A widely prevalent but deeply flawed belief is that the poor and vulnerable do not care about their health and well-being. This results in poor health seeking behaviour and increased vulnerability to disease. Contrary to this belief, poor or at risk populations are actually deeply invested in their health. Across the world, they bear the larger burden of disease and continuously look for new ways to improve well-being. Not just that — they also absorb and value health information that is relevant to them. This, however, is contingent on how effectively this information is communicated to them.
Small experiments across the world reveal that the vulnerable populations absorb health information well if it is relevant, localized, integrates well with current cultural and social situations and is entertaining (hardly surprising). Research also reveals that health communication is neither delivered nor received in a vacuum.
The audience, their values, aspirations, lifestyles and environment impact the communication process. The environment i.e. political, social and economic conditions influence reception and interpretation of messages.
What does this mean? That vulnerable populations like any other audience demand effort and understanding. They are discriminating consumers of information and easily bored with long-winded, didactic and boring messages. They demand, like all consumers, that the message connects with them and only then will they connect with the message.
However, policy makers and program planners rarely view engaging the most vulnerable creatively on issues of prevention and health seeking behaviour as a priority. This negligence to health communication is the result of overly medicalised approaches to health where the focus is to treat the patient but not to prevent the disease. The underlying assumption is that the individual is incapable of health seeking behaviour. Thus, the patient is at the receiving end of choices made about their health by a group of doctors.
Disinterest among public health officials about health communication is not the only reason for deprioritised or poor health communication. These activities are supervised not by communication professionals but by doctors who understand and know nothing of health communication. These doctors are often at a loss with no training on the subject. As result, these activities are at best unimaginative, instructive and unengaging with little or no impact.
Moreover, health messaging is viewed as a soft aspect of public health programming. ‘Real’ doctors are reluctant to do health communications.
Public health authorities need to understand that if we expect people to change lifestyle choices, we need to engage them with health messages that are persuasive. Clearly, this is a job for communication professionals not doctors.
In India, two examples of successful health communication that had considerable impact are polio and HIV. In either case, a host of agencies worked together to develop a multi-pronged strategy led by communication professionals. This helped in creating multiple strategies that were used to engage diverse audiences.
Polio messaging for example was built on simple idea — two drops that could save your child’s life. This message was everywhere — from print, TV and radio from the more urban and semi-urban audiences and on roadsides, on the back of buses and lorries and in small village fairs.
HIV was perhaps India’s most complex disease communication exercise. In a society with ingrained double standards, limited women’s rights and a complete lack of conversation on sexuality and sexual diversity talking about HIV may have been impossible. However, HIV program managers within the government understood the importance of prevention and sought help from external agencies creating what was perhaps the most elaborate and effective health communication campaign in recent history.
The HIV campaign used every possible medium and celebrities to transmit messages on prevention, on treatment and on stigma. An important aspect of this campaign was it consciously focused on being entertaining and connecting with the audience. It also consciously avoided being judgmental of lifestyle choices. HIV programming in particular was relevant as it emphasized the notion of choice — an idea that was empowering to an audience used to directive messaging.
Public health authorities across high-burden countries need to reorder their approach to public health communication. For starters, this communication needs to be managed by communication professionals and not doctors. Public health communication must be multi-pronged, regionally suitable and easy too absorb. Finally, public health authorities need to take up public health communications as a priority.
(The author is with the Delhi-based Global Health Strategies)
