Great disparities in health care exist within local communities and around the world, but change will require rethinking some health communication approaches, the keynote speaker at a graduate communication conference at the University of Oklahoma said Saturday.

Dr. Mohan Dutta from Purdue University spoke about "Communicating Health to Address Global Inequalities" at the Sooner Communication Conference, an annual event organized by OU communication graduate students. This year, the theme was health communication.

Dutta drew on his quantitative and objective research both in the U.S. and throughout the world to make the case for a culture-centered agenda for communicating health.

There are differences in health knowledge, health care availability and health services use within local communities, inside individual countries and around the world, he said.

Many professionals and academics have focused time and money to try to make these disparities more just, but Dutta said some of those attempts have been misguided.

"We are really doing a cosmetic job of addressing inequalities," Dutta said.

Oftentimes, disparities in health care are viewed as a cultural problem, he said. Efforts to reach the marginalized focus on educating them about better health practices, with the hope that the culture will be changed and thus the disparity will disappear, Dutta said. But this view fails to take into consideration that communities are often marginalized as a result of a problem within the system's structure, he said.

Dutta gave the example of a study he conducted within the homeless community in Indiana. People often assume homeless people don't use health care because they don't know about it.

But Dutta said in his study he found the reason the homeless community did not take advantage of the health care available to them was because of bad experiences the first time they tried to use it. They were treated poorly by health care practitioners and had to fill out confusing forms.

When one realizes that disparities are not only cultural but also structural, however, the path to the solution to those inequalities changes.

"Ultimately, success in the culture-centered approach lies in being able to change policy," Dutta said.

Outsiders who want to bring equality need to listen to the people within the community, he said. They will know what is the most pressing need, he said. Once those within the community recognize where they are being marginalized, it is important to let them take control of organizing for change, Dutta said.

He gave an example of sex workers in Calcutta, India, with whom he worked. The sex workers took the leadership in the campaign to prevent HIV/AIDS. Among the sex workers, condoms were used only about 3 percent of the time because the workers were so desperate for money they couldn't negotiate with those who solicited them. If they didn't agree to unprotected sex, customers would go somewhere else.

To solve this problem, the sex workers created a lending mechanism to eliminate the urgent financial need of the workers. Then they collectively decided not to negotiate with customers who did not want protection. As a result of the community's efforts, condom usage rose to 96 percent, Dutta said.

Dutta said this example has become the poster child for participatory campaigns, "the idea being to create participatory strategies for listening to cultural voices."