The Emergency Helix: A Framework for Strengthening Public Health Emergency Response with Social and Behavior Change Communication (SBCC)

"In the same way that the structure of DNA ensures stability over long periods of time yet allows for adaptation to the changing environment, The Emergency Helix describes a communication backbone that strengthens community stability, health system adaptability and the evolution toward resilience."

To catalyse a dialogue on the power of social and behaviour change communication (SBCC) in emergencies, the Health Communication Capacity Collaborative (HC3) developed this framework based on HC3's work on Ebola and Zika. The SBCC approach to emergencies focuses on building coordination and resilience in the health system and the community. SBCC builds on an understanding of social determinants that affect people's behaviours and shapes these behaviours into collectively protective actions. It is human-centred, and addresses not only the intellectual needs of individuals and communities for factual information, but also the deeply emotional drivers associated with behaviour. The idea is that, when SBCC is integrated into emergency preparedness and response, it bridges health systems with the communities they serve and can change the course of an emergency. Institutionalisation of SBCC into emergency planning can help to create the conditions under which future emergencies avoid unfolding into long-term development losses by building resilience in health systems and communities.

In the helix, the 7 strategic actions of emergency SBCC are supported by 4 underlying principles, and emphasise the "unending" cycle of emergency preparedness, response, recovery, and resilience - with communities at the centre of it all. In the backdrop of the visual, a representation of a disaster curve is set against the phases of a public health emergency (bottom) and the SBCC actions that must be taken in each phase (top). The key concept, however, is the interplay between health systems and the communities. When SBCC is incorporated into the emergency response, the efforts between them are linked and form a dynamic relationship.

In brief, the 7 actions are:

1. PREPARE: Strengthen a Communication Foundation - "SBCC can be leveraged before an emergency to prepare for and mitigate a potential threat. In some cases, public health emergencies may be anticipated in the near future, such as in the case of disease outbreaks in neighboring countries. SBCC capacity varies by context, but strengthening this capacity before a crisis can help ensure a robust foundation for a rapid and effective SBCC response when an emergency strikes."
2. INQUIRE: Ground the Response in Current Realities - "When a public health emergency is confirmed, anxiety, panic and rumors are likely to spread among affected communities and, if not addressed properly, can lead to denial or the adoption of unhealthy practices. SBCC can support initial risk communication efforts through rapid research to understand the knowledge, attitudes and behaviors that may fuel the emergency."
3. MOBILIZE: Activate the Communication Response and Feedback Loops - "When a public health emergency is ramping up, SBCC can ensure that communities, health systems and emergency responders are working together for a stronger, more effective response that promotes trust and mutual cooperation."
4. SUSTAIN: Ensure Ongoing Attention to Emergency and Other Health Issues - "Description: After an initial outbreak, the crisis is still in full force but communities and health systems' efforts may begin to wane as an emergency becomes the 'new normal' and donors, emergency response actors and health systems begin to face burnout. At the same time, non-emergency health issues neglected during the initial outbreak may surge."
5. ADAPT: Collect and Respond to Feedback - "When a public health emergency begins to slow or stabilize, feedback from stakeholders and communities is essential. SBCC can utilize this feedback to inform evolving communication activities and ensure messages are in line with contextual realities and respond to changing needs."
6. REFLECT: Evaluate the Communication Response - "When the public health emergency is under control and response activities begin to give way to recovery activities, evaluation of SBCC can help identify critical lessons that can feed into further mitigation and preparedness strategies, beginning the cycle of building stronger, more resilient communities and health systems."
7. EVOLVE: Build Resilient Communities and Health Systems - "Once a public health emergency subsides, communities and health systems may face critical new realities as they recover and rebuild. SBCC can play a critical role to strengthen health systems, engage communities and ensure that, together, they are more resilient and able to mitigate the impact of future emergencies."

Throughout each of the stages outlined above, 4 key principles are fundamental to integrating SBCC within an effective emergency response:

1. Community-centred: SBCC for public health emergencies puts communities at the heart of the response.
2. Rapid: SBCC for public health emergencies can accelerate evidence-based implementation.
3. Systematic: SBCC for public health emergencies is strategic, evidence-based, and grounded in theory.
4. Coordinated: SBCC for public health emergencies links stakeholders.

Click here to access the helix in PDF format.