Talking Public Health: Language Developing America’s Second Language Lawrence Wallack, Dean, College of Urban & Public Affairs Portland State University 1 st Annual University of New Mexico National Health Disparities Conference Albuquerque, NM May 23, 2011

Thanks to CCPHA for this cartoon

Childhood Obesity Arguments Personal, Individual, Behavioral Social, Environmental, Political Poor ParentingMassively promoted cheap, convenient, junk food Bad Habits & Personal ChoicesNeighborhood connectivity & safety (e.g. recreation, transportation) Overactive Thumbs, Underactive LegsInstitutional policies (e.g. school lunches, phys ed classes) Victims of ExcessLocal, state & federal policy issues (farm, tax, advertising, zoning)

Basic Question For Public Health Will improved population health status come about primarily as a result of: individuals getting more knowledge about personal health behaviors? or groups getting more power to change social and economic conditions?

Some things to consider We are all reasonable people, aren’t we? It seemed like a great story, didn’t it? It’s about getting the right message, isn’t it?

YOYOs WITTs Jared Bernstein All Together Now: Common Sense for a Fair Economy

Frame basics Frames are mental structures that help people understand the world. Frames are shortcuts for people that connect abstract ideas to familiar things (and do so very, very quickly).

BHPJ J G I IFAI TI I

“We've been talking about on how much we agree on different issues, but there really is a difference between us, and it's basically this: We don't think the government should be in control of all of this. We want people to be in control. And that, at the end of the day, is the big difference.” -- Rep. PAUL RYAN (R, WI) February 25, discussion-deficit-bipartisan-meeting-health-care-reform

HEALTH CARE REFORM, as a cue, what does it mean…? To supportersTo opponentsTo others

John Boehner on Health Care Reform (House Minority Leader on PBS NewsHour 11/5/09) “This bill is the greatest threat to freedom that I have seen in the 19 years I have been here in Washington….It’s going to lead to a government takeover of our health care system, with tens of thousands of new bureaucrats right down the street, making these decisions [choose your doctor, buy your own health insurance] for you.”

No Blank slate

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OBESITY, as a cue, what does it mean…? To supportersTo opponentsTo others

Lakoff’s three levels of analysis.Level 1: Big ideas and universal values like fairness, equality, justice, family, community.Level 2: Issue types such as housing, education, civil rights, the environment, public health.Level 3: Specific issues such as beer taxes, toxic waste sites, health care coverage Adapted from The Frameworks Institute

It’s the values “…economic policies are about values. If your policies undermine personal responsibility by separating the link between effort and reward, voters will punish you for it.” David Brooks, “Faustus Makes a Deal,” New York Times, June 22, 2010.

Framing Tension Social JusticeDominant (Market) Values Shared responsibility Self-determination/Self discipline/Rugged individualism Interconnectedness Benefits based solely on effort Strong obligation to collective good Limited obligation to collective good Basic benefits should be assured Voluntary and moral nature of behavior Government involvement necessary Limited government intervention Adapted from Beauchamp, 1976

Reframing Questions What stories are we telling? What cues are we giving? What values are we activating? What actions are we advocating?

Understand the starting point of the discussion is not a blank slate Be clear about the social justice values and how to integrate these values into the story Move from values to policy/ program; don’t start at policy/program assuming values Think in terms of larger social narratives that guide public policy making