1. Pushing the Boundaries of Health Communication: Trends and Challenges Rafael Obregon, Ph.D. School of Media Arts & Studies Communication & Development Studies Ohio University Roskilde University, Denmark May 4 th, 2010

2. Pushing the Boundaries of Health Communication: Trends and Challenges Rafael Obregon School of Media Arts & Studies Communication & Development Studies We Have Met the Enemy and He Is PowerPoint Ohio University, USA Communication for social change: Lessons learned from public health Roskilde University, Demark May 4 th, 2010 We Have Met the Enemy and He Is PowerPoint “When we understand that slide, we’ll have won the war,” General McChrystal, NY Times, April 27 th, 2010

3. Outline of Presentation A quick tour of international health communication experiences Health Communication and Communication for Social Change A quick tour of international health communication experiences Health Communication and Communication for Social Change Trends and Challenges Trends and Challenges Conclusions Conclusions

4. A quick tour of international health communication experiences

5. Public Debate and Social Mobilization on HIV/AIDS and Children’s Rights in Southern Africa Theory and research-driven process Multimedia / multi-strategy /multi- communication channel platform - contributes to addressing health issues in southern Africa Change at individual, community, social and policy levels Theory and research-driven process Multimedia / multi-strategy /multi- communication channel platform - contributes to addressing health issues in southern Africa Change at individual, community, social and policy levels Promotion of public debate and discussion Changes in social norms Focus on community engagement

6. Community Dialogue and Women’s Rights and Empowerment in the Amazon Constructivism, interculturality and dialogue to address gender-based violence and promote women’s rights Radio magazine Bienvenida Salud, education, and income generation – focus on voice and social determinants; long- term approach Minga Peru

7. Positive deviance and nutritional improvement of children in Asia and Africa Positive deviance (PD) - approach to social and organizational change that enables communities to discover wisdom they already have, and act on it Focus on local/within community solutions and resources

8. Complexifying social mobilization in health communication: learning from polio communication Activist SM - community participation and empowerment - bottom-up approach: communities express demands, define goals, make key decisions Pragmatist SM - means to strengthen health services and achieve goals Activist SM - community participation and empowerment - bottom-up approach: communities express demands, define goals, make key decisions Pragmatist SM - means to strengthen health services and achieve goals Competing understandings of SM Media as social and political institution Interpersonal comm as dialogue and engagement Gender

9. ICTs and access to information in South Africa – Cell Life Mass messaging for prevention; Mass information for positive living; Linking patients and clinics; Peer-peer support and counselling; Building organisational capacity of HIV-related organisations; Monitoring and evaluation.

10. News agendas and children’s rights in Brazil - ANDI Media monitoring Social mobilization Capacity strengthening and editorial analysis Accountability Social control Media, democracy and governance

11. What key concepts emerge from those experiences? Voice Public debate and dialogue Participation and engagement Empowerment and agency Rights and citizenship Social mobilization

12. Health Communication and Public Health

13. The Public Health System Assuring the Conditions for Population Health Employers and Business Academia Governmental Public Health Infrastructure Media/Comm unication Health care delivery system Community Institute of Medicine, Public Health in the 21 st Century, 2003

14. Health Communication Promotion of public health Health care delivery Mediated Communication Interpersonal Communication From: http://www.drrangarajan.com/comm5000_6000/Class1-Notes.pptFrom: http://www.drrangarajan.com/comm5000_6000/Class1-Notes.ppt.

15. Health Promotion Principles - Developing personal skills - Building healthy public policy - Creating supportive environments - Support/promote community action - Re-orientation of services COMMUNICATIONCOMMUNICATION

16. Social determinants of health Over the life span Adapted from Dahlgren and Whitehead, 1991. The dotted lines denote interaction effects between and among the various levels of health determinants (Worthman, 1999).

17. Health communication can… Increase intended audience’s knowledge and awareness of a health issue, problem, or solution; Influence perceptions, beliefs, attitudes that may change social norms; prompt action; demonstrate or illustrate healthy skills; Reinforce knowledge, attitudes, or behavior; Show the benefit of behavior change; Advocate a position on a health issue or policy; Increase demand or support for health services; Refute myths and misconceptions; Strengthen organizational relationships Increase intended audience’s knowledge and awareness of a health issue, problem, or solution; Influence perceptions, beliefs, attitudes that may change social norms; prompt action; demonstrate or illustrate healthy skills; Reinforce knowledge, attitudes, or behavior; Show the benefit of behavior change; Advocate a position on a health issue or policy; Increase demand or support for health services; Refute myths and misconceptions; Strengthen organizational relationships Freimuth, 2004

18. Conceptual trends in communication for social change and health communication

19. C4D Continuum: Approaches/Theories/Models (adapted from Obregon & Mosquera, 2005) Diffusion/ Individual Participatory/ Structural Diffusion/ Persuasion/ Social Marketing Information/ Education/ Communication Behavior Change Communication Social Ecological Approach Communication For Social Change Convergence model No magic formula New conceptual approaches + diversity of frameworks + diversity of strategies + multiplicity of interventions = (Growth of the field)

20. Health Communication Continuum: Approaches/Theories/Models Diffusion/ Individual Participatory/ Structural While the field is largely dominated by two theoretical models, its ability to generate new conceptual approaches to development is the result of a creative convergence of diverse frameworks, strategies and interventions. Diffusion/ Persuasion/ Social Marketing Behavior Change Communication Communication For Social Change Social Ecological Approach Diffusion/ Persuasion/ Social Marketing Information/ Education/ Communication C4D/HC (Adapted from Obregon & Mosquera, 2005 )

21. Communication for social change and health promotion People as objects Agents of own change Delivering messages Supporting dialogue/debate Individual behaviour focusSocial norms/policies/culture and supportive environments Persuading people Negotiating the best way forward Away from technical expertsPeople affected in central role

22. Context & the UNAIDS HIV/AIDS Communication Framework

23. Communication, Culture and Health Communication campaigns with common- denominator messages relevant to most audiences Unified campaigns with systematic variations in messages to increase relevance for different audience segments, retaining one fundamental message Developing distinctly different messages or interventions for each audience segment

24. Communication, Culture and Health Culture as a central element in health communication Two approaches (Dutta, 2009) – Cultural sensitivity – Culture-centered Two levels (Resnicow and Braithwaite, in Freimuth 2004) – Surface structure – Deep structure

25. Audiences and Health Communication Powerful media assumptions in many health communication campaigns Effects of health messages Limited attention to audience reception and negotiation of meanings Analysis of reception of health messages – an audience perspective Media ethnography and reception studies

26. Trends in health communication practice

27. Trends in HC practice – Evaluate communication strategies and tactics and identify under which conditions they function more effectively Maximize resources/impact – Identify strategies for synthesis and integration of multiple data sources Epi data – Polio Socio-demographic data-marketing – audiences/lifestyles Qualitative / ethnographic data /sense-making

28. Trends in HC practice – Integrate communication strategies into broader public health initiatives – Evaluate aspects related to cost, reach, impact, etc. Interdisciplinary teams – Create trust and credibility Prepare audiences – Ethical Considerations

29. Challenges in health communication theory and practice

30. Challenges Incorporating increasing theoretical growth and interdisciplinarity – from public health, communication, and other disciplines Reflecting trends toward theoretical and methodological convergence– strategic and catalyzing; participatory; multimedia; change at different levels

31. Challenges Addressing structural issues that determine people’s health or create vulnerability Responding to increased (donor) pressure on demonstrating impact of interventions Incorporating innovative evaluation methodologies - ethnographic approaches that provide deeper understanding of complexity of public health issues

32. Challenges Positioning itself as a legitimate field through professional and graduate level training (i.e. MPH/SBCC program at Univ of Witwatersrand) Emphasis on competency-based training

33. Final thoughts Growth of health communication as field – different approaches Expansion of health communication thinking and integration into broader development and social change issues

34. Social change starts with public debate Amartya Sen

35. Thank you…time for questions…