a healthy, happy life.

Healthier Relationships

If your mental health is in good standing, you might be more capable of providing your friends and family with quality time , affection , and support. When you're not in emotional distress, it can be easier to show up and support the people you care about.

Better Productivity

Dealing with depression or other mental health disorders can impact your productivity levels. If you feel mentally strong , it's more likely that you will be able to work more efficiently and provide higher quality work.

Higher Quality of Life

When mental well-being thrives, your quality of life may improve. This can give room for greater participation in community building. For example, you may begin volunteering in soup kitchens, at food drives, shelters, etc.

You might also pick up new hobbies , and make new acquaintances , and travel to new cities.

Because mental health is so important to general wellness, it’s important that you take care of your mental health.

To keep mental health in shape, a few introductions to and changes to lifestyle practices may be required. These include:

• Taking up regular exercise
• Prioritizing rest and sleep on a daily basis
• Trying meditation
• Learning coping skills for life challenges
• Keeping in touch with loved ones
• Maintaining a positive outlook on life

Another proven way to improve and maintain mental well-being is through the guidance of a professional. Talk therapy can teach you healthier ways to interact with others and coping mechanisms to try during difficult times.

Therapy can also help you address some of your own negative behaviors and provide you with the tools to make some changes in your own life.

The Bottom Line

So why is mental health so important? That's an easy answer: It profoundly affects every area of your life. If you're finding it difficult to address mental health concerns on your own, don't hesitate to seek help from a licensed therapist .

World Health Organization. Mental Health: Strengthening our Response .

Lippard ETC, Nemeroff CB. The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders . Am J Psychiatry . 2020;177(1):20-36. doi:10.1176/appi.ajp.2019.19010020

 Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

Helbich M. Mental Health and Environmental Exposures: An Editorial. Int J Environ Res Public Health . 2018;15(10):2207. Published 2018 Oct 10. doi:10.3390/ijerph15102207

National Institutes of Health. Common Genetic Factors Found in 5 Mental Disorders .

Zaman R, Hankir A, Jemni M. Lifestyle Factors and Mental Health . Psychiatr Danub . 2019;31(Suppl 3):217-220.

Medline Plus. What Is mental health? .

National Alliance on Mental Health. Why Self-Esteem Is Important for Mental Health .

By Elizabeth Plumptre Elizabeth is a freelance health and wellness writer. She helps brands craft factual, yet relatable content that resonates with diverse audiences.

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MASTER OF COMMUNICATION MANAGEMENT ONLINE

The Importance of Communication in Health Care and Tips to Improve

November 15, 2023

View all blog posts under Articles

Technology is everywhere, and its use is only growing. 91.8% of the U.S. population uses the internet, according to the data aggregate site Statista. A 2021 study by Pew Research Center stated that 85% of Americans also own a smartphone — a dramatic rise from the 35% ownership Pew reported in 2011. The survey also noted that 15% of American adults exclusively use their smartphone to access the internet.

This increased use of tech also changed the way people consume health information and underscored the importance of communication in health care. Roughly 60% of Americans were granted online access to their health information in 2020, and nearly 40% of these individuals took advantage of this at least once, according to a  2020 report from HealthIT.gov. Additionally, a survey conducted by the U.S. Department of Health and Human Services (HHS) revealed nearly one in four patients used telehealth services within a four week period between April and October of 2021.

As technology continues to flourish, health care professionals can leverage innovative communication degree online and strategies to become effective leaders in the field.

Why Is Communication in Health Care Important?

Effective communication can have a positive impact on the patient-provider dynamic in numerous ways. It can allow patients to be better educated about their own health, which could enable them to embrace proactive health and wellness strategies. It can also help patients develop a comprehensive understanding of current care strategies involving their health, including acute health situations.

Communication can also help develop a sense of trust between the patient and provider, which might make it easier for patients to adhere to a provider’s recommendations. These elements can lead to several key potential long-term benefits, such as reduced patient visits, reduced costs and improved patient outcomes.

The increased presence of technology makes effective communication even more important in health care. It can help mitigate the potential impact of health misinformation that could otherwise lead patients to make poor or improper decisions about their health. It can also help improve communication among other health care professionals who may need to coordinate care across multiple facilities. This can also lead to improved opportunities for delivering care.

Types of Communication in Health Care

Because technology constantly evolves, continuously strengthening communication is important for health care providers to meet patient expectations. In today’s modern landscape, there are several ways types of communication in health care that can help providers stay ahead of the curve.

Patient Portals Provide Access to Health Information

Health care facilities can develop patient portals, which allow patients to sign up and have confidential access to their individual health care information. Educational health information can be placed on the patient’s portal that is relevant to the patient’s specific health needs. Clinical summaries can be made accessible. These summaries can be a review of the patient’s last appointment or a summary of recent test results with explanations. The summaries can also include recommendations, such as the need for follow-up appointments.

Emailing Can Improve the Patient-Provider Connection

Health care providers, once wary of using email as a communication tool, are finding that email is actually saving them great amounts of time. Responding to patient emails during downtimes is much quicker than returning phone calls. Many emails contain basic questions that can be answered quickly, or emails can be used as reminders to send orders to other providers.

Medication requests can also easily be reviewed and addressed through emails, which are more time-saving than phone calls.

Texting Can Keep the Patient Informed

Text messaging can be an effective tool that allows health care professionals to immediately reach the patient with important information. Texting can be used to directly communicate appointment delays, prescription reminders and patient-portal messages. It can also help keep a patient’s portal information secure by being a key component of patient security measures, such as two-factor login authentication.

Social Media Can Reach a Large Audience

Social media is one of the least expensive ways to disseminate information to large numbers of people. General questions can be answered and information provided. Negative comments made on social media sites can be addressed, which can make a difference in the public opinion of your health care facility. It can also promote a facility’s health-related special events.

In times of public health crises, information can be shared that will give people the correct facts and guidance, which can help prevent the spread of misinformation and panic.

Apps and Websites Can Target Different People

Health care providers can use apps to communicate and target different groups of people. They may have a website with educational health information available for those who seek out information. Additionally, they may offer videos of real people to show how a treatment works.

Health care providers could develop an app that can remind people to engage in certain healthy behaviors, like exercising or checking their blood sugar. Digital forums can also allow patients with similar issues to provide each other with support. Live chat can also be offered to patients.

Become a Builder of Quality Care

Strong communication in health care is important. In today’s digital world, effectively communicating goes beyond enhancing the dynamic between the patient and provider, it can be a tool that transforms the quality of care, which can ultimately improve patient outcomes.

If you are thinking about going into the field of health care — or are just interested in learning more about communication — the online masters in Management program at USC Annenberg ​​School of Communication and Journalism can prepare you to build impactful communication strategies. Our program is designed to help you cultivate expertise in the tactics and strategies of clear and effective communication, which can be deftly applied to health care, business and more.

Discover how we can help advance your professional future, by enhancing your reputation for communicative excellence.

Recommended Readings

Crisis Communications: 2021 and Beyond

Disruptive Communication in Today’s Digital World

Why is Effective Communication Important to Career Success?

Agency for Healthcare Research and Quality, “Approach to Improving Patient Safety: Communication”

HealthIT.gov, Individuals’ Access and Use of Patient Portals and Smartphone Health Apps, 2020

HIPAA Journal, Text Messaging in Healthcare

Journal of Medical Internet Research , “Social Media Use for Health Purposes: Systematic Review”

MedlinePlus, Communicating with Patients

MedlinePlus, Patient Portals - an Online Tool for Your Health

JMIR Medical Education , “Email Use Reconsidered in Health Professions Education: Viewpoint”

Pew Research Center, Mobile Fact Sheet

Statista, Internet Usage in the United States - Statistics & Facts

U.S. Department of Health and Human Services, “Confronting Health Misinformation”

U.S. Department of Health and Human Services, “National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services”

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Biden announces $150 million in research grants as part of his ‘moonshot’ push to fight cancer

President Joe Biden promotes his “moonshot” initiative aimed at reducing cancer deaths in New Orleans. The president announces $150 million in awards from the Advanced Research Projects Agency for Health supporting eight research teams around the country.

President Joe Biden and first lady Jill Biden listen during a demonstration of cancer research and detection techniques at Tulane University, Tuesday, Aug. 13, 2024, in New Orleans. (AP Photo/Mark Schiefelbein)

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President Joe Biden listens as Tulane University President Michael Fitts speaks during a demonstration of cancer research and detection techniques at Tulane University, Tuesday, Aug. 13, 2024, in New Orleans. (AP Photo/Mark Schiefelbein)

President Joe Biden greets former New Orleans Mayor Mitch Landrieu and his wife Cheryl Tuesday, Aug. 13, 2024, at Louis Armstrong International Airport in New Orleans. (AP Photo/Mark Schiefelbein)

President Joe Biden talks with reporters Tuesday, Aug. 13, 2024, at Louis Armstrong International Airport in New Orleans. (AP Photo/Mark Schiefelbein)

President Joe Biden speaks to reporters as he departs the White House for a trip to New Orleans, Tuesday, Aug. 13, 2024, in Washington. (AP Photo/Manuel Balce Ceneta)

FILE - President Joe Biden speaks on the cancer moonshot initiative at the John F. Kennedy Library and Museum, Sept. 12, 2022, in Boston. (AP Photo/Evan Vucci)

President Joe Biden speaks to reporters as he leaves the White House for a trip to New Orleans, La., Tuesday, Aug. 13, 2024, in Washington. (AP Photo/Manuel Balce Ceneta)

President Joe Biden and first lady Jill Biden board Air Force One as they arrive to depart, Tuesday, Aug. 13, 2024, at Joint Base Andrews, Md., en route to New Orleans. (AP Photo/Mark Schiefelbein)

President Joe Biden, escorted by Air Force Col. Angela Ochoa, Commander, 89th Airlift Wing, walks to Air Force One as he arrives to depart, Tuesday, Aug. 13, 2024, at Joint Base Andrews, Md., en route to New Orleans. (AP Photo/Mark Schiefelbein)

NEW ORLEANS (AP) — President Joe Biden is zeroing in on the policy goals closest to his heart now that he’s no longer seeking a second term , visiting New Orleans on Tuesday to promote his administration’s “moonshot” initiative aiming to dramatically reduce cancer deaths.

The president and first lady Jill Biden toured medical facilities that receive federal funding to investigate cancer treatments at Tulane University. Researchers used a piece of raw meat to demonstrate how they are working to improve scanning technology to quickly distinguish between healthy and cancerous cells during surgeries.

The Bidens then championed the announcement of $150 million in awards from the Advanced Research Projects Agency for Health. Those will support eight teams of researchers around the country working on ways to help surgeons more successfully remove tumors from people with cancer. It brings the total amount awarded by the agency to develop breakthrough treatments for cancers to $400 million.

Cancer surgery “takes the best surgeons and takes its toll on families,” Biden said. He said the demonstration of cutting-edge technology he witnessed would offer doctors a way to visualize tumors in real time, reducing the need for follow-on surgeries.

“We’re moving quickly because we know that all families touched by cancer are in a race against time,” Biden said.

The teams receiving awards include ones from Tulane, Dartmouth College, Johns Hopkins University, Rice University, the University of California, San Francisco, the University of Illinois Urbana-Champaign, the University of Washington and Cision Vision in Mountain View, California.

Before he leaves office in January, Biden hopes to move the U.S. closer to the goal he set in 2022 to cut U.S. cancer fatalities by 50% over the next 25 years, and to improve the lives of caregivers and those suffering from cancer.

“I’m a congenital optimist about what Americans can do,” Biden said. “There’s so much that we’re doing. It matters”

Experts say the objective is attainable — with adequate investments.

“We’re curing people of diseases that we previously thought were absolutely intractable and not survivable,” said Karen Knudsen, CEO of the American Cancer Society and the American Cancer Society Cancer Action Network.

Cancer is the second-highest killer of people in the U.S. after heart disease. This year alone, the American Cancer Society estimates that 2 million new cases will be diagnosed and 611,720 people will die of cancer diseases.

Still, “if all innovation ended today and we could just get people access to the innovations that we know about right now, we think we could reduce cancer mortality by another 20 to 30%,” Knudsen said.

The issue is personal enough for Biden that, in his recent Oval Office address about bowing out of the 2024 campaign, the president promised to keep fighting for “my cancer moonshot so we can end cancer as we know it.”

“Because we can do it,” Biden said then.

He said in that speech that the initiative would be a priority of his final months in office, along with working to strengthen the economy and defend abortion rights, protecting children from gun violence and making changes to the Supreme Court, which he called “extreme” in its current makeup during a recent event.

Both the president and first lady have had lesions removed from their skin in the past that were determined to be basal cell carcinoma, a common and easily treated form of cancer. In 2015, their eldest son, Beau, died of an aggressive brain cancer at age 46.

“It’s not just personal,” Biden said Tuesday. “It’s about what’s possible.”

The president’s public schedule has been much quieter since he left the race and endorsed Vice President Kamala Harris , making Tuesday’s trip stand out.

Advocates have praised Biden for keeping the spotlight on cancer, bringing stakeholders together and gathering commitments from private companies, nonprofit organizations and patient groups.

They say that the extra attention the administration has paid has put the nation on track to cut cancer death rates by at least half, preventing more than 4 million deaths from the disease, by 2047. It has done so by bolstering access to cancer treatments and reminding people of the importance of screening, which hit a setback during the coronavirus pandemic.

“President Biden’s passion and commitment to this effort has made monumental differences for the entire cancer community, including those who are suffering from cancer,” said Jon Retzlaff, the chief policy officer at the American Association for Cancer Research.

Looking ahead, Retzlaff said, “The No. 1 thing is for us to see robust, sustained and predictable annual funding support for the National Institutes of Health. And, if we see that through NIH and through the National Cancer Institute, the programs that have been created through the cancer moonshot will be allowed to continue.”

Initiatives under Biden include changes that make screening and cancer care more accessible to more people, said Knudsen, with the American Cancer Society.

For instance, Medicare has started to pay for follow-up colonoscopies if a stool-based test suggests cancer, she said, and Medicare will now pay for navigation services to guide patients through the maze of their cancer care.

“You’ve already paid for the cancer research. You’ve already paid for the innovation. Now let’s get it to people,” Knudsen said.

She also said she’d like to see the next administration pursue a ban on menthol-flavored cigarettes, which she said could save 654,000 lives over the next 40 years.

Scientists now understand that cancer is not a single disease, but hundreds of diseases that respond differently to different treatments. Some cancers have biomarkers that can be targeted by existing drugs that will slow a tumor’s growth. Many more targets await discovery.

“We hope that the next administration, whoever it may be, will continue to keep the focus and emphasis on our national commitment to end cancer as we know it,” said Dr. Crystal Denlinger, CEO of the National Comprehensive Cancer Network, a group of elite cancer centers.

Johnson reported from Washington state.

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Words matter: language can reduce mental health and addiction stigma, NIH leaders say

In a perspective published in Neuropsychopharmacology , leaders from the National Institutes of Health address how using appropriate language to describe mental illness and addiction can help to reduce stigma and improve how people with these conditions are treated in health care settings and throughout society. The authors define stigma as negative attitudes toward people that are based on certain distinguishing characteristics. More than a decade of research has shown that stigma contributes significantly to negative health outcomes and can pose a barrier to seeking treatment for mental illness or substance use disorders.

Thirty five percent of people with serious mental illness in the U.S., and nearly 90% of people with substance use disorders, do not receive treatment. The perspective authors point to evidence that stigma-related bias among clinicians can contribute to a treatment-averse mindset and to flawed clinical care, including failure to implement proven methods of treatment. Further, when a person with a mental illness or substance use disorder continues to experience stigma, they may begin to internalize it. This “self-stigma” can lead to lower self-esteem and feelings of self-worth and can become an ongoing source of distress that may exacerbate symptoms and create barriers to successful treatment.

Conversely, efforts to reduce stigma may reduce the psychological burden it places on individuals and can be an important component of removing barriers to care. The authors highlight numerous studies showing that using scientifically accurate language and terms that centralize the experience of patients with mental illness and substance use disorders is one key component to reducing stigma. They argue that a shift in language is crucial for mobilizing resources toward mental health and addiction services and eroding the prejudices that keep people who need those services from seeking or receiving them. Though stigma is difficult to eliminate, they contend that changing the language we use to describe these conditions can make a significant and immediate difference for the people experiencing them.

ND Volkow, JA Gordon, and GF Koob. Choosing Appropriate Language to Reduce the Stigma Around Mental Illness and Substance Use Disorders . Neuropsychopharmacology. DOI: 10.1038/s41386-021-01069-4 (2021).

• Nora D. Volkow, M.D., director of the National Institute on Drug Abuse (NIDA)
• George F. Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA)

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov .

About the National Institute on Alcohol Abuse and Alcoholism (NIAAA): The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, diagnosis, prevention, and treatment of alcohol use disorder. NIAAA also disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at www.niaaa.nih.gov .

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

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Health Literacy

Health Care Access and Quality

About This Literature Summary

This summary of the literature on Health Literacy as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Language and Literacy literature summary.

Related Objectives (4)

Here's a snapshot of the objectives related to topics covered in this literature summary. Browse all objectives .

• Increase the proportion of adolescents who speak privately with a provider at a preventive medical visit — AH‑02
• Increase the proportion of adults whose health care provider checked their understanding — HC/HIT‑01
• Decrease the proportion of adults who report poor communication with their health care provider — HC/HIT‑02
• Increase the health literacy of the population — HC/HIT‑R01

Related Evidence-Based Resources (4)

Here's a snapshot of the evidence-based resources related to topics covered in this literature summary. Browse all evidence-based resources .

• Decision Aids for People Facing Health Treatment or Screening Decisions
• Health Communication and Social Marketing: Campaigns That Include Mass Media and Health-Related Product Distribution
• Informed Decision Making
• Patient Engagement Playbook

Literature Summary

Healthy People 2030 has elevated the importance of health literacy by declaring it a foundational principle and overarching goal , and by adopting two definitions that together constitute health literacy .

Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

Healthy People and the U.S. Department of Health and Human Services have long recognized that health literacy is not just the result of individual capacities but also the health-literacy related demands and complexities of the health care system. 1 , 2 This official recognition of the two dimensions of health literacy clarifies the different routes to health literacy improvement and encourages stakeholders to engage on both levels. Healthy People’s new definitions of health literacy also underscores the differences between social risks and social determinants of health.

Personal Health Literacy Is a Social Risk

Personal health literacy is a social risk, one associated with worse health care and health outcomes. 3 When individuals have limited personal health literacy, they are at higher risk of misunderstanding information that is important to achieving and maintaining health or losing their way in the fragmented health care system.

Most measures of personal health literacy assess people’s ability to understand written health information and numbers. Using such an assessment in English, the only national health literacy measure found that over a third of adults in the U.S. have limited personal health literacy. 4 Assessing personal health literacy at a given point in time for the purpose of targeting interventions to individuals has limitations; measurement tools can lack precision, and personal health literacy skills can fluctuate, declining at times of illness or stress. 5 Assessment at the aggregate level, however, allows support and resources to be targeted to communities and populations in greatest need. Currently, there is no national measure of personal health literacy.

Organizational Health Literacy Is a Social Determinant of Health

Living in communities served by health care organizations that lack organizational health literacy can affect the quality of health care delivered and, consequently, health outcomes. People residing in the catchment areas of organizations with limited health literacy may be more likely to suffer from miscommunication and have difficulty accessing services. Even people with high personal health literacy can suffer ill effects from low organizational health literacy. Healthy People 2030 organizational health literacy objectives focus on provider-patient communication and shared decision-making.

The concept of organizational health literacy is still evolving. Attributes of a health-literate organization, as well as strategies for becoming a health-literate organization, have been articulated. 6–11 Many measures of aspects of organizational health literacy have been developed, but currently there is no measure of the extent of organizational health literacy in the nation. 12 , 13 Studies of organizational health literacy have largely been descriptive, with few impacts reported. 9 , 14-18 Additional research on the effect of organizational health literacy is needed. 19

Health Literacy and Health Equity

Personal health literacy is associated with racial/ethnic minority status, age, poverty, health insurance coverage, educational attainment, language spoken before starting school, and self-reported health. 20 Strategies to increase personal health literacy disproportionately benefit populations that have been marginalized and therefore have the potential to decrease health disparities.  

Similarly, improving organizational health literacy may reduce disparities. For example, one aspect of being a health-literate organization is meeting the needs of populations with a range of health literacy levels. By ensuring that everyone, regardless of their abilities, can make use of health information and services, health-literate organizations advance health equity.

The National Action Plan to Improve Health Literacy called for interventions that increase both organizational and personal health literacy. 2 On the organizational health literacy front, its goals include promoting changes in the health care system that improve communication, informed decision-making, and access to culturally and linguistically appropriate health information and services. On the personal health literacy front, it promotes accurate, standards-based, and developmentally appropriate health and science information and curricula in child care and education through the university level, as well as expanding adult education and English language instruction.

U.S. Department of Health and Human Services. (2003). Communicating health: Priorities and strategies for progress: Action plans to achieve the health communication objectives in Healthy People 2010 .

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National action plan to improve health literacy.

Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155 (2), 97–107.

U. S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2008). America’s health literacy: Why we need accessible health information.

Pleasant, A., Rudd, R. E., O’Leary, C., Paasche-Orlow, M. K., Allen, M. P., Alvarado-Little, W., ... & Rosen, S. (2016). Considerations for a new definition of health literacy . National Academy of Medicine.

Brach, C., Keller, D., Hernandez, L. M., Baur, C., Parker, R., Dreyer, B., ... & Schillinger, D. (2012). Ten attributes of health literate health care organizations . NAM Perspectives.

Abrams, M. A., Kurtz-Rossi, S., Riffenburgh, A., & Savage, B. A. (2014). Building health literate organizations: A guidebook to achieving organizational change. Journal of Research and Practice for Adult Literacy, Secondary, and Basic Education , 69.

Brega, A. G., Barnard, J., Mabachi, N. M., Weiss, B. D., DeWalt, D. A., Brach, C., ... & West, D. (2015). AHRQ health literacy universal precautions toolkit . Agency for Healthcare Research and Quality.

Brach, C. (2017). The journey to become a health literate organization: A snapshot of health system improvement. Studies in Health Technology and Informatics , 240, 203.

Farmanova, E., Bonneville, L., & Bouchard, L. (2018). Organizational health literacy: Review of theories, frameworks, guides, and implementation issues. INQUIRY: The Journal of Health Care Organization, Provision, and Financing , 55. doi: 0046958018757848

Koh, H. K., Brach, C., Harris, L. M., & Parchman, M. L. (2013). A proposed “health literate care model” would constitute a systems approach to improving patients’ engagement in care. Health Affairs , 32(2), 357–367.

Kripalani, S., Wallston, K., Cavanaugh, K. L., … & Rothman, R. L. (2014). Measures to assess a health-literate organization. National Academies of Medicine.

Brega, A. G., Hamer, M. K., Albright, K., Brach, C., Saliba, D., Abbey, D., & Gritz, R. M. (2019). Organizational health literacy: Quality improvement measures with expert consensus. HLRP: Health Literacy Research and Practice, 3(2), e127–e146.

Weaver, N. L., Wray, R. J., Zellin, S., Gautam, K., & Jupka, K. (2012). Advancing organizational health literacy in health care organizations serving high-needs populations: A case study. Journal of Health Communication, 17 (sup3), 55–66.

Adsul, P., Wray, R., Gautam, K., Jupka, K., Weaver, N., & Wilson, K. (2017). Becoming a health literate organization: Formative research results from healthcare organizations providing care for undeserved communities. Health Services Management Research, 30 (4), 188–196.

Institute of Medicine. (2013). Organizational change to improve health literacy: Workshop summary. National Academies Press.

Isibel, D. (2020). Improving health literacy at the organizational level. Journal of Doctoral Nursing Practice, 13(1), 79-83.

Kaphingst, K. A., Weaver, N. L., Wray, R. J., Brown, M. L., Buskirk, T., & Kreuter, M. W. (2014). Effects of patient health literacy, patient engagement and a system-level health literacy attribute on patient-reported outcomes: A representative statewide survey. BMC Health Services Research, 14 (1), 1–8.

Agency for Healthcare Research and Quality. (2020). Special emphasis notice (SEN): AHRQ announces interest in research on improving organizational health literacy to prevent and manage chronic disease. https://grants.nih.gov/grants/guide/notice-files/NOT-HS-20-009.html

Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Institute of Education Sciences, National Center for Education Statistics.

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BREAKING: Supreme Court bars Biden administration from enforcing parts of its Title IX expansion

Trump says presidential civilian award is 'better' than top military honor whose recipients are 'dead' or 'hit' by bullets

BEDMINSTER, N.J. — Former President Donald Trump lauded a wealthy donor on whom he bestowed the Presidential Medal of Freedom as having gotten the "better" award compared to the top military honor, the Medal of Honor, because those recipients are often deceased or injured.

Speaking at a campaign event intended to discuss antisemitism, Trump was introduced by Miriam Adelson, a wealthy Republican donor and widow of Sheldon Adelson, who pumped millions of dollars of his own money into electing Republican candidates. He died in 2021 .

“I watched Sheldon sitting so proud in the White House when we gave Miriam the Presidential Medal of Freedom," Trump said at his New Jersey resort.

"That’s the highest award you can get as a civilian. It’s the equivalent of the Congressional Medal of Honor," Trump continued, referring to the highest military honor bestowed for valor in combat. The Medal of Honor is often mistakenly called the Congressional Medal of Honor. "But civilian version, it’s actually much better because everyone [who] gets the Congressional Medal of Honor, they're soldiers. They’re either in very bad shape because they’ve been hit so many times by bullets or they’re dead," Trump concluded. “She gets it, and she’s a healthy, beautiful woman, and they’re rated equal, but she got the Presidential Medal of Freedom, and she got it for — and that’s through committees and everything else.”

Trump and his running mate, Sen. JD Vance, R-Ohio, have criticized the Democratic vice presidential nominee, Minnesota Gov. Tim Walz, for his military record and have sought to make reverence for military service an issue in the election . Vance, who is also a veteran, has criticized Walz for opting to retire after more than 20 years in the National Guard but before his unit was set to be deployed to Iraq. Walz has defended his military service .

Trump awarded Miriam Adelson the Medal of Freedom in 2018, commending her donations to anti-addiction facilities and her work as a doctor. The Trump White House described her as a “committed member of the American Jewish community" who "has supported Jewish schools, Holocaust memorial organizations, Friends of the Israel Defense Forces, and Birthright Israel, among other causes.”

President John F. Kennedy established the Medal of Freedom in 1963. Intended to recognize a wide variety of people, the award is created to honor civilians who have contributed to the "interests of the United States," "world peace" or other cultural or "significant public or private endeavors." A president may unilaterally issue the honor.

In the award's more than 60 years, over 600 civilians have been granted the honor.

The Medal of Honor, in an earlier iteration, was first established in 1861, and there have been 3,519 recipients, including more than 1,500 during the Civil War . There were 472 honored for acts of service during World War II. There are 60 living recipients .

The most recent requirements for the honor say a military member must distinguish "himself conspicuously by gallantry and intrepidity at the risk of his life above and beyond the call of duty." To be honored, the military members must be engaged in active combat on behalf of the U.S. against a foreign foe, but there is no requirement that recipients be injured in war.

To be honored, military members must have their acts of valor documented with multiple witnesses and run up the chain of command, with approval from the president. The citations accompanying the honor often detail bravery under fire, such as saving fellow military members or civilians in the face of personal risk.

Jake Traylor is a 2024 NBC News campaign embed.

Ginger Gibson is the senior Washington editor for NBC News Digital.

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Speech, language and communication needs and mental health: the experiences of speech and language therapists and mental health professionals

Annabel hancock.

1 Division of Psychology and Language Sciences, University College London, London UK

Sarah Northcott

2 Division of Language and Communication Science, City University of London, London UK

Hannah Hobson

3 Department of Psychology, University of York, York UK

Michael Clarke

Associated data.

Data are available on request due to privacy/ethical restrictions. The data are not publicly available due to privacy or ethical restrictions.

While the relationship between speech, language and communication needs (SLCN) and mental health difficulties has been recognized, speech and language therapists (SLTs), and mental health professionals face challenges in assessing and treating children with these co‐occurring needs. There exists a gap in the evidence base for best practice for professionals working with children and young people (CYP) who experience difficulties in both areas.

To explore the views of SLTs and mental health clinicians about their experiences of working with CYP exhibiting co‐occurring SLCN and mental health difficulties.

Methods & Procedures

Semi‐structured interviews were conducted with eight SLTs and six mental health professionals, including psychotherapists, clinical psychologists, play therapists and counsellors, with experience working with CYP with SLCN. Interviews were analysed using reflexive thematic analysis and themes were identified from the data.

Outcomes & Results

Participants felt that SLCN and mental health difficulties frequently co‐occur. Participants described how CYP with SLCN and mental health issues commonly experience difficulties across and between the domains of language and cognition, emotional well‐being and challenging behaviour. Findings suggest that there are organizational limitations in the fields of SLT and mental health that have implications for the efficacy of assessment and treatment of CYP with SLCN and mental health difficulties. Traditional talking therapies were perceived to be inaccessible and ineffective for CYP with SLCN and mental health difficulties. Interventions blending behaviour and emotion programmes with language and communication interventions were considered potentially beneficial.

Conclusions & Implications

Future research should explore and evaluate current services and service set‐up in SLT and mental health. The findings from this study have important implications for the efficacy of treatments provided to this population suggesting that more research needs to be done into effective diagnosis and interventions for this population.

WHAT THIS PAPER ADDS

What is already known on the subject.

• Research suggests that CYP with SLCN, such as developmental language disorder (DLD), are likely to experience mental health difficulties including depression, anxiety and poor emotional well‐being. CYP who experience difficulties with SLCN and poor mental health are not well understood and this area remains under‐researched. This has implications for clinician knowledge and therefore the effective diagnosis and treatment of children and adolescents experiencing SLCN and mental health difficulties. In addition, little is known about the accessibility of talking therapies to CYP presenting with SLCN and mental health difficulties.

What this paper adds to existing knowledge

• SLCN issues are understood by SLTs and mental health issues are understood by mental health professionals, but where these co‐occur difficulties exist for the diagnostic process, with professionals perceiving that CYP in this category are often undiagnosed or misdiagnosed. Organizational boundaries between SLT and mental health were perceived to contribute to a lack of understanding of SLCN and mental health needs, which has implications for effective diagnosis and treatment. Traditional talking therapies were thought to be inaccessible for CYP with SLCN and mental health difficulties. Interventions used in both SLT and psychotherapy were perceived as clinically useful if combined.

What are the potential or actual clinical implications of this work?

• This paper highlights implications for the accessibility and efficacy of the assessment and treatment provided to this population and to the organization of services currently treating this group of CYP. A direction for future research would be to undertake service evaluations and intervention‐based studies.

INTRODUCTION

The relationship between speech, language and communication needs (SLCN) and mental health is interwoven and highly complex and often poses real problems for speech and language therapists (SLTs) and mental health professionals to understand, diagnose and treat. SLCN is a broad category that covers a wide range of conditions affecting speech, language and communication (Bishop et al., 2017 ). For simplicity and consistency, the term ‘mental health’ or ‘mental health difficulties’ will be used to refer to children and young people (CYP) with social–emotional and mental health needs, anxiety and depression.

The aim of this study was to explore the views of SLTs and mental health clinicians about their experiences of working with CYP with SLCN and mental health difficulties and, if identified by participants, to explore issues around language and social communication disorders. We begin by first reviewing the existing evidence on the links between language, communication and mental health.

Language, social communication and mental health

There is extensive evidence that language and communication problems co‐occur with mental health problems, although the mechanisms behind this relationship remain unclear. Poor language skills are common in CYP with emotional–behavioural disorders. A 2014 systematic review reported that four out of five children with emotional–behavioural disorders had at least mild language difficulties that had not been previously identified (Hollo et al., 2014 ). Poor mental health can present as challenging behaviour, and is associated with disorders of social communication and language (Georgiades et al., 2010 ). In addition to externalizing problems, children with social communication difficulties (SCDs) are likely to experience anxiety (Moree & Davis, 2010 ). Cohen et al. ( 2013 ) and Wadman et al. ( 2011 ) reported that anxiety symptoms frequently occur in individuals with DLD in young adulthood. DLD can severely impact on mental health, and an increased risk for depressive symptoms has been consistently reported in this group. For example, clinical levels of depression range from 20% to 39% in children and adolescents with DLD compared with 14–18% in peers without DLD (Conti‐Ramsden & Botting, 2008 ). Difficulties with language and communication can affect daily living and extend across the lifespan to affect life outcomes. For instance, young offenders with language impairment are at a higher risk for mental health problems (Snow & Powell, 2004 ) and one of the biggest predictors of reoffending is unrecognized DLD (Winstanley et al., 2019 ).

It is possible that certain aspects of language and communication hold particular relevance for mental health. Van den Bedem et al. ( 2018 ) reported specifically more semantic problems in individuals with DLD and the contribution of this to the prediction of depressive symptoms. Children with pragmatic language difficulties also appear prone to emotional and psychosocial difficulties (Cohen et al., 2013 ). For example, in a community‐based longitudinal study, Sullivan et al. ( 2016 ) reported an association between poor pragmatic language in childhood and adolescent psychotic experiences, and that poor pragmatic language skills preceded early adolescent depression. Some children with pragmatic language impairments also show difficulties recognizing facial emotions (Merkenschlager et al., 2012 ), which may impact on their ability to respond appropriately to others and to form close relationships with those around them (Merkenschlager et al., 2012 ). Van den Bedem et al. ( 2018 ) suggested that children with social communication problems are more likely to adopt maladaptive emotional regulation strategies. These maladaptive strategies may contribute to the prediction of higher levels of depressive symptoms. Children with SLCN are also more likely to be the target of bullying and to experience emotional difficulties compared with their typically developing peers (Lloyd‐Esenkaya et al., 2021 ). SCDs are thought to predict social anxiety, and those who experience peer victimization are likely to present with SCDs (Pickard et al., 2018 ).

In clinical practice, those commonly diagnosed with SCDs and/or autism spectrum disorder (ASD) may also present with pragmatic problems. Research shows that CYP with ASD and SCDs meet the diagnostic criteria for co‐morbid diagnoses of depression and anxiety disorders (Hofvander et al., 2009 ). The prevalence of mental health disorders in ASD is high. For example, in an interview study of 54 young adults with Asperger syndrome, 70% reported experiencing one major episode of depression and 56% reported experiencing anxiety disorders (Lugnegard et al., 2011 ). Furthermore, children with SCDs as part of ASD experience attention and challenging behaviour disorders (Moree & Davis, 2010 ; Georgiades et al., 2010 ) and this may lead to poor mental health.

Another factor that may link language, communication and mental health is the role of emotions and the impact of language and communication upon emotional processes. The ability to effectively vocalize feelings and thoughts relies heavily upon robust language skills, especially in relation to gaining a sense of self‐expression, self‐control and emotional insight (Unsworth & Engle, 2007 ). Neuropsychological evidence also highlights that damage to classic language areas in the brain affects emotion processing. Computerised tomography (CT) scans of patients who had sustained a traumatic brain injury found that damage to the inferior frontal gyrus (i.e., Broca's area) was associated with increased alexithymia scores (difficulties identifying and describing one's own emotions) (Hobson et al., 2018 ). Similarly, communication problems of people who have had a stroke are associated with high alexithymia scores, even after accounting for depression and anxiety (Hobson et al., 2020 ). Such research has led to the proposal that the link between language and identifying emotions is intrinsic, and that language impairment could contribute to alexithymia and/or vice versa. This has been coined as the alexithymia language hypothesis (Hobson et al., 2020 ). While these studies reflect data from acquired language disorders (i.e., following traumatic brain injury or stroke), Hobson et al. ( 2020 ) suggests that individuals with developmental language problems are also likely to experience difficulties with alexithymia. Indeed, initial examinations of levels of alexithymia in DLD suggest that, at least according to children's parents, children with DLD have higher alexithymic traits and problems with recognizing and expressing their own emotions (Hobson & van den Bedem, 2021 ). If language problems lead to greater alexithymic traits, it would be expected that such emotional problems will increase the risk for mental health problems and impact on treatment.

Interventions for mental health and SLCN

There are clear links between language and communication problems and mental health, and plausible models for how these two domains interact. It is thus pertinent to ask: What can interventions do to help and are current interventions suitable for CYP with SLCN? The use of appropriately modified talking therapies for CYP with language and SCDs is lacking evidence. Nonetheless, deficits in speech, language and communication would be expected to negatively impact the effect of talking therapies as CYP with SLCN would have difficulties with understanding pragmatic and inferential language, understanding and using narrative language, and understanding and interpreting emotions. Furthermore, difficulties communicating abstract concepts in verbal and non‐verbal children have been identified as limiting factors to effectively access psychological therapies (Lang et al., 2010 ). Thus, social communication and language difficulties may reduce the accessibility and therefore efficacy of traditional talking therapies.

There appears little acknowledgement about the role of language and communication in modifications of talking therapies. The National Institute for Health and Care Excellence (NICE) guidelines for the use of psychosocial interventions with adults with ASD (NICE, 2013 ) recommend using plain English during therapy sessions and avoiding the use of metaphors. In addition, much of the research in this area has focused largely on the use of cognitive behavioural therapy (CBT) in children and adolescents and often with overt SLCN such as voice disorders, stammering and selective mutism (Bercow et al., 2016 ; Menzies et al., 2008 ). There is also a growing body of research on the use of adapted talking therapies for adults with SLCN. For instance, the Solution Focused Brief Therapy (SFBT) in Poststroke Aphasia SOFIA trial (Northcott et al., 2021 ) applied modified SFBT so that it was accessible to language‐impaired stoke survivors. There is no direct evidence for the use of adapted talking therapies in CYP with DLD or language impairments.

Without knowledge about the nature of the SLCN, suitable access to a talking therapy may be ineffective. For instance, individuals with ASD have more trouble understanding psychotherapy concepts than non‐autistic controls (Hall et al., 2015 ). Furthermore, differences in social communication may mean a lack of social chat, difficulties initiating and maintaining conversations and interpreting language literally, all of which would significantly impact upon effective accessibility to talking therapies (Bliss & Edmonds, 2008 ).

In summary, despite the evidence for a relationship between SLCN and mental health needs, there are considerable knowledge gaps in understanding the impact of SLCN on the efficacy and accessibility of treatments, and the role of SLCN in traditional talking therapies has been largely unexplored. Little is known about clinicians’ perspectives of SLCN and mental health difficulties. Therefore, to inform and build the evidence base, the current study explored the views and experiences of clinicians assessing and treating CYP with SLCN and mental health difficulties. The aim of the study was to explore clinicians’ experiences of working with CYP with SLCN and mental health difficulties. The study addressed the following research questions:

• With what difficulties do CYP with SLCN and mental health needs typically present?
• How do clinicians experience assessing and delivering therapies to CYP with SLCN and mental health difficulties?
• What treatments are thought to be clinically useful for CYP with SLCN and mental health difficulties?

Research design

A qualitative research design using reflexive thematic analysis (TA) was chosen for this study in order to obtain a richness and depth to the data set that would appropriately answer the research questions. This approach facilitated an exploration of clinician experiences, observations and knowledge. A reflexive approach to TA was chosen due to the emphasis placed on the importance of the researcher's subjectivity as an analytic resource, and the reflexive engagement with theory, data and interpretation (Braun & Clarke, 2020 ). A reflexive approach is compatible with experiential qualitative research and was fundamental to the research questions. The approach adopted was an active and flexible process with the acknowledgement of theory. This process ensured a quality demonstrated in gold standard TA (Braun & Clarke, 2020 ). Interview questions were semi‐structured in nature; an interview guide and questions were constructed (see in the additional supporting information ) and followed from a flexible and dynamic perspective. The questions were designed to be open‐ended to facilitate flow of conversation with the aim to build rapport and encourage participants to talk about issues pertinent to the research questions.

Participants and recruitment

This study received ethical approval from University College London (LCD‐2020‐10). This study involved 14 clinicians: eight SLTs and six mental health professionals (Table  1 ). Inclusion criteria were that participants should be qualified allied health professionals in the field of speech and language therapy or mental health. Participants had to have sufficient professional experience (at least one year post‐qualification) working with CYP. Participants were provided with an information sheet written in plain English regarding the research area, interview procedure and research aims. Informed consent was obtained before each interview and participants were given the opportunity to ask questions.

Participant characteristics

Data collection

Interviews lasted for up to one hour and were conducted by the first author online via Microsoft Teams video conferencing software. Video‐audio data were collected. Online interviews were chosen for participant convenience and to ensure that the research could take place despite COVID‐19 pandemic restrictions. Each interview was recorded and transcribed verbatim by the first author and field notes were taken. Personally identifying information such as names and places of work were not transcribed to ensure participant anonymity. Video recordings were securely stored under encryption and deleted after analysis.

Data analysis

The transcribed interviews were subjected to an inductive thematic analysis. An inductive approach to thematic analysis was chosen due to the acknowledgement that epistemological assumptions would inevitably inform the analytic process (Braun & Clarke, 2020 ). However, the recognition that thematic analysis is a theoretically flexible approach was accepted and informed the analytic process. Therefore, the approach was descriptive but not wholly atheoretical. A flexible, active and interactive approach was central to the data analysis to support the process of theme generation, as opposed to theme emergence which could be deemed as not reflective of the data and the positionality of the researchers (Braun & Clarke, 2020 ).

NVivo 20 software was used to support line‐by‐line coding of all transcripts. A reflective diary was used to support the identification of themes from codes. Online team coding was conducted with two postgraduate research students and three senior researchers to support the process of reflexivity and refinement of theme generation. The first author presented raw data, identified codes and initial generated themes to the coding group; these were discussed, challenged and refined.

Reflexivity

As reflexive TA captures the skills the researcher brings to the process (Braun & Clarke, 2020 : 6), it is necessary to consider the researcher's perspective. The lead author is a female clinical academic SLT specializing in paediatric ASD, DLD and challenging behaviour. She is also a solution‐focused therapist and practices hypnotherapy with children and adults. The current project formed part of the lead researcher's pre‐doctoral clinical fellowship funded by The National Institute of Health Research. The co‐authors are senior researchers with experience in the fields of speech and language therapy and psychology with research in aphasia and solution‐focused brief therapy, alexithymia and SLCN. Participants were informed about the lead researcher's occupation, background and research aims. The lead researcher's interests and aims were not shared with the participants, and the researcher attempted to maintain a neutral stance throughout the interviews in order to obtain a true picture of clinicians’ experiences and understanding of specific subtypes of SLCN and their relationship to mental health.

Four main themes were generated from the data: (1) boundaries around professional relationships, (2) knowledge of SLCN and mental health, (3) being misunderstood: how CYP are perceived by others and (4) blended interventions. These are summarized in Figure  1 . We unpack each theme and its subthemes below.

Summary of the main themes and subthemes [Colour figure can be viewed at wileyonlinelibrary.com ]

Note: SLT, speech and language therapy; MH, mental health; MDT, multidisciplinary team.

In addition, data were gathered regarding how participants characterize this population. SLCN and difficulties with mental health were identified by participants as frequently co‐occurring. These data are presented following a discussion of the four themes under Figure  2 : SLCN and mental health difficulties: typical difficulties reported in this population.

Speech, language and communication needs (SLCN) and mental health difficulties: typical difficulties reported in this population [Colour figure can be viewed at wileyonlinelibrary.com ]

Theme 1: Boundaries around professional relationships

This theme describes observed discrepancies in the identification of children with SLCN and mental health difficulties, and discrepancies in approaches to working with this population between mental health professional participants and SLT participants. Differences in service provision, professional practice and lack of multidisciplinary team working were cited by participants as contributing factors to the observed discrepancies.

One subtheme concerned marked differences in the organization of SLT and mental health services. SLT and mental health services were not only considered differently organized but also highly variable depending upon postcode, funding and service set‐up. How services were set‐up was construed to play a large part in the appropriate management, or perceived mismanagement, of children with SLCN and mental health difficulties. Service boundaries were identified as contributing to a range of difficulties working across and between disciplines. For example, SLTs discussed difficulties referring to services such as child and adolescent mental health services (CAMHS), often receiving referral rejections from CAMHS with limited or no feedback. Other examples cited by participants were related to limited feedback or acknowledgement to receiving patient reports, a physical distance between services, and difficulties identifying appropriate treatment pathways for CYP with SLCN and mental health difficulties, particularly in mental health services. ‘Lots of referrals get rejected, so many referrals that we really feel as a team need CAMHS support’ (participant (P)5: SLT).

Participants described how services are often entirely separate and working in respective isolation. This was interpreted to contribute to a limited or total absence of joint working, resulting in a lack of knowledge of each profession's discipline and of discipline protocols, for example, referral systems, use of screening for appropriate referrals and confidentiality policies. Service level differences were also cited as causing difficulties identifying which discipline should assess and manage CYP. ‘It was sort of, oh no, that has to be CAMHS, CAMHS has to deal with them, and if they were under seven, then CAMHS would say, oh no, that has to be speech therapy, speech therapy is dealing with them’ (P3: SLT).

A second subtheme was limited multidisciplinary team (MDT) working. An MDT is a group of health or social care workers and professionals who are members of different disciplines, each of which provides a specific service to service users (Hodder Education, 2021 ). Differences in service provision and service funding resulting in a separation of professionals, both at a geographic and organization level, was construed as a contributing factor to limited MDT working between mental health and speech and language therapy. Participants described how SLTs and mental health professionals are often not part of the same MDT and therefore have fewer opportunities to provide integrated care. SLT participants commented that their profession is often unaccounted for within acute mental health services, and one mental health professional considered her role under the safeguarding team as being cut‐off from the SLT's role which was under the SEN team. In addition, some participants attributed limited MDT working to policy level differences such as psychological services not sharing information with SLT due to confidentiality policies and differences in patient note systems:

‘we're often funded by different streams and funded by different people, we work in different health trusts quite often, and that actually has massive implications for the fact a) that you're not physically in the same building, so you don't get to see these people very often, but that even things about how we collect data, our electronic patient systems, we often use very different data technology that, that can make things very difficult in terms of information sharing’. (P13: mental health professional)

SLT participants also described a lack of approachability from mental health professionals which was seen as alienating and limiting from a diagnostic and therapeutic perspective, further contributing to limited MDT working, collaboration and cohesion between these professional groups.

‘because you've talked about an incident or challenging behaviour or something like that, certain psychology colleagues see that as inappropriate or you've overstepped a boundary because you're talking about a kind of emotion when that's something that they do, or they perceive themselves as doing quite exclusively’. (P7: SLT)

Theme 2: Knowledge of SLCN and mental health difficulties

The first theme ‘Boundaries around professional relationships’ directly interacts with the second theme ‘Knowledge of SLCN and mental health difficulties’. A perceived lack of shared knowledge was seen to be related to limited opportunities for multidisciplinary experiences and the clinical service set‐up overall.

The first subtheme concerned the ‘visibility’ of SLCN. It was construed that potentially less immediately obvious SLCN, such as DLD, are less likely to be identified by mental health professionals than more visible SLCN, such as stammering and selective mutism. Visible SLCNs discussed more frequently by mental health professionals as opposed to invisible SLCNs. This discrepancy was described by participants as potentially contributing to unidentified SLCN and mental health difficulties within mental health services, and the lack of knowledge universally with assessment and treatment of this population.

‘I don't think that's typical for mental health practitioners (to consider language difficulties). No, I would definitely think I know my team, the teams that I've worked in, most people would not think about language, particularly language disorders in a young person as part of the part of their (psychology) assessment, unless a parent disclosed something like that, or unless they were very, it was very clear evidence that there were quite obvious difficulties’. (P13: mental health professional)

Difficulty teasing out SLCN from mental health issues (and vice versa) was also interpreted as contributing to a lack of knowledge regarding appropriate diagnosis of CYP with SLCN and mental health difficulties. It was construed that a lack of understanding of the relationship between SLCN and mental health often impacts upon which professional should and would assess and treat this population. Participants discussed how social skills historically have been explicitly taught by SLTs but that mental health professionals are increasingly using this approach as an intervention strategy. Participants discussed a general lack of clarity around role boundaries which could sometimes lead to perceptions of overstepping a professional role or boundary. ‘In my kind of experience, I find certain psychologists very much see emotion, or kinds of challenging behaviour as their domain and they don't like anyone stepping into it’ (P7: SLT).

Barriers to accessing talking therapies was the second subtheme. Knowledge around diagnosis was construed as relating directly to providing appropriate interventions for this population, particularly regarding talking therapies. Traditional talking therapies were interpreted as being potentially inaccessible and inflexible for individuals presenting with SLCN and mental health difficulties, particularly if language difficulties were unidentified. SLTs and some mental health professional participants viewed psychological therapies as language heavy, involving higher level language and concepts that CYP with SLCN would struggle to comprehend and verbalize.

‘I might go and observe a psychology session with them and then the language they're using is far too complex the, the psychological language, the therapy materials, they often use a metaphorical language, they're using kind of these images and symbolism, which is far too complex for the person in general and then they're not really understanding’ (P7: SLT).

Due to a perceived lack of knowledge, identification of CYP with less visible SLCN might be missed by mental health professionals and unaccounted for within traditional psychological therapies. SLT participants described how in such instances appropriate accessibility and efficacy of talking therapies for CYP with SLCN may be compromised. ‘I'm not sure how much they know about these particular children's language needs and like how therefore their intervention with DEAF‐CAMHS‐H [CAMHS for the hearing impaired] is delivered effectively’ (P2: SLT).

Theme 3: Being misunderstood/labelled as naughty

Both SLT and mental health professional participants construed CYP presenting with SLCN and mental health difficulties as misunderstood and often perceived negatively by staff, carers, parents and the wider environment. In particular, difficulties with challenging behaviour, dysregulation and disengagement were interpreted by participants as being misunderstood and perceived as ‘naughty’. Participants considered the high prevalence of behaviours such as disengagement, a distrust of professionals and school refusal as contributing to this perception. Participants interpreted this population as commonly using non‐typical social communication skills that may result in difficulties building and maintaining relationships with peers, staff, parents and carers, further contributing to a negative perception. Difficulties with understanding and expressing language were seen to be related directly to instances of challenging behaviour.

‘We tend to get a lot of young people who are presenting at school, with quite significant behavioural difficulties and we tend to find that being viewed as a behavioural child, rather than a child that's got underlying language needs that have been un‐diagnosed’ (P5: SLT).

Theme 4: Blended interventions

The final theme concerns blended interventions. This theme describes participants’ descriptions of optimum interventions for CYP with SLCN and mental health difficulties. It was construed that working with the systems and environment around CYP is clinically useful for this population.

The first subtheme concerns working with the environment. The use of positive behavioural support systems, emotional regulation strategies and programmes, staff training, and the involvement of parents within interventions were deemed as clinically useful interventions for CYP experiencing SLCN and mental health issues. Parent–child interaction therapy (PCIT) is used by SLTs with the aim of improving interactions between children and their parents/carers (Falkus et al., 2016 ). Theraplay is used by psychotherapists to support healthy child/caregiver attachments (Institute of Theraplay, 2021 ). Both PCIT and Theraplay offer similar programmes where parents are involved as part of the intervention process. Participants discussed the potential of combining or utilizing such approaches in a more joined‐up manner for future targeted interventions. A functional approach to mitigating SLCN was also construed as beneficial for this population. Participants discussed how targeting specific aspects of SLCN may not be as beneficial as focusing on increasing overall functioning and well‐being of CYP.

‘So, I think in terms of delivering therapy, lots of it is about that environmental to therapeutics, so sort of, let's see if we can normalize the environment as much as we can in this environment and support behaviour through communication’ (P3: SLT).

The second subtheme concerned supports for communication. This theme was discussed universally by participants. The need to adapt language and consider therapist delivery within all diagnostic and therapeutic processes was seen as paramount for CYP experiencing SLCN and mental health difficulties. Using simple or no language to take the pressure off a requirement for verbal communication was interpreted as being necessary within any intervention for this population. Other visual supports, such as talking mats (Murphy et al., 2013 ) and communication systems, such as visual timetables and ‘now and next’ boards, were considered useful.

‘The use visuals, the use of visuals full stop. Whether that's visual or written timetable, even if the child has literacy so implementing a sort of routine on a timetable and consistent use of that across the day, I think works well’ (P4: SLT).

Play therapy or the use of play as a vehicle for access to psychological therapy for CYP with SLCN and mental health difficulties was considered a potentially useful psychological approach for this population due to the lack of emphasis upon verbal communication:

‘So, I think the use of toys and play can help bring their outer world about what's going on when, what they see inside and speech doesn't need to be, it doesn't need to be a part of that’ (P12: mental health professional). ‘I think the therapy it's different because I'm not expecting, they don't have to talk’ (P11: mental health professional).

Explicitly teaching higher level language was deemed an important intervention strategy, particularly in relation to comprehending and expressing emotions. One SLT participant described how they had combined a cognitive developmental theory of emotion and a psychotherapy model, with a vocabulary intervention directed through talking mats (Murphy et al., 2013 ) to facilitate communication. This was discussed and explored as a potentially useful way to develop emotion vocabulary comprehension and processing with this population.

‘You give people labels to understand what they're feeling physically, and then you move it onto more cognitive levels where that's the more kind of established sort of CBT, that kind of approach where they're thinking about their emotions and their thoughts … then you move on to the word level stage (of the vocabulary intervention) and that's very much around introducing kind of very basic semantic understanding of the word of the meaning and then you're building in the syntax and you're trying to get a really deep, you're trying to get there because they often have a vague notion of what certain words mean, but their understanding is very poor so you're trying to really reinforce a particular meaning or understanding of an emotion word’ (P7: SLT).

Merging interventions drawing upon practices from speech and language therapy and mental health was discussed. For instance, an SLT talked about how they had successfully combined shape coding (Ebbels, 2021 ), which is an established intervention used by SLTs, with social communication, emotional regulation, and transactional support (SCERTS), which is a behaviour intervention (Prizant et al., 2006 ). Participants also interpreted the use of relatable, non‐hypothetical language, and teaching how emotions look and feel in the body as being clinically necessary for this population. Participants advocated for the need to modify and adapt traditional talking therapies such as cognitive behavioural therapy and using an individualized approach. ‘Lots of more sort of explicit ways of doing things and using lots of examples from his own his own life and things that he would bring to the session rather than me coming up with example’ (P13: mental health professional).

Common difficulties reported by interviewees to be seen in CYP with SLCN and poor mental health

In addition to the themes described above, participants generated discussion regarding how they characterize this population. In answer to the question ‘can you tell me about some of the difficulties these CYP experience?’, participants described a range of difficulties this population typically present with. This is not a diagnostic criterion; it is a set of descriptions used by participants to describe their experience of this population (Figure  2 ).

Participants felt that characterizing the overall presentation of this population is often problematic. Participants reported that it is difficult to determine what is specifically a SLCN and what is a mental health need. SLCN and difficulties with mental health were identified by participants as frequently co‐occurring. Key aspects of development were identified by participants as being typically delayed or disordered with CYP experiencing SLCN and mental health difficulties. Participants reported that CYP in this population would commonly experience difficulties across these areas. The first area identified was emotional well‐being. Participants felt that this population significantly struggle with feelings of self‐consciousness, low self‐esteem, and anxiety, often about the presence of a communication impairment, and the impact of their communication difficulty on their experiences with the world around them. Participants felt that difficulties with self‐esteem and anxiety could sometimes result in poor emotional resilience. One participant described how young offenders are at particular risk of developing low self‐esteem because of multiple exclusions from education and therefore a sense of rejection that they may experience throughout life. Another participant described how difficulties with SLCN could impact on their well‐being and levels of anxiety and distress and behaviour. ‘We definitely see those children, they're often very anxious and there is definitely an impact of some of their difficulties on their well‐being, self‐esteem and their mental health’ (P5: SLT).

The second common characteristic was challenging behaviour. Participants described this population as typically experiencing difficulties with engagement, staying on task, and finding it hard to comply with work in the classroom or, with other professionals. Typical behavioural difficulties were problems with emotional regulation and the presence of anger or aggressive behaviours. Participants described how CYP can be disruptive or conversely appear withdrawn and isolated in social situations. Other reported difficulties in this area were with attention and listening and with building and maintaining relationships, particularly with peers.

‘We see quite a lot of, we describe it as anxiety for the children that, that I work with and dysregulation is a term that I've been using much more recently, so that can present as very elevated, it can present us physical aggression, some self‐harm and behaviours, yeah, sort of, socially inappropriate behaviours in terms of removing clothes and smearing and that sort of thing’ (P10: mental health professional).

The final area identified as characteristic of this population was language and cognition. Participants felt that this category of CYP experience difficulties with general language comprehension, processing of spoken language and with their expressive language. ‘Verbally he (a patient) appeared to understand things very well or he had a good, he had a good vocabulary, but actually his understanding was limited so he could be quite misleading’ (P13: mental health professional).

Difficulties with executive function was also discussed, often in relation to CYP being able to appropriately plan and organize themselves. One participant cited how it is common for CYP to arrive late to lessons, getting lost en‐route and forgetting school equipment. Difficulties with verbal reasoning were also described as commonly present with this population. ‘They're breaking their curfews and they end up in trouble with the police and things because they can't tell the time’ (P5: SLT).

Difficulties with metacognition (thinking about thinking) was also highlighted by participants as a typical difficulty seen in these CYP. Difficulties with insight, being able to monitor their communication and planning how to approach a learning task were all discussed as typical problems for this population. ‘They may not have insight into their own language use or behaviour’ (P2: SLT).

‘Difficulties with higher order language and the use of sophisticated, abstract and emotional language was also reported. Participants reported CYP in this population often experience difficulties understanding and using emotion language, particularly labelling emotions. They don't know what it means when somebody uses those words (emotional words), or is sarcastic’ (P5: SLT).

The misunderstanding of negative constructions was discussed as being a barrier to understanding emotions:

‘You might conceive that someone's doing something to you because you can't understand negative constructions, for instance, you just you assume everyone's just doing things to you but you're the one who's not quite understanding like the word no, or negative things’ (P7: SLT).

Difficulties with being able to understand abstract language and using language in a more abstract way to make predictions, use hypothetical language and humour was also cited as a typical difficulty in this population. ‘He would struggle with transferring that knowledge from a discussion about a hypothetical person to himself’ (P10: mental health professional).

The current study explored the experiences and views of SLTs and mental health professionals working with CYP with SLCN and mental health difficulties. Discussion around CYP with SCDs such as ASD, and developmental language disorder (DLD) was of particular interest. SLTs and mental health professionals in this study perceived certain subtypes of SLCN to commonly co‐occur with mental health difficulties. Findings suggest that there are organizational and service set‐up boundaries between SLTs and mental health clinicians, which has implications for the efficacy of assessment and treatment of this population. Findings also suggest that this population is often misunderstood and misidentified. The current research indicates that combined approaches in SLT and mental health may be beneficial for CYP who present with co‐occurring SLCN and mental health needs.

The current research has also identified that distinct barriers exist between mental health clinicians and SLTs which has led to boundaries between these professional groups. The most significant barrier was found to be around service organization and set‐up. Participants described how, as professionals, they felt organizational difficulties led to feelings of ‘failing’ this cohort. Findings suggest that mental health professionals and SLTs are often not in the same MDT and that SLT is often not a recognised professional group within children and adolescent mental health services. SLT and mental health services appear to be functioning in parallel, working under different teams, services, NHS trusts, local authorities, and sometimes entirely different organizations. Service set‐up and organization limitations were deemed to result in fewer opportunities for MDT working which has a negative impact on the knowledge professionals have of CYP with co‐occurring SLCN and mental health difficulties. Within the United Kingdom there is currently an ongoing consultation process with The Royal College of Speech and Language Therapists (RCSLT) and CAMHS to recognise the role of SLT within mental services and to increase SLT roles within core CAMHS services.

The current research highlights how a lack of understanding of this population is a clinical concern and has been described by participants in this study as having implications for effective diagnosis and treatment. The current study also illustrates that availability of joined up and multidisciplinary services for this population is scarce. This has resulted in a lack of shared knowledge about this population, leading to challenges with diagnosis, particularly with CYP who exhibit invisible SLCN and mental health difficulties such as DLD. The current research highlights that CYP with co‐occurring SLCN and mental health difficulties may be undiagnosed or misdiagnosed by professionals. This may mean CYP in this population fail to receive appropriately modified and evidence‐based treatment. The current findings resonate with other recent investigations of parents’ experiences concerning mental health support for their children with SLCN. Parents have reported concerns that mental health treatments were not accessible for their children and lacked adaptations necessary for them to work for children with conditions such as DLD (Hobson et al., 2021 ).

Typical behaviours and characteristics of CYP with co‐occurring SLCN and mental health needs are often misunderstood by parents, carers and professionals resulting in this population being misinterpreted and often labelled as ‘naughty’. Behaviours that are typically misunderstood include anger or emotional outbursts due to difficulties with emotional regulation, disengagement, language difficulties and problems with building and maintaining adult and peer relationships. Participants reported that children in this population are frequently ‘angry’ or show aggressive behaviours, and experience difficulties with friendships, can be distrusting of professionals, and are likely to show poor school attendance. Participants observed that CYP in this population are also likely to experience school expulsion, attendance to pupil referral units, and in some cases youth offending institutions/team (YOT).

A key finding was that interventions used in both speech and language therapy and psychotherapy are perceived as clinically useful if combined. Other research (Bercow et al., 2016 ; Menzies et al., 2018 ) has applied mental health interventions to specific subtypes of SLCN such as stammering, selective mutism and ASD, but little in relation to DLD. Participants discussed how they have successfully blended behaviour and emotion programmes with language and communication interventions. Similarly, participants discussed how combining traditional talking therapies, such as CBT, with modifications to account for communication difficulties, such as using visual supports, can be beneficial.

Hollo et al. ( 2014 ) has called for the development of interventions to ameliorate the effects of these dual deficits. Findings from the current study show that some existing or modified interventions are anecdotally effective. A good starting point for future research would be with the exploration of adapted traditional talking therapies and psychological therapies combined with SLT. A preliminary finding from the current research is that play therapy could also offer a potentially useful psychological therapy for CYP with co‐occurring SLCN and mental health difficulties due to its child‐led nature and lack of emphasis upon language and communication. Interestingly, play therapy was also raised by parents of children with DLD in the study by Hobson et al. ( 2021 ) as an approach that they felt would be worth pursuing. This has yet to be directly explored in individuals with SLCN but could offer further direction for future research into interventions for this population.

Findings from the current research show that it is not typical for mental health clinicians to consider language and communication skills within their assessment and treatment processes. The potential impact of this omission was described by participants as limiting CYP with co‐occurring SLCN and mental health needs to therapies that would likely be inaccessible. The current study has found that traditional talking therapies may not be modified for this population, unless the CYP have an obvious or diagnosed SLCN. This has implications for the efficacy of treatments provided, highlighting that traditional talking therapies, if not appropriately modified, are likely to be suboptimal for this cohort. Participants felt that traditional talking therapies could be reasonably adjusted to be accessible to individuals with SLCN. In a recent intervention study where aphasic adult patients received SFBT, Northcott et al. ( 2015 ) concluded that modifying question forms of therapy enabled greater accessibility.

Clinicians identified that CYP with SLCN and mental health difficulties most commonly experience difficulties across and between the domains of language and cognition, emotional well‐being and challenging behaviour. Fundamentally, participants considered that it is typical for CYP to present with co‐occurring SLCN and mental health difficulties, that is, difficulties across speech, language and communication and mental health. Previous research reports that children and adolescents with DLD and ASD are likely to experience difficulties with anxiety and depression (Cohen et al., 2013 ; Hofvander et al., 2009 ; Wadman et al., 2011 ). Results from the current study reflect this, indicating that difficulties with language and social communication are likely to interact with mental health difficulties. In addition, participants felt that SLCN can profoundly affect a person's social and emotional well‐being, and this can lead to poor mental health.

Participants described how CYP typically experiencing difficulties with higher level language are likely to find understanding and expressing emotions challenging. This supports existing frameworks such as the alexithymia language hypothesis (Hobson et al., 2020 ) which proposes that because of the intrinsic relationship between language and emotions, CYP with conditions such as ASD and DLD may be more likely to experience co‐occurring difficulties with mental health.

A limitation of the current study was that some of the participants were recruited from the researcher's professional network. Thus, a convenience sample was used and therefore potential selection bias may have been present, resulting in a failure to capture important perspectives from hard‐to‐reach participants. However, it is important to note that the range of participant specialities, knowledge and skill set was heterogenous and diverse.

Clear directions for future research have been identified from the results of the current study. The service organization, set‐up and service provision for this population is problematic. Future studies could explore and evaluate current services, set‐up and structure across and between SLT and mental health. The findings from the current study have important implications for the efficacy of treatments provided to this population, suggesting that more research needs to be done in this area. There exists a large gap in the evidence base for intervention‐based studies with this population. Larger scale intervention studies could also provide evidence for the efficacy of psychological approaches with this population. Future studies could also explore the adaptability of traditional talking therapies, combining approaches drawn from SLT and psychological therapies and the exploration of play therapy. Intervention studies analysing the efficacy of psychological therapies in children and adolescents with SLCN should arguably be conducted in part with SLT to provide input regarding SLCN. Modifications to talking therapies in young people with SLCN are therefore necessary in order to reflect and treat the presence of SLCN and mental health difficulties. Research from Solution Focused Brief Therapy (SFBT) in Poststroke Aphasia SOFIA trial (Northcott et al., 2021 ) suggests that modifications to SFBT is a promising psychotherapy approach for adults with aphasia, and that it is possible to adapt a language‐based psychological intervention for people with language disorders. In addition, behavioural activation therapy has also been shown to be successfully modifiable for adults with aphasia (Thomas et al., 2013 ) but further evidence, especially in a paediatric population, is scarce.

The current study aimed to describe typical presentations of this population, clinician experiences treating this population and clinically useful treatment approaches. The findings present a picture of the problems CYP with SLCN and mental health needs commonly experience and has enabled the documentation of a range of clinician experiences and views to inform and build a limited evidence base. Findings suggest that there are distinct organizational and service set‐up limitations with implications for the assessment and treatment of CYP with SLCN and mental health difficulties. Interventions drawing upon SLT, and mental health approaches may be beneficial for this population.

Supporting information

Supporting Information

ACKNOWLEDGEMENTS

Annabel Hancock thanks The Owl Therapy Centre for their invaluable support and for making this project a reality. She also thanks her supervisors and The NIHR for funding this project as part of the Predoctoral Clinical Academic Fellowship. She is also grateful to the participants who took part in this project, without which this research would not have been possible.

Hancock, A. , Northcott, S. , Hobson, H. , & Clarke, M. (2023) Speech, language and communication needs and mental health: the experiences of speech and language therapists and mental health professionals . International Journal of Language & Communication Disorders , 58 , 52–66. 10.1111/1460-6984.12767 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

The NIHR funded this project as part of Annabel Hancock's Predoctoral Clinical Academic Fellowship.

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How sexual 'aftercare' can improve connection and consent

What do you like to do after sex? Have a cuddle? Take a shower? Maybe it's sipping a cup of tea in bed.

While we may not always have time for a relaxed wind-down with our sexual partner/s post-sex, "aftercare" can be as simple as asking someone how they are feeling, explains Jennifer Power.

She's an associate professor at La Trobe University's Australian Research Centre in Sex, Health and Society and has been looking at sexual aftercare and why it's an important part of consent education.

"It is about seeing or understanding your and the other person's needs more holistically," Dr Power says.

"It doesn't have to take a heap of time … a few minutes to have a chat and make sure someone is in a good space."

Where aftercare comes from

Dr Power says the concept of aftercare isn't a new idea — many people will be familiar with the concept of "cuddling" after sex.

She says the term aftercare comes from the kink community, but has become more mainstream.

"In kink it comes from the way people plan BDSM scenes — so the planning of a scene, what do you want to do, what are your boundaries, talking trough what it might involve, and what happens after."

What aftercare can look like

For a lot of people, sex isn't just an isolated event, explains Kassandra Mourikis, a sex therapist based in Naarm/Melbourne.

"There is a build-up, there might be a discussion about how and what you will explore and your limits [beforehand], and then the experience, then the post-wind down care."

She says that wind down, known as aftercare, can be any kind of practice that follows a sexual experience to slow down, reflect, and debrief.

"Talk about how you felt, what went well, what didn't go so well.

"It can even be practical things like having a shower, cleaning up together, spooning and cuddles, a massage.

"Someone might like to be wrapped in a warm dressing gown."

Ms Mourikis says aftercare can take place in casual and ongoing relationships, and is whatever helps all parties feel like there is intentional "connection, care, and curiosity".

"It's continuing to support and offer care for the human being that we are with."

How aftercare can improve connection, consent, and pleasure

Sex is a place we are always learning — and part of that is making mistakes, Ms Mourikis says.

"Aftercare is an opportunity to integrate that learning; what worked and what can you do to make it even better next time?"

She says if something didn't go as well as someone would have liked, that can be hard to say in the moment.

Creating space afterwards to share those things helps us practice accountability and invite feedback.

"People aren't bad for making mistakes, but it's easy to leave with those unaddressed and that can create rifts and rupture that makes it hard to move towards sex again next time."

It's also a chance to share with people what you loved about the experience, she says.

"It's about doing something that feels good to wind down, but also ... [asking for example] how would you feel it we talked about what we loved, or what we could keep doing if we did this again?

"You can learn how people like to be touched and … and what feels pleasurable for them."

Dr Power says post-care intimacy, affection, and communication supports relationship satisfaction and wellbeing.

And aftercare broadens the conversation around consent, she says, something we typically think of a conversation that happens before and during sex .

"Introducing the concept of sexual aftercare into consent education facilitates a focus on consent as an ongoing dialogue."

Ms Mourikis says not everyone will feel comfortable debriefing immediately after sex, and that's OK.

"Maybe it's over dinner that night, or a week later by message, or next time you meet. Sometimes it takes a little bit of time for people to process."

• X (formerly Twitter)

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Susan Wojcicki, Former Chief of YouTube, Dies at 56

The business executive helped turn Google into an internet juggernaut and became one of the most prominent women in Silicon Valley.

By John Yoon and Mike Isaac

Susan Wojcicki , who helped turn Google from a start-up in her garage into an internet juggernaut, and who became one of Silicon Valley’s most prominent female executives with her leadership of YouTube, died on Friday. She was 56.

Her death was confirmed by her husband, Dennis Troper, who wrote on Facebook that she had been living with lung cancer for two years. He did not say where she died.

Ms. Wojcicki’s more than two decades with Google began in 1998 in her house in Menlo Park, Calif., part of which she rented to her friends Larry Page and Sergey Brin, the company’s founders. For $1,700 a month, the two used the garage as their office to build the search engine.

Ms. Wojcicki, who had been working at Intel, soon joined Google as one of its earliest employees and was its first marketing manager. Over the years, she reached its executive ranks, becoming Google’s most senior woman employee. She eventually led YouTube, which Google acquired in 2006, and which became one of the world’s largest social media companies.

“She is as core to the history of Google as anyone, and it’s hard to imagine the world without her,” Sundar Pichai, Google’s chief executive, said in a statement .

When she became YouTube’s chief executive in 2014, Ms. Wojcicki was hailed as the most powerful woman in advertising. She had made Google enormously profitable, and she was expected to repeat the trick at YouTube. She led Google’s ad business and played a key role in its acquisition of DoubleClick , an advertising technology company, in 2007.

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Trump keeps losing his train of thought. Cognitive experts have theories about why

By Olivia Goldhill Aug. 7, 2024

I n a speech earlier this year, former President Trump was mocking President Biden’s ability to walk through sand when he suddenly switched to talking about the old Hollywood icon Cary Grant.

“Somebody said he [Biden] looks great in a bathing suit, right? When he was in the sand and he was having a hard time lifting his feet through the sand, because you know, sand is heavy. They figure three solid ounces per foot. But sand is a little heavy. And he’s sitting in a bathing suit. Look, at 81, do you remember Cary Grant? How good was Cary Grant, right? I don’t think Cary Grant — he was good. I don’t know what happened to movie stars today,” he said at a March rally in Georgia. Trump went on to talk about contemporary actors, Michael Jackson, and border policies before returning to the theme of how Biden looks on the beach.

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This shifting from topic to topic, with few connections — a pattern of speech called tangentiality — is one of several disjointed and occasionally incoherent verbal habits that seem to have increased in Trump’s speech in recent years, according to interviews with experts in memory, psychology, and linguistics.

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About the Author Reprints

Olivia goldhill.

Investigative Reporter

Olivia Goldhill works to hold corporations and public bodies to account, with a particular interest in reproductive health, mental health, and psychedelics.

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Speech on Importance Of Mental Health

Mental health matters just as much as physical health. It impacts your thoughts, feelings, and overall enjoyment of life. Your mental wellbeing shapes how you handle stress, relate to others, and make choices.

1-minute Speech on Importance Of Mental Health

Ladies and Gentlemen,

Today, we talk about a topic close to everyone – Mental Health. Just like we look after our bodies, we need to care for our minds as well. Mental health is not just about being happy all the time. It’s about feeling good about who you are, having balance in your life, and managing life’s highs and lows.

Think about this, you can’t run with a broken leg, can you? Similarly, you can’t live your best life if your mind is not at its best. Your ideas, thoughts, and feelings come from your mind. If your mind is not healthy, it’s like trying to draw with a broken pencil. It’s just harder.

Ensuring good mental health can make life better. It can boost confidence, improve relationships, and help us achieve our goals. So, let’s promise to take care of our mental health, just like we do for our physical health. Because a healthy mind is a key to a healthy and happy life.

2-minute Speech on Importance Of Mental Health

Mental health is just as important as physical health. You may ask, “Why is that?” Well, let’s break it down. When you have a cold, you feel tired and weak, right? You might even need to stay in bed. Mental health is similar. When your mental health is not good, you might feel sad, worried, or scared all the time. It can make it hard to do everyday things, like go to school or work.

Let’s imagine our mind like a garden. If you water the plants every day, give them sunlight, and remove the weeds, they will grow well. But, what if you forget to water them, or if they don’t get enough sun? The plants won’t grow well. They may even die. Our minds are like those plants. We need to take care of them every day.

Sometimes, people think that if they can’t see a problem, it’s not there. But that’s not true. Just like you can’t see the wind, but you can feel it, mental health problems are real even if you can’t see them. They can hurt a lot and make life difficult.

Taking care of your mental health is not hard. You can talk to your friends and family about your feelings. You can do things you enjoy, like playing sports or reading books. You can also ask for help if you need it. There’s no shame in asking for help. It’s just like asking for a band-aid when you fall and hurt your knee.

In conclusion, mental health is very important. It helps us to be happy, healthy, and strong. It helps us to learn, to work, and to make friends. It’s something we should all care about, no matter how young or old we are. It’s not something to be scared of or ashamed about. It’s just another part of being human. So, let’s all promise to take care of our mental health, just like we take care of our physical health.

We also have speeches on more interesting topics that you may want to explore.

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