The Social and Economic Costs of Communication

Communication is embedded in nearly every aspect of daily life. Education, employment, healthcare access, and social participation all rely on and are supported by communication. Yet, the social and economic consequences of communication difficulties remain under-recognized and inconsistently addressed in policy and practice (World Health Organization, 2021). This is due, in part, to communication often being conceptualized as a “soft skill,” rather than recognized as a foundational factor influencing participation, accessibility, opportunity, and overall quality of life. This contributes to disparities between those who can meet modern communication demands and those who are disadvantaged by communication barriers (Flores & Rosa, 2015).

“ … understanding communication as both a health and economic issue becomes increasingly important. Early identification, accessible support, and communication-inclusive environments may not only improve individual outcomes, but also reduce long-term societal costs.” (Vermeir et al., 2015)

This article will outline the impact of poor communication across multiple social and economic domains, including reduced employability, increased isolation, medical misinterpretations, workplace inefficiencies, and increased mental health-related costs, among others.

Limited communication skills in interviews and workplace settings, can lead to barriers, rapport breakdowns and missed opportunities.

Expressive Communication Breakdowns

Expressive difficulties occur when an individual cannot clearly or efficiently convey ideas, needs, or expertise. What this may look like: 

• You ask for a promotion but use overly indirect, verbose, or rapid speech → your message is perceived as unclear or lacking confidence, reducing likelihood of advancement
• You want to sell a service but provide unfocused or disorganized explanations → key value propositions are lost, and clients choose alternatives
• You present an idea or speak in meetings but struggle to retrieve language in the moment → you appear uncertain despite understanding the content
• You repeat or fail to directly answer interview questions → responses are perceived as weak or unfocused, reducing selection likelihood
• You write proposals using overly complex or insufficiently structured language → ideas are not clearly understood, reducing approval or uptake

Receptive / Listening Breakdowns

Receptive difficulties occur when information is not accurately processed, retained, or interpreted. What this may look like: 

• You struggle to sustain attention during instructions or meetings → expectations are misunderstood or forgotten
• You misinterpret unclear, fast, or poorly delivered instructions → tasks are completed incorrectly or require repetition
• You respond without fully processing patient or colleague questions → communication becomes inefficient and may require clarification cycles

Interpersonal / Rapport Effects

Communication breakdowns also affect perceived credibility, trust, and relational dynamics in professional environments. What this may look like: 

• Limited clarity or word-finding difficulty in meetings or presentations → reduced perceived confidence and leadership presence
• Closed or minimal responsive communication with clients or patients → reduced trust, satisfaction, and sense of being heard
• Indirect or vague responses in interviews or workplace discussions → weakened rapport and reduced perceived competence
• Repetitive or unfocused responses under pressure → reduced professional credibility and engagement from others

Physical / Vocal Strain

Communication demands can also result in physical and vocal consequences when efficiency and clarity are reduced.

• Poor vocal hygiene (e.g., low hydration, excessive voice use, limited breath support) → increased vocal fatigue, hoarseness, or voice loss
• Reduced breath support or projection → increased effort required for communication, contributing to fatigue and reduced clarity over time
• Frequent repetition due to unclear output or listener misunderstanding → increased vocal load and occupational strain

Communication skills play a critical role in workplace success and efficiency. Communication can influence professionalism, clarity, gravitas, leadership and collaboration. A lack of effective communication skills may lead to reduced performance, misunderstandings, delayed production, missed career opportunities, strained professional relationships and decreased confidence and trust in the employee and the business overall. 

Effective communication, both expressive and receptive, is essential for navigating healthcare systems. Healthcare settings involve processing complex verbal and written information, describing lived experiences, sharing health history and symptoms, providing informed consent, and completing documentation.

The Joint Commission (2017) reported that up to 60% of hospital adverse events in the United States are associated with poor communication, underscoring communication as a critical component of patient safety.

“When we get communication ‘right’, it leads to better relationships with colleagues and patients. When we get it wrong, it can have negative consequences for both patient care and healthcare workers.” (The Medical Defence Union, 2025)

Limited communication skills in healthcare can lead to:

Provider–Patient Communication

• Misunderstanding diagnoses, instructions, procedures, or medications, reducing adherence
• Delayed diagnosis and treatment
• Reduced ability to advocate for needs or ask clarifying questions
• Heightened anxiety, confusion, or distress
• Missed appointments
• Reduced shared decision-making
• Longer hospital stays and increased system use
• Inequitable access to care
• Reduced satisfaction and trust in providers and systems
• Breakdowns in caregiver understanding
• Reduced patient safety
• Inappropriate assessment or intervention
• Misinterpretation of symptoms and functional needs

(Berkman et al., 2011; Ha & Longnecker, 2010; The Joint Commission, 2017; World Health Organization, 2021)

Patient–System / Administrative Communication

(e.g., insurance, clinics, hospitals, public health messaging)

• Errors in registration, intake, or records
• Difficulty booking appointments due to phone/online barriers
• Insurance claim errors or delays
• Misunderstanding eligibility, coverage, or benefits
• Reduced awareness of community supports
• Ineffective discharge planning and unclear instructions
• Misinterpretation of public health guidance
• Increased risk of preventable readmission

(Agency for Healthcare Research and Quality, n.d.; Berkman et al., 2011; World Health Organization, 2021)

Provider-to-Provider Communication

• Breakdown in care coordination
• Incomplete or inaccurate hand-offs
• Unclear referrals and consult requests
• Delayed decision-making
• Redundant or conflicting interventions
• Misaligned treatment goals
• Reduced continuity of care across settings

(Kripalani et al., 2007; The Joint Commission, 2017)

Communication skills are necessary to support a safe, effective, and equitable healthcare system. Without these skills, there is increased risk to patient safety, reduced access to timely and accurate care, and greater strain on the healthcare system due to increased healthcare use and service demands.

Mental health factors (e.g., anxiety, rumination, reduced cognitive flexibility) can directly impact an individual’s ability to organize, initiate, and maintain effective communication across contexts.

Communication and mental health are bidirectionally linked as mental health challenges can reduce communicative effectiveness, while communication difficulties can reinforce stress, anxiety, and reduced confidence (Ha & Longnecker, 2010; Mosler et al., 2023).

In professional and academic contexts, reduced clarity or excessive focus on perceived errors can contribute to ongoing performance difficulties. In interpersonal conflict, indirect or vague communication may limit problem identification and resolution. In healthcare and accommodation contexts, passive or minimized language may reduce perceived need and limit access to support. In referral systems, insufficient explanation of functional impact may delay or prevent access to services (Ontario Human Rights Commission, n.d.).

Social anxiety or fear of speaking at the wrong time can also reduce participation, gradually contributing to social withdrawal and isolation.

Examples:

• You ruminate on a mistake in a previous presentation and believe you do not deserve your role → you continue to struggle in subsequent presentations
• You raise a workplace concern but do not clearly identify the issue → the behaviour does not change
• You use passive language when requesting accommodations → the request is not supported
• You provide limited explanation in a referral request → access to services is delayed or denied
• You avoid speaking due to timing anxiety → you withdraw from participation in social settings

These patterns highlight how mental health can influence communication in everyday contexts, particularly in self-advocacy and help-seeking.

Prejudice, racism, and assumptions about racial and ethnic groups can shape how communication is interpreted and responded to, affecting equitable access to care and opportunity (Flores & Rosa, 2015).

Persistent systemic gaps exist in access to health information among racial and ethnic minority groups, particularly where digital, linguistic, and culturally appropriate resources are limited (Goulbourne & Yanovitzky, 2021).

Communities with stronger communication infrastructure are better able to access, exchange, and act on health information and advocate within systems (Goulbourne & Yanovitzky, 2021).

Speech, accent, and dialect may be misinterpreted or devalued in clinical, educational, and social contexts, contributing to biased judgments of credibility, competence, and intelligence. These perceptions can influence opportunities, participation, and interaction quality (Flores & Rosa, 2015; Lippi-Green, 2012).

Importantly, the issue is not accent differences, but the role of the listener. The accent itself is not poor communication; it is a biased interpretation that creates inequity.

Communication should not be viewed solely as an individual skill or deficit. Rather, it is foundational to social participation, equity, and access, shaping engagement across healthcare, education, employment, relationships, and digital environments.

As a Speech-Language Pathologist, my role extends beyond traditional speech and language disorders such as lisps, stuttering, or acquired brain injuries. It also includes supporting communication access, participation, confidence, clarity, self-advocacy, and functional communication across real-world environments. No matter the context, communication support can significantly improve an individual’s ability to participate fully and equitably in society.

• Agency for Healthcare Research and Quality. (2025). Health literacy universal precautions toolkit.https://www.ahrq.gov/health-literacy/improve/precautions/index.html
• 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.https://doi.org/10.7326/0003-4819-155-2-201107190-00005
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• Goulbourne, J. D., & Yanovitzky, I. (2021). The role of communication infrastructure in health disparities among racial and ethnic minority populations. Journal of Communication in Healthcare, 14(3), 215–223.
• Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: A review. The Ochsner Journal, 10(1), 38–43.
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• Mosler, F., et al. (2023). Structured communication methods in mental health consultations. BMC Primary Care, 24, 175.
• Ontario Human Rights Commission. (n.d.). Policy on preventing discrimination based on mental health disabilities and addictions.
• The Joint Commission. (2017). Sentinel event data: Root causes by event type.https://www.jointcommission.org
• The Medical Defence Union. (2025). Good communication in healthcare: Why it matters.https://www.themdu.com/guidance-and-advice/guides/good-communication-in-healthcare
• Vermeir, P., et al. (2015). Communication in healthcare: A narrative review. International Journal of Clinical Practice, 69(11), 1257–1267.https://doi.org/10.1111/ijcp.12686
• World Health Organization. (2021). Health literacy development for the prevention and control of noncommunicable diseases.https://www.who.int