Improving public health messaging

I wrote this post for Croakey and Reporting on Health a little while ago. The ideas are relevant to a lot of health-related communication.

If you follow health reporting on TV or in newspapers you could be forgiven for thinking that the only things that happen are scandals in clinical services or trials of new drugs.

But journalists and PR people aren’t necessarily all to blame. As health professionals we often do a pretty bad job at explaining what we’re doing.

I’ve been thinking about how we can do a better job of explaining the slightly more complex interventions that are required for a lot of the population health problems we face. New drugs and clinical stuff-ups fit into well understood tropes. We don’t have to explain everything, the audience can take shortcuts because they understand what type of story it is.

When it comes to population health issues it’s often not as easy because the issues are interdependent, and many of the interventions are unfamiliar to a mainstream audience.

A lot of my work is on health impact assessment, which involves developing evidence-informed recommendations to inform decision-making and implementation.

When it’s explained like that, it’s no wonder journalists aren’t interested. It sounds like a technocratic snooze-fest.

Instead, let’s think about the demand for new housing in most Australian cities and the pressures to release new land on the fringe. Also think about how disastrous the design of some new suburbs has been for population health in the past by promoting car dependence, limiting walkability and increasing social isolation. The design of our suburbs matters.

Health impact assessment has been a practical way to get people to think about the health consequences of the way suburbs are designed and here’s a few examples…

Contrast that story with the bland description of health impact assessment in the earlier paragraph. It sounds a lot more engaging.

We often fail to describe this broader story in population health, not just when pitching stories but also when we communicate with other sectors (or even within the health sector).

Here are four ways I think we could get better at messaging.

1. Don’t explain the solution, explain the problem

Or better yet, explain the causes of the problem. This piece from the Atlantic Cities is a good example. It describes the phenomenon of “ghost estates” in Ireland, which came about when 2,800 housing developments were abandoned as a result of the GFC. A community group has started planting trees on these sites to reintroduce some aspects of nature into these abandoned building sites. The piece works because rather than leaping into a description of the NAMA to Nature group, it first describes the problem as well as its causes. Too often we forget the broader context when describing what we’re doing in population health.

 2. Don’t rely on the usual suspects

There’s evidence that people are more willing to listen to arguments when they come from unexpected sources, at argued in this Ramp Up post. A good example recently is the conservative economist Judith Sloane’s calls for an increase in the NewStart allowance. She could hardly be described as a usual suspect when discussing the rights of the unemployed. Different people paid attention to her comments as a result.

3. Avoid jargon and language that alienates people

The importance of this is emphasised in the Robert Wood Johnson Foundation report A New Way to Talk About the Social Determinants of Health. People switch off when things are described in stereotypical or politicised terms. As health professionals we often tend to fixate on the solutions and the jargon that surround them, partly because it’s what occupies most of our time but also because we are already convinced about the importance of the problem.

4. Describe the human impact

This is often the hardest part for population health stories. Individual stories can illustrate broader population issues but they can also be misleading and seem glib. We often understandably resist this because we have an obligation to respect the dignity and privacy of the people we work with and we can’t control how their experiences will be reported. Without the human dimension though it’s difficult for not only journalists but also the audience to connect with the story. Human-scale narratives still matter, even with the most abstract ideas.

A good example of a media piece that embraces history, messiness, complexity and a population approach is Melissa Sweet’s description of Miller for Inside Story. It’s a story about the problems faced by a suburb in South West Sydney.

It’s an almost impossible story to convey in usual journalistic form because it has a lot of history and people involved and doesn’t have a neat narrative arc or resolution. Despite this, the piece manages to convey a lot of the complexity to the reader and provides a number of insights. The point is that it is still possible to tell even the most complicated stories in engaging ways.

We’re confronting big social and population health challenges but we have some ideas about the solutions. We just need to make sure we don’t bury the lede.

Health Impact Assessment: The state of the art


Several International Association for Impact Assessment Health Section members and I have written a paper in the latest issue of Impact Assessment and Project Appraisal on Health Impact Assessment: The state of the art. It’s part of a special issue on the state of the art in impact assessment that was edited by Alan Bond and Jenny Pope. Most of the papers are excellent reading for anyone interested in impact assessment.

Harris-Roxas B, Viliani F, Bond A, Cave B, Divall M, Furu P, Harris P, Soeberg M, Wernham A, Winkler M.  Health Impact Assessment: The state of the art, Impact Assessment and Project Appraisal, eFirst.

The paper is available for free to IAIA members, just log into the IAIA website and follow the IAPA link. If you have difficulty accessing the paper please contact me.

A curator is not a digital dilettante

There’s been a lot of discussion about online curation recently in the wake of the Curator’s Code and the video below from Percolate. Most of it hasn’t sat well with me. I’m a compulsive consumer and sharer of online media. I think people mostly follow me for the links I share. I probably fit more into the “online curator” category than any other. Why, then, do I consider so much of the discussion about online curation to be self-indulgent silliness?

Marco Arment, the developer of Instapaper, posted a salient critique of the Curator’s Code. Most of the critiques to date have focused on the silliness of promoting squiggly lines for attribution but the fundamental problem runs much deeper. It’s the nonsense notion that finding and sharing information on the “whimsical rabbit hole of discovery” (urgh) is a creative act that warrants attribution.

Marco’s right about this fundamental point. My personal critique of the online curation movement is based on two central concerns and thinking about this has also prompted me to think about whether things should or could be done differently.

My first concern is that being obsessed with “ideas” and “interesting things” encourages superficial engagement with topics. It encourages us to focus on stuff that’s fun, exciting, and almost immediately gone from our minds. Very rarely does it challenge us or encourage deeper engagement with topics. As any actual expert will tell you, the more you know about a subject, the more you realise how nuanced, conditional and dependent on other factors much knowledge is. We also collectively face an increasingly complex set of wicked problems. Exposing people to often overly simplistic and superficial descriptions of topics is not curation; it’s entertainment. That’s a legitimate activity but don’t pretend it’s something that it’s not.

My second concern is that curation is more than just presenting a grab-bag of links based on your personal taste or what you think will attract clicks. Curating tells a story. It involves bringing together several works in a way that may lead to greater appreciation, understanding and insight. Instead of worrying about via or ht (hat-tip) attribution for links we should be worrying about the story that’s told by the links we share, as a gestalt. What do they say about us and what we care about? What do they give to the people who take the trouble to read or watch what we link to?

So what is the story we should be telling through online curation? (though that term still doesn’t sit well with me) I’m not sure. Thinking about this prompted me to consider what broader messages I’ve been trying to convey through the links I share. I think I’ve been trying to say three things:

  • Many issues are related and interconnected;
  • We face huge problems that we have a responsibility to tackle; and
  • The best thing about humans is our capacity to have fun!
  • I’m fairly sure I haven’t succeeded in conveying these ideas to my audience, which I wouldn’t like to pretend is overly large. Even thinking about it has helped me though, because it’s also forced me to consider what I’m not trying to suggest when I link to stuff online.

    Attribution, via squiggly unicode characters or otherwise, should be the least of our concerns. Such egoistic behaviour is beneath us.

    Referring to this sort of activity as curation also dishonours the hard work of actual curators going back centuries. When was the last time you went into a museum and found a pile of unrelated stuff that someone thought was “interesting”? That’s not a curated collection, it’s a garage sale.

    Be honest about what you’re doing – sharing links and having some fun.

    New US Guidance on Health Impact Assessment

    The US National Research Council has released a guidance report on HIA. It “calls for increased education and training, more emphasis on stakeholder involvement and reducing health disparities, and collaboration at all levels of government to support the incorporation of health considerations into decision-making”.

    The project to develop the guidance was funded by the Robert Wood Johnson Foundation (RWJF), the National Institute of Environmental Health Sciences, the California Endowment, and the Centers for Disease Control and Prevention. Well worth a look.

    More at the HIA Blog.

    Book Chapter: Using HIA to address the social determinants of health

    Along with colleagues from the UNSW Research Centre for Primary Health Care and Equity and Sydney South West Area Health Population Health we have published a chapter on HIA for a book on the social determinants of health in Australia. The details of the chatper are:

    Harris-Roxas B, Maxwell M, Thornell M, Peters S, Harris P. From Description to Action: Using health impact assessment to address the social determinants of health, in Laverty M, Callaghan L (eds) Determining the Future: A Fair Go & Health for All, Connor Court Publishing: Melbourne, p 119-130, 2011. ISBN 9 7819 2142 1952

    Download Chapter

    Purchase Book