THE COST OF DIVERSITY: AN ANAYLSIS OF REPRESENTATION AND COST BARRIERS IN STOCK PHOTO LIBRARIES FOR HEALTH EDUCATION MATERIALS, 2021

Abstract

Ineffective health communication can drive health disparities and limit the effectiveness of interventions to reduce health disparities. Stock photo libraries are a critical tool for developers of patient education and intervention materials. It is not clear how well stock photo libraries represent communities bearing disproportionate burdens of disease. We conducted a search using five popular stock image libraries (Adobe Stock Images, Canva, Getty Images, Microsoft Office Image Library, and Pixabay) in November 2021 to evaluate diversity and representation in health-related stock photos. We searched for five key preventive health topics: healthy eating, exercising, quitting smoking, vaccination, and pregnancy. The images (N=495) were coded for representation of perceived minoritized racial/ethnic identity, skin color using the Massey-Martin Skin Color scale, markers of high socioeconomic status (SES), and access costs. We established inter-rater coding reliability. The representation of perceived minoritized people, darker skin color, and inclusion of markers of high SES varied greatly by the search term and database. After excluding images without people or with ambiguous representation, 51.5% of images across all databases depicted a person of a perceived minoritized racial/ethnic identity. Images in databases with any paywall were significantly more likely to depict a person of perceived minoritized racial/ethnic identity, depict darker skin colors, and significantly less likely to contain markers of high SES identity than images in databases that were free to use. We found it costs more to develop quality health education materials for minoritized populations and that do not represent high SES populations. This may hinder the development of effective communication interventions.