Health Communication

Health Communication:
“This is our time”
Cartagena , Spain
7June 2013
Franklin Apfel MD, MHS – Managing Director,
World Health Communication Associates (WHCA)
To have a conversation with you about :
• Why communication is an increasingly important
determinant of health
• Why “this is our time” – how public health can
use “new “ and old communication tools and
platforms to make healthier choices easier
What is health communication?
• A multifaceted and multidisciplinary approach
to reach different audiences and share healthrelated information with the goal of
influencing, engaging, and supporting
individuals, communities, health professionals,
special groups, policymakers and the public to
champion, introduce, adopt, or sustain a
behavior, practice, or policy that will ultimately
improve health outcomes (Schiavo, 2007, p.7)
Conversation- dialogue
Communication is a 2-way reality
Two-way thinking
Traditional information communications & ‘message based’ approach
OUR mission
& crafting
‘our messages’
communicating the
& messages
‘the audience’
Audience centred or insight based approach
1: the audieence
& 2: the
starting with
‘the audience ’
everyday lives hopes
hopes & fears / values &
beliefs behaviours
what really
‘moves & motivates’
The behavioural challenge
Car seats = self evidently safer!
Directly reducing injury & deaths
Child care seats & Hispanic mums
‘My child is safest in my arms’
‘God will decide
when to take my baby’
How to create a valued
product or service?
Priests bless
the car seats
“Its very important
to get drunk.
I’m spending money
and I want to get drunk,
and if I don’t
it’s just a waste of
Quoted in Alcohol Harm Reduction Strategy for England,
Cabinet Office 2004
What causes binge drinking ?
You only have to look at the
price list
(Bar manager)
Supply Side logic
Binge drinkers consider it
their right. It’s a release for
the working class to forget
their lives
(Youth worker)
Socio political logic
is the key
Why (1) is
Health communication is an
determinant of health
Determinants of health
Dahlgren and Whitehead’s Rainbow Model
Dahlgren and Whitehead, 1993
Health literacy is the key
mediating factor and metric
Health literacy friendliness
Social nor
Hazard Marketing
Dahlgren and Whitehead, 1993
Health Literacy
The capacity to obtain, interpret,
understand and use health
information and services to
enhance health.
HLS-EU Definition
Measuring health literacy- the
Country scores
( HLS-EU consortium,2012)
Inadequate and problematic
health literacy – inequities
Health outcomes of “ inadequate
and problematic” health Literacy
Poorer health choices
Riskier behaviours
Less use of preventive services
More delayed diagnoses
Poorer understanding of medical conditions
Less adherence to medical instructions
Poorer self-management skills
Increased risk of hospitalization
Poorer physical and mental health
Increased mortality risk
Higher health costs
Health Literacy for all and by all
• People- risk assessment, disease
prevention, health care seeking, disease
• Providers- social determinants of health,
patient centered care
• Policy Makers- Health in all policies
• Health literacy is a dynamic reality. It occurs
when skills and abilities to get and use
information are aligned with the
complexity/clarity of demands/tasks required
for health.
Many sectors and settings
• Health Systems
• Education
• Media health information marketplaces
• Home Community
• Workplace
• Policy Making Arenas
Why (2) is
“This is our time”
• How can we use our new knowledge, tools
and platforms to reach individuals and mass
audiences and strengthen health literacy and
make healthier choices easier
Are you part of the “we” ?
When you think of a health
communicator- what is your
Many have this image
The “spokesperson”
At the bedside
In the clinic
In the community
Public health is all about
We are all communicators!
In fact 60- 80% of most public health
workers time relates to communication
Provider-patient, emails ,social media, conferences,
report writing, telephoning, intelligence/insight
gathering , publishing ,reading, advocating, talking
to ourselves and others
Making health systems more health
literacy friendly
Adopting “universal precautions”
(re)Design systems
around access
• Provides easy access to health information and
services and navigation assistance
• Redesigns systems and physical space
• Make signage and instructional materails
• Provides “navigator” assistance where needed
Strengthen our
communication skills
• Use health literacy strategies in interpersonal
communication and confirm understanding at all
points of contact
• Confirm understanding (such as using the teach-back,
show-me or chunk-and-check methods)
• Secure language assistance for speakers of languages other
than the dominant language
• Limit to two to three messages at a time
• Use easily understood symbols in way-finding signage
Engage with audience
• Design and distribute print, audiovisual and
social media content that is easy to
understand and act on .
• Involve diverse audiences, including those with
limited health literacy, in development and
rigorous user testing
• Use a quality translation process to produce
materials in languages other than the
dominant language
Use new and old tools to enhance
our impact and reach
Print media
Formative research
Social Marketing
Media Advocacy
Advocacy communication
Social media
Internet based advocacy
Community –based
Framing is key
Framing is “selecting some aspects of a perceived
reality and making them more salient …in such a way
as to promote a particular problem definition, causal
interpretation, moral evaluation and/or treatment
recommendation” (Entman, cited in Chapman 2004, p.362).
Frames create the context within which policy debate
takes place
Learning from the Hazard
Big Tobacco
Reframing Alcohol Ads
Less is better
• Linking alcohol and abuse
Reframe investment
Value not cost
Use new platforms – to enhance
our skills
To empower
To gather intelligence (Citizen
To interact- social media sites
Why social media is critical
To connect
More mobile phones than toilets
• Out of the world’s estimated 7 billion people, 6
billion have access to mobile phones. Far
fewer — only 4.5 billion people — have access
to working toilets. ( and toothbrushes) .
Implications for health
• Unprecedented access to information
• Monologue- dialogue
• Rapid
• Anywhere, anytime
• Patient diagnostic and treatment support
- Identifying patient symptoms correctly
• Healthcare provider training &
communications support
- Expediting the delivery of medical
• Remote patient data collection
- Monitoring effectiveness of treatment
m-Health cont
• Remote patient monitoring
- Increasing patient compliance with prescribed
• Education and awareness
- Empowering patients to make better
informed decisions
• Citizen science
Collecting data, surveys
• Disease and epidemic outbreak tracking
- Providing decision makers with timely, locationrelated information
Example : Digital Health Scorecard
Seven Risk factors
A single number score
To entertain- edutainment
• Educational soaps
To inform- work with journalists as
key health information intermediaries
And much much more …
Just a taste…
•Lets make some healthy “noise”
Thank You
Contact [email protected]

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