Behind the Scenes: DEI in Health Education Illustrations

Tamara Shores, Creative Director

Effective health education must meet patients’ needs—otherwise, what’s the point? One way to make sure health education works for patients is by making it easy to understand. For example, the federal government recommends writing health information in plain language. And the CDC has recommendations for using inclusive, culturally sensitive language. But how do you apply this advice to other elements of health education—like illustrations—to ensure they best serve patients?

Of course, just like text, illustrations need to be accurate. But beyond that, illustrations can help increase the presence of diversity, equity, and inclusion (DEI) in health education. Clarity and inclusivity become particularly important as Healthwise shifts some of our education from text-heavy to more highly visual formats. To address DEI in our illustrations, we engage a team of reviewers on the Healthwise content team and from across the company who help ensure our education is focused on the end user. Their perspectives come together not only to make our education medically accurate but to make sure it’s thoughtful, intentional, and meets DEI standards too.

Read on to see the time, effort, and thought that went into updating just one image we use to help patients learn about healthy portions in their diets.

The Art of an Inclusive Illustration

Food is a sensitive subject. As we develop content and images, we take into account a person’s relationship with food and their body, dietary considerations, health conditions, and, last but not least, culture. When we’re working with food images, we also try to teach without being triggering. For example, we don’t want to put an image of a big, juicy burger in our content and then say, “Don’t eat this.”

This is the image we’ve been using to teach healthy portions. It was time to overhaul the image for accuracy (changing “meat” to “proteins”) and to make the image more helpful and inclusive.

An older version of a Healthwise health education illustration showing a plate with healthy portion sizes


Version 1

We decided to use our icon style to present the information, which gives us visual consistency. And it prints well in black and white for clients who work in a variety of care settings.

The first version of an updated Healthwise health education illustration showing portions for protein, carbohydrates and non-starchy vegetables


Each week the Healthwise Multimedia Studio staff meet to share images and videos we’re working on to get feedback. When I shared the illustration above at that critique meeting, our medical animator pointed out that this way of showing food makes the amount of food look really spare and sad. She suggested I move the food outside of the plate.

Version 2

Right away I realized what a great suggestion this was. Not only did it solve the problem of looking like a near-empty plate, but it also gave me more room so I could include more suggestions of foods.

And I also realized version 1 was mostly examples of culturally Western foods.

By adding vegetarian options, rice, a tortilla (watch how it changes in a later version), eggplant, and mushrooms, we’re hoping more people will see familiar food options and how those foods fit into their eating goals.

The second version of an updated Healthwise health education illustration showing portion sizes updated to include more diverse foods


More feedback

Reaching out to people outside the workflow can help make sure we’re on the right track, so I shared the image with one of our health education strategists who used to be a diabetes nurse educator and is deeply familiar with the kind of materials that are given to patients who are newly diagnosed with diabetes. I was very pleased with her response:

Wow. What strikes me is this is the first time that the “plate” doesn’t have actual food on it. I’ve seen versions of this plate with portions so small that I think, “Who would agree to eat that way?” This takes the portions out of it, which is what the “plate” is supposed to be helping to control.

Final review

The image was ready for our review process. During the accessibility review, our associate editor noticed a significant and unintended cultural symbol in the image:

A conversation between a Healthwise illustrator and editor notes that the illustration of the bowl of rice needs updated to reflect cultural nuances


Final image

With a few more refinements, including changing the tortilla to a taco for visual clarity, adding dairy products, and changing the angle of the chopsticks, we arrived at this image:

The final updated illustration showing a more inclusive view of healthy portion sizes of various foods from many cultures and diet preferences


Collaboration and refinement

We have found that the refinement process helps us achieve our goal to create inclusive content. We captured the collaborative ideas in the “Culture and lifestyle” section of the Healthwise Style Guide.

As we collaborate, we each bring different insights, expertise, and experience to our work. Healthwise has built a culture of interacting humbly. We try to be both open to feedback as well as mindful of the implications to others’ work when giving feedback. And the role of feedback highlights the necessity of having a diverse workforce, to bring even more perspectives and experiences to our work.

To learn more about Healthwise health education and how it can serve your patients, contact us.