Health Communication, Advocacy and Integrated Strategic Communication. The case of HIV/AIDS Jan Servaes Professor and Chair, Department of Communication Director, Center ‘Communication for Sustainable Social Change (CSSC)’, University of Massachusetts, Amherst, USA Jan Servaes Professor and Chair, Department of Communication Director, Center ‘Communication for Sustainable Social Change (CSSC)’, University of Massachusetts, Amherst, USA

The HIV/AIDS ‘crisis’ Education, awareness, information, advocacy and empowerment are five key tools in turning the tide against HIV/AIDS 2001 Nicaragua Communication for Development Roundtable, UNFPA, 2002 Education, awareness, information, advocacy and empowerment are five key tools in turning the tide against HIV/AIDS 2001 Nicaragua Communication for Development Roundtable, UNFPA, 2002

Existing HIV/AIDS communication strategies have proved inadequate in containing and mitigating the effects of the epidemic “For example, they have often:  Treated people as objects of change rather than the agents of their own change;  Focused exclusively on a few individual behaviors rather than also addressing social norms, policies, culture and supportive environments;  Conveyed information from technical experts rather than sensitively placing accurate information into dialogue and debate;  Tried to persuade people to do something, rather than negotiate the best way forward in a partnership process. Progress in slowing the epidemic will require a multi-sectoral response and use of communication to tackle the behaviors related to the spread of the epidemic and to address its causes (inequality, prejudice, poverty, social and political exclusion, discrimination, particularly against women).” “For example, they have often:  Treated people as objects of change rather than the agents of their own change;  Focused exclusively on a few individual behaviors rather than also addressing social norms, policies, culture and supportive environments;  Conveyed information from technical experts rather than sensitively placing accurate information into dialogue and debate;  Tried to persuade people to do something, rather than negotiate the best way forward in a partnership process. Progress in slowing the epidemic will require a multi-sectoral response and use of communication to tackle the behaviors related to the spread of the epidemic and to address its causes (inequality, prejudice, poverty, social and political exclusion, discrimination, particularly against women).”

An analytical framework The political context – political and economic structures and processes, culture, institutional pressures, incremental vs radical change etc. The evidence – credibility, the degree it challenges received wisdom, research approaches and methodology, simplicity of the message, how it is packaged etc The links between policy and research communities – networks, relationships, power, competing discourses, trust, knowledge etc. External Influences Socio-economic and cultural influences, donor policies, etc

The ‘context’ External Influences political context evidence links Campaigning, Lobbying Politics and Policymaking Media, Advocacy, Networking Research, learning & thinking Scientific information exchange & validation Policy analysis, & research

Five basic communication strategies  Behavior change communication (BCC) (mainly interpersonal communication),  Mass communication (MC) (community media, mass media and ICTs),  Advocacy communication (AC) (interpersonal and/or mass communication),  Participatory communication (PC) (interpersonal communication and community media), and  Communication for structural and sustainable social change (CSSC) (interpersonal communication, participatory communication and mass communication).  Behavior change communication (BCC) (mainly interpersonal communication),  Mass communication (MC) (community media, mass media and ICTs),  Advocacy communication (AC) (interpersonal and/or mass communication),  Participatory communication (PC) (interpersonal communication and community media), and  Communication for structural and sustainable social change (CSSC) (interpersonal communication, participatory communication and mass communication).

Identifying the Right Health Communication Strategy  A distinction between typologies of health problems  A distinction between emergency diseases and development-oriented health problems  A distinction between a broad-based (horizontal) versus a narrow-based (vertical) definition of the health problem  A distinction between typologies of health problems  A distinction between emergency diseases and development-oriented health problems  A distinction between a broad-based (horizontal) versus a narrow-based (vertical) definition of the health problem

Advocacy Advocacy for development is a combination of social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular goal or program. It involves collecting and structuring information into a persuasive case; communicating the case to decision-makers and other potential supporters, including the public, through various interpersonal and media channels; and stimulating actions by social institutions, stakeholders and policy-makers in support of the goal or program (Servaes, 1992: 2).

Advocacy communication Different kinds of problems and situations may call for different solutions. However, there is no universal approach that can be used in all circumstances, flexibility is required in selecting appropriate strategies. Basically, one can distinguish between two fundamentally opposite strategies, which in practice should be viewed as extremes on a continuum: (a) strategies for decision-making (top-down); and (b) strategies for decision- reaching (interactive). Therefore, one could propagate either a combination of policies or strategies, or the creation of a hybrid approach drawing on several theories.

Advocacy Communication Advocacy is most effective when individuals, groups and all sectors of society are involved. Therefore, three main interrelated strategies for action can be identified: (a) Advocacy generating political commitment for supportive policies and heightening public interest and demand for development issues; (b) Social support developing alliances and social support systems that legitimize and encourage development-related actions as a social norm; and (c) Empowerment equipping individuals and groups with the knowledge, values and skills that encourage effective action for development. Advocacy is most effective when individuals, groups and all sectors of society are involved. Therefore, three main interrelated strategies for action can be identified: (a) Advocacy generating political commitment for supportive policies and heightening public interest and demand for development issues; (b) Social support developing alliances and social support systems that legitimize and encourage development-related actions as a social norm; and (c) Empowerment equipping individuals and groups with the knowledge, values and skills that encourage effective action for development.

Decision-making Decision-making builds on a number of 'resources': (a) Expertise/knowledge; (b) Availability/control over information; (c) Political access and sensitivity; (d) Assessed stature and personality; (e) Group support/empowerment; and (f) A favorable socio-cultural and political- economic environment. Decision-making builds on a number of 'resources': (a) Expertise/knowledge; (b) Availability/control over information; (c) Political access and sensitivity; (d) Assessed stature and personality; (e) Group support/empowerment; and (f) A favorable socio-cultural and political- economic environment.

Criteria for success of advocacy messages  Relevance  Timing  Validity  Cultural sensitivity  Orientation of the relevant stakeholders  Planning  Communication  Action orientation  Dissemination of information  Relevance  Timing  Validity  Cultural sensitivity  Orientation of the relevant stakeholders  Planning  Communication  Action orientation  Dissemination of information

Competence indicators  Individual/family  Community  Service system  Social/political environment  Individual/family  Community  Service system  Social/political environment

Health competence  Health competence is not an either/or condition; rather it lies along a continuum from low to high  The more health competent a society and its members are, the more positive health outcomes will be  Health competence is not an either/or condition; rather it lies along a continuum from low to high  The more health competent a society and its members are, the more positive health outcomes will be

In sum: 3 streams of action  Media to build public support and pressure for decision-reaching.  Networking of interest groups and societal forces to reach common understanding.  Public demand and empowerment to evoke a response from leaders and policymakers.  Media to build public support and pressure for decision-reaching.  Networking of interest groups and societal forces to reach common understanding.  Public demand and empowerment to evoke a response from leaders and policymakers.

Thank you Thank you