Advocating for our field: Compelling Argument and Data?

In developing the longer, initial form of this possible advocacy document I wnated to start with something that grabbed attention, addressed a response with which we are all too familiar, and was up-front in claiming our space; with the added element of a teaser that this would be different. How do you react to below? Will this approach (edited and sharper eventually) achieve that purpose?  Is a different approach needed?

Draft titles – all votes and suggestions most welcome

ALL MASHED UP!

SPEAKING UP?

SPEAKING OUT?

A HEALTHY CONVERSATION

MOVING COMMUNICATION

HEALTHY COMMUNICATION MOVEMENTS

MOVING HEALTH COMMUNICATION

SOCIAL HEALTH COMMUNICATION

RAISED VOICES

The required communication strategic elements for effective health and development, derived from demonstrated long-term health and development progress.  

CAN TALK, THEREFORE …

There is a common impression in local, national and international Development that because people can talk, write, phone, type and “chat” … therefore everyone is a communicator. That is, of course, not the case. Communication to achieve Development goals requires very sophisticated skills and knowledge. Because we can all handle a knife does not mean that we are all surgeons. And, closer to our Development home, because we can all count does not mean that we are all epidemiologists.  

Sophisticated communication strategies have played a major role in the progress achieved across a range of local, national and global development issues, including health. Effective communication initiatives have been at the heart of some of the most substantial progress on health issues including family size, tobacco, Ebola, polio, HIV/AIDS and child health. Blame can be apportioned to either the absence of relevant and effective communication and/or poor communication choices for those stubborn issues on which it is proving difficult to “move the needle”.

How do we justify these statements? What have we learned about the required local, national and international policies and funding priorities for more effective development action? From these experiences, what core communication principles appear as essential for health policies from local wards and districts, through governments, to major international organizations? 

The answers follow the analysis below. But as a forewarning, hopefully not a “spoiler”, the answers are not the normally understood and referred to communication strategies and actions. Messages, media channels, behavior change and supportive environments, for example, do not feature. There are different big communication dogs at play.

DRIVING FORCES FOR MAJOR HEALTH CHANGES

When we assess the major reasons why significant health improvements have taken place it is tempting to exclusively focus on health products with proven physical science attributes – condoms, vaccines, oral rehydration salts, clean water systems, food supplements, and many more.

But many of those “services” or “products” would not have been possible without a high degree of entanglement with a series of social changes. This is not supportive environment where the change is designed to simply support the availability and use of a product.

It is enmeshment, entwinement, entanglement of the health issue or problem with a series of social changes taking place that are equally as important for health progress as the physical products being developed and promoted.

Those social changes, some “natural”, others the result of initiatives designed to encourage and support that change, often a mix of the two, provide us with the strategic insights required for future, effective health communication policies, strategies, action and funding priorities.

Lets take a look at this dynamic specific to a few major health issues on which significant, positive change has been experienced over the past 20plus years.  

Please do comment on above. Further bite-size chunks of this text to follow. If you wish to see the full text now please let me know. Thanks - Warren 

Explanation:

For many years our field of work under various names has made the case that "we have the impact data". Johns Hopkins has 25 years of extensive research. BBC Media Action now has a squadron of researchers and papers. Soul City has done multiple high quality evaluations. The Journal of Health Communication has multiple papers. The USAID led Evidence Summit on Social and Behavioural Change related to Child Health and Development reviewed and selected a lot of impact data. And much more.

But still we get asked "where is the impact data?". My analysis of why we all still face this question is that we need a narrative, a set of stories, that seek to resonate with policy makers, funders and other Development practitioners, into which this data fits. That we need to tell broader sweep stories that are easily comprehensible to people who are not communication and media for development insiders. Stories that show our central role in some of the biggest (in this case) Health and Development progress and impact stories.

Hence what follows. First, a brief introduction that respositions us from "support" to part of the core, "entangled", and then a series of stories. The initial one is below. 6  others to follow.

Questions: (1) Is this a good way forward? (2) Does the repositioing make sense? (3) Are these stories compelling and persuasive?   

continuing the DRAFT text

DRIVING FORCES FOR MAJOR HEALTH CHANGES

When we assess the major reasons why significant health improvements have taken place it is tempting to exclusively focus on health products with proven physical science attributes – condoms, vaccines, oral rehydration salts, clean water systems, food supplements, and many more.

But many of those “services” or “products” would not have been possible without a high degree of entanglement with a series of social changes. This is not supportive environment where the change is designed to simply support the availability and use of a product.

It is enmeshment, entwinement, entanglement of the health issue or problem with a series of social changes taking place that are equally as important for health progress as the physical products being developed and promoted.

Those social changes, some “natural”, others the result of initiatives designed to encourage and support that change, often a mix of the two, provide us with the strategic insights required for future, effective health communication policies, strategies, action and funding priorities.

Lets take a look at this dynamic specific to a few major health issues on which significant, positive change has been experienced over the past 20plus years.   

FAMILY SIZE – FERTILITY TRENDS

Family size is falling in most countries of the world. See for example the right column of the Word Bank table for country trends and play with the decade data comparisons. There has been a very rapid decline in live births per 100,000 and fertility rates since the 1970s as highlighted in this chart - Birth rates (live births per 1,000 people per year) over the long run – Max Roser.

The International Conference on Population and Development (ICPD) in Cairo in 1990 identified why this trend was happening. It learned from the 1970s and 1980s and distilled the pathway for future progress. Though it is tempting, and normal, to credit vastly improved use of contraceptives as the core reason for family size decrease, some of those contraceptive products and services had been available for a long time with little impact prior to the 1970s. Others were of course new.

The ICPD identified that a key element for further progress on fertility rate and births per 100,000 was going to be (and turned out to be) the “recognition that reproductive health and rights, as well as women's empowerment and gender equality, are cornerstones of population and development programmes.” (UNFPA).

Rights, empowerment, equality and gender. There is no vaccine for these. Only communication strategies can move, and have moved, those issues in a positive direction. 

Campaigns for the rights of women, initiatives that stressed male responsibility and involvement, the opening up of conversations across media and in other public spaces on often sensitive sexuality issues, support for conversations within households, the priority focus on girls going to and staying in school, and creating the positive social space for displaying and purchasing contraceptives, are just some of the communication processes that proved vitally important in helping to bring down fertility rate and births per 100,000 in so many countries. These processes were not simply oriented to support contraceptive use. Nor were they just a basic supporting environment for condom and birth control use. These social processes are enmeshed with, entangled with, intertwined with, those products. One cannot happen without the other.

To: The CI Partners - this is the 2nd example of a compelling health story that illuminates the impact of communication and media for development stories on major health issues. Please see this full thread for the full argument and the initial example (Fertility and Family Size) as well as the overall perspective taken for this argument. Question: Is this a compelling argument?. More to come soon. Please note that if you are reviewing the overall thread (click complete posting below) you should start at the bottom and work your way up - most recent are at the top.  

TOBACCO 

There has been a major social norm change related to tobacco and smoking in so many countries. Challenges remain of course. But over a 20year period, in many countries, smoking has gone from being the ultra-cool thing to do … to smokers being the new pariahs. As a result there has been a significant increase in the % of the global population over 15 years who are not “smokers”[1].  Progress has of course been uneven: spectacular in some countries; regressive in others. 

This change has been in the face of a product that is highly addictive with gazillions of dollars being spent by some of the largest and wealthiest companies in the world on their own highly expert, global scale, sophisticated, message driven communication campaigns to encourage and support people to start and continue a pack-a-day habit. For the first 25 (approximate) years after the initial United States Surgeon General’s report linking tobacco use to negative health results, including high incidences of lung cancer, much was tried but not much worked. From the patch to hypnosis, quit smoking campaigns based on individual responsibility to scare messages on the packaging, making progress was a real struggle. And then something happened. 

A smoke-free social movement rapidly emerged. Tobacco became an issue for public debate in families, communities, local municipalities/councils, governments and gatherings of all stripes, colours and locales. Emerging from these conversations, by-laws, rules, regulations and customs were introduced; national and local governments banned smoking in their buildings; corporations banned smoking in places of work; taxes were raised to ensure a price barrier to purchase; sponsorship bans and restrictions quickly followed; parents paid much higher attention to discussing tobacco with their children and preventing them being around smokers; media campaigns highlighted what happens if you smoke; tobacco became a big news story; and people in their communities and countries started to organize - they raised their voices. 

This was a social movement communication process. It was not narrowly focused on message delivery seeking to influence people to make individual behaviour changes. That would have been a losing proposition given the overwhelming power of tobacco messaging.

Like all social movements, stimulus points are vital. For tobacco this included the data on the negative health effects of second hand (or environmental) smoke, first in a secret Tobacco industry study in 1978 and later confirmed in a series of studies. Now, tobacco was everyone’s health business. 

Despite being vastly (really vastly!) out-muscled and out-spent, and facing an addictive “agent”, the anti-tobacco forces have scored some considerable victories with their social communication processes. Momentum remains on their side.