Getting the message across [full issue]

~ l ~ W WII'- \I RLD ~ I rJ THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION Theme articles Getting the message across 3 Hiroshi Nakajima A new strategy to empower people in Africa 4 An Internet forum for the management of disasters? 6 Patricio Bittner 8. Claude de Ville de Goyet Using electronic links for monitoring diseases 8 Joan Dzenowogis A library without walls 10 Yvonne Grandbois 8. Barbaro Aronson Health and the media: uneasy partners? 12 Philippe Stroot Helping scientists to improve their communication skills 14 Jitendro Khanna Kick polio out of Africa! 15 Peace through health in Bosnia and Herzegovina 16 Gregory Hess Breaking down the barriers to health information 18 Neil Pokenhom-Wolsh 8. Carol Priestley STOP AIDS 20 Markus Allemonn The influence of Al DS Today radio 22 Jomes Deane Soul City 24 Sue Armstrong Sport sponsorship 26 Addy Carroll Media advocacy for public health 28 Simon Chapmon Features News from the Regions Reaching out by radio 30 Polio will soon be history in the Western Pacific 30 WHO publications 31 World Health • 50th Year, No. 6 November-December 1997 IX ISSN 0043-8502 Correspondence should be addressed to the Editor, World Health Magazine, World Health Organization, CH-1211 Geneva 27, Switzerland, or direcrly to outho~, whose addresses ore given at the end of eoch article. for subscriptions see order form on page 31. HEALTH Photo WHO/H Anenden World Health is the official illustrated magazine of the World Health Organization. It appears six times a yeor in English, French and Spanish, ond four times o year in Arabic and Fo~i. The Arabic edition is available from WHO's Regional Office for the Eastern Mediterranean, P.O. Box 1517, Alexandria 21511, Egypt. The Fo~i edition is obtainable from the Public Health Committee, Iron Univmity Press, 85 Pork Avenue, Teheron 15875-47 48, Islamic Republic of Iron. page 12 © World Health Organization 1997 All rights reserved. Articles and photographs that ore not subject to separate copyright may be reproduced for non-commercial purposes, provided that WHO' s copyright is duly acknowledged. Signed articles do not necessarily reflect WHO's views. The designations employed and the presentation of material published in World Health do not imply the expression of ony opinion whatsoever on the port of the Organization concerning the legol status of any country, territory, city or oreo or of its authorities, or concerning the delimitation of its frontiers or boundaries. World Health • SOth Year, No. 6, November-December 1997 3 Editorial Getting the message across I nformation and communication are at the very heart of the work of WHO. The Organization was established in 1948 with a mandate "to act as the world 's directing and coordinating authority" on questions of human health. For this, good communication is indispensable. As our Constitution points out, "informed opinion and active coop- eration on the part of the public are of the utmost importance in the improvement of health". WHO's natural partners in dia- logue have always been the scientific community and ministries of health. Set up in the wake of a devastating war, the immediate need was to assess the health situation in coun- tries and suggest ways of dealing with the most pressing health prob- lems. Using the conventional tools of epidemiology, the Organization began building what has become, over the years, one of the world's most comprehensive and authorita- tive data banks on health and disease. It did this by establishing links with individuals and institutions in the scientific community to gather and synthesize information from the field and define the many kinds of action required to meet global health needs. The fact that it is people them- selves who must be at the centre of health policy was fully recognized by our Constitution, and it has gained worldwide acceptance over the years. It implies the need to communicate more fully and clearly with the pub- lic. This public today is extremely diverse, making it especially impor- tant to remember that scientific data - no matter how sound - are not a universal currency. To be accessible and meaningful, information must be couched in terms that take into ac- Dr Hiroshi Nakajima, Director-General of WHO Photo WHO/ H. Anenden count the culture and priorities of the target audience. Effective communi- cation starts with listening to others, and this must be the guiding princi- ple behind all our work. In the field of research, for exam- ple, agendas must be set not by scientific curiosity alone, but by public health needs established through widely inclusive dialogue. Furthermore, we should remember that data become information only when they have been validated and organized, and information becomes knowledge only when it has been analysed and interpreted. A great deal of unnecessary confusion results when any of these steps are left out. Regarding epidemiology, I have frequently stressed the need for a new approach: in addition to the routine gathering of data on disease, epidemiologists today should be prepared to analyse trends and pro- vide advice for policy-making. Our most direct communication with the general public is through advocacy, and here we are constantly responding to changing needs. WHO produces a wealth of information materials aimed at different audi- ences, and in 1995 these were aug- mented by the first edition of our annual World Health Report offering an up-to-date picture of the global situation and trends, and highlighting the most urgently needed action. Profound changes are occurring as a result of the revolution in infor- mation technology, which brings new opportunities as well as new pressures and responsibilities. The increasing speed and volume of communication open up entirely new possibilities for health care. They have also helped to make the public more demanding, discerning and assertive while enabling us to engage in more active dialogue with all our partners. With the continuous increase in the dissemination of information, WHO today has a special responsi- bility to ~ake sure its messages are not only scientifically and ethically sound, but as clear as possible. As an intergovernmental authority on health, the Organj.zation's duty is to provide health messages that are both reliable and universally relevant. We depend on our partners at every level of society to make them locally meaningful, and in these pages you will get some insight into the many imaginative ways in which they are fulfilling that task. • Hiroshi Nakajima, M.D., Ph.D. 4 World Health • SOth Year, No. 6, November-December 1997 A new strategy to empower people in Africa The African Region is caught in a downward spiral in which the poor health of the population is undermining economic performance, and the resulting poverty means there is less and less being spent on health care. The health infrastructure in many countries is in a dire state: hospitals, clinics, health centres and dispensaries have become dilapi- dated and often lack the most basic equipment and drugs. Many facilities are also short of staff. New diseases such as HIV I AIDS are emerging, and old ones like malaria, tuberculosis and diarrhoea are putting a greater burden on the health care system. Reversing this trend calls for imagination and the careful use of scarce resources. Information, educa- tion and communication have a crucial role to play in this regard and are among the most cost-effective interventions for health. Their impor- tance is recognized in the Constitution of the World Health Organization and has been under- lined many times over the years by resolutions of the World Health Assembly. Yet despite a number of initiatives, they are still very far from being used to their full potential. A great deal of information exists in research and medical institutions and organizations such as WHO and ministries of health which, if it were made available to people in a form they could understand, would enable them to take better care of their health, prevent diseases, and cope effectively with many problems without recourse to the health ser- vices. But at present only a small proportion of the population has access to such information. Analysis of the current situation offers some explanations. The greatest need for health information is in the rural areas where the majority of people live. Immunizing a child in Malawi. Target population groups would benefit more from health services if they were better informed about health. Photo Environmental lmages/5. Morgan© Yet the mass media on which much responsibility lies for disseminating such information are largely urban- based and cater predominantly for an urban audience whose needs they understand. Reaching rural audi- ences is a challenge. Distribution of printed material, including newspa- pers, in rural areas is often difficult because of poor roads and transport systems and lack of adequate provi- sion in the budget of information programmes. Moreover, rural people tend to have limited access to televi- sion and radio. Language, too, may be a barrier to effective communication. With the exception of a few countries, official languages in Africa differ from the languages most people use in their everyday lives. In spite of this, health information material is produced mostly in English, French or Portuguese, which may be appro- priate for the people running the programmes but not for the target audiences: they need information in their mother tongue if they are to understand it and take heed. Another major weakness of existing health information pro- grammes is the lack of involvement of the target audience in the process of communication for health. An effective information campaign should start with the assumption that people know best what their prob- lems are and what they need in order to cope with them. They should be involved in setting the agenda, and in World Health • SOth Year, No. 6, November-December 1997 creating and delivering the informa- tion messages. Much effort is cur- rently wasted on information and education programmes that do not address communities' priority needs , are inappropriate and lacking in credibility and are therefore rejected. The attitude of professionals may also create barriers to the dissemina- tion of health information. Health professionals tend not to see why technical and scientific information should be made available to people who might not understand it. And media professionals do little to chal- lenge this prejudice because they tend to lack confidence in handling scientific subjects. This means that health workers at grass-roots level are often inadequately equipped with information, materials and communi- cation skills to take advantage of the opportunities offered by regular contact with communities. Systematic monitoring and evalu- ation of programmes would enable countries to identify weaknesses such as these, and allow timely adjustments to be made. They are crucial elements in successful infor- mation programmes and should always be an integral part of their design rather than an afterthought. In many countries the telecom- munications infrastructure is still poor. In 1994, the average number of telephones per 100 inhabitants in Africa was 1.6 compared with 45 in Europe. As of 1996, only 15 African countries had full access to the Internet. It is now recognized that, used effectively, modern information technology offers Africa and other developing regions of the world the opportunity to leap-frog some of the stages of development by taking advantage of low cost access to the "information super-highway". The urgent need for new approaches and new policies to ensure that all the people of Africa have access to relevant and timely health information is now well rec- ognized, and the WHO Regional Committee for Africa, at its meeting in September 1997, approved a strategy detailing measures to be taken to make this possible. The new strategy has as its goal full coverage of the population with information, education and communication activi- ties by the year 2010, and the hope is that this greatly improved access to information will bring about changes in behaviour that will result in signif- icant improvements in health by the year 2025 . The principal beneficiaries will be the populations of rural communi- ties and urban shanty towns who are currently neglected. The strategy proposes that all channels of commu- nication be used to reach people. Thus, besides taking better advantage of modern technology, countries will be encouraged to use traditional forms of mass communication such as music, drama, puppet shows and story-telling. Seminars and work- s shops for media professionals are also proposed, to raise their aware- ness of the value of health informa- tion and enhance their capacity to interpret and report on such matters. Institutions that train media staff will be encouraged to include health reporting in their mainstream curric- ula, and media organizations will be helped to set up or strengthen their health desks. The development and prestesting of health information materials in local languages will be promoted. The strategy also proposes that countries be given support to improve the capacity of the informa- tion, education and communication units within their ministries of health. Moreover, the WHO Regional Office for Africa has committed itself to producing information packages on a variety of health topics for use by the media and the general public in member countries. The first of these packages was launched in Harare, Zimbabwe, in July 1997. Undoubtedly the proposed strat- egy has ambitious goals. But given political will and the true commit- ment of countries across the Region, there is no reason why these goals should not be reached, and the deteri- orating health situation in Africa reversed. • This article is based on documents prepared for technical discussions at the 47th meeting of the WHO Regional Committee for Africa, which took place in Sun City, South Africa, in September 1997 A village in Burkina Faso, a shanty town in Kenya: the main beneficiaries of the new communication strategy will be rural communities and urban shanty towns, which are currently neglected. Photos Still Pictures/M. Edwards © 6 World Health • SOth Year, No. 6, November-December 1997 An Internet forum for the management of disasters? Patricia Bittner & Claude de Ville de Goyet A city in Nicaragua was destroyed by a hurricane in 1988. Latin America is particularly prone ta disasters; discussions an preparedness will help prev.ent extensive damage. Photo Panas Pictures/5 Sprague © Since the early 1980s, the Pan American Health Organization (PAHO) has sponsored yearly meetings of health sector disaster managers in the Americas in an effort to encourage the formation of links. These meetings offer people the chance to share experience and advice and often result in disaster managers pledging solidarity and support to one another's pro- grammes (solidarity after a disaster has never been lacking!). Often, however, the meetings end, time passes and promises fall victim to the reality of heavy workloads, the high cost of telecommunications, and other constraints. Despite the best intentions, communicating is hard work. But in the 1990s shouldn't we be able to harness the power of the Internet to make communication easier? Isn' t electronic mail the tool that disaster managers in Latin America and the Caribbean have been waiting for to overcome barri- ers to sustained dialogue? WHO's Regional Office for the Americas, PAHO, thought it might be, and in 1995 launched a project to create an electronic disaster management network in Central America. The objective of the project, which has now expanded into South America, was to improve communication among disaster managers, both within and between countries and to provide access to global sources of information. The idea was not to develop more sophisticated services for the few Internet users but rather to expand the user base by providing access to and training in the Internet's basic services. This article is about one of the services set up by the project - an electronic "disaster discussion group". The initial assumption was that simply creating the discussion group would be enough to trigger a flow of communication. But the assumption was wrong. Some major lessons were learned about how to create a successful Internet forum. What's in it for me? Some people face a big enough challenge just keeping up with their regular e-mail, and the multitude of specialized discussion groups on the Internet often contributes to infor- mation overload. Despite the fact that no Spanish-language discussion group for disaster managers existed in Latin America, creating the framework was not enough on its own to get one going. To attract members, a discussion group must demonstrate a clear purpose and convince people it is worthwhile for them to invest their time. Corner the market on one topic Few people have the time to chat idly. Each discussion group should have a clear focus and become a source of specialized and authorita- tive information. Just as successful meetings focus on specific topics and discussions are guided by back- ground documents and knowledge- able moderators, electronic discus- sion groups must be run the same way. Latin America and the Caribbean are highly vulnerable to natural and manmade disasters; the region therefore has many experts in the field of disaster management - from physicians to structural engi- neers to supply logisticians. This kind of expertise is exactly what is needed to stimulate debate in a discussion group and give weight and credibility to the topic. As a discussion group's membership grows, interests tend to diversify, and administrators can create spin- off groups if necessary. World Health • SOth Year, No. 6, November-December 1997 Pick a strong leader Every group needs a strong leader - one who is sensitive to the varying needs and interests of members, is able to provoke discussion and de- bate, to give encouragement where necessary, and to keep the group on track. The leader, or moderator, should be an expert on the topic under discussion and should set a schedule of subjects that meets the group's needs. Contributions from members, however, are what keeps the group alive! Users have told us that it takes time to explore the World Wide Web and master the use of the software packages. But time is often short, and people stumble around these soft- ware packages becoming frustrated and ultimately not using the tools to the best effect. Time is also money, and in many developing countries it is hard to justify the extremely high telephone charges for on-line time if one is merely "honing" skills. Problems such as this are serious; they need to be aired and solutions found if discussion groups are to work effectively. Those who have participated in Internet discussion groups agree they have the potential to transform the way we do business. However, there are a few points to remember. • We need to consider the human dimension to be as important as the technological dimension. One can start an Internet discussion group in virtually any corner of the world; it doesn't matter where it's maintained or where its mem- bers live. The difficult part is providing constant support and motivation to the users so that this tool is used to best effect. • We need to provide and then follow up training. After the basic training, there must be constant follow-up in the form of formal training, user support and just plain hand-holding. A focal point should be identified in the coun- tries represented by the members to aid in these tasks. • We need to encourage members of specialized discussion groups 7 In the Amazon region of Ecuador, heavy deforestation is the cause of repeated flooding of villages. Forward thinking and good communication could limit such events. Photo Still Pictures/ H Bloch © to use the Internet to publish technical information that they have produced. This applies particularly to non-English lan- guage material which is in short supply on the World Wide Web and other Internet services. • We need to communicate periodi- cally with the decision-makers of the organizations represented in a discussion group to reinforce the group 's purpose and progress. This will encourage users and will help to secure the institu- tional backing that is necessary for a discussion group to prosper. • We need to highlight the initia- tives of members, either by fea- turing their concerns as topics of discussion, using the membership for peer review of technical documents, or circulating success stories and solutions to problems that are common in the region. On-site meetings are not likely to disappear soon. They offer incentives such as social interaction or interna- tional travel that are not found in cyberspace. E-mail discussion groups should be thought of as "ex- tensions" of traditional meetings since, by harnessing the power of the Internet, we can continue to share ideas and pursue common objectives during the off season when face-to- face gatherings are not possible. • Patricia Bittner and Dr Claude de Ville de Goyet are with the Emergency Preparedness and Disaster Relief Coordination Programme, World Health Organization Regional Office for the Americas/Pan American Sanitary Bureau, 525 23rd Street NW, Washington, DC 20037, USA Disaster resources in cyberspace desastres-ca@ops.org.ni: a predom inantly Span ish-speaking group on a variety of issues related to disaster management in Latin America ec_desastresur@mia.lac.net: a predom inantly Spanish-speaking d iscussion group comprised of the South American disaster commun ity. Eventua lly these two discussion groups wil l be merged http://www.paho.org/english/disaster.htm: PAHO/WHO Information on Disasters in the Americas. http://www.netsalud.sa.cr/crid: the Regional Disaster Information Center, provid ing an on-line search service through a database of more than ,] 0 OOO documents. http://www.netsalud.sa.cr/ suma: the Web si te of SUMA, a computerized relief and humanitar ian supply management project. http://www.ops .org.ni/desass-ni/db-ped.htm: the first Spanish-language W eb site created under the Central American Internet communication project; it contains a database of disaster management specialists in Latin America , and lists of recent disasters and other d isaster si tes. 8 World Health • SOth Year, No. 6, November-December 1997 Using electronic links for monitoring diseases Joan Dzenowagis Only two decades ago there was widespread optimism that infectious diseases would soqn be eliminated. Discoveries in science and medicine brought us antibiotics and vaccines which, along with advances in public health, pest control and sanitation, led to the prevention or control of many infectious diseases. Today we are seeing a dramatic increase in new diseases, as well as the recurrence and spread of familiar diseases once thought to be under control. There has been a rise in the spread of strains of bacteria resistant to antibiotics, and fresh concerns have arisen about new infectious agents of animal origin that could infect humans, as in the case of bovine spongiform encephalopathy. These problems are most severe in developing countries, but the risk is increasing in all countries. It is particularly high where people live in poverty and in the most difficult conditions: crowding and depriva- tion, undernutrition, chronic expo- sure to disease, and inadequate access to health care. The spread of communicable disease concerns every country. Internationally, we must build up our ability to track all communicable India . Women destroy garbage to prevent the spread of plague. Accurate and timely information can avert outbreaks of infectious diseases. Photo Keystone/ AFP © diseases of public health importance and respond to them. It is only by consistently following our common and known diseases that we will be able to detect the unusual and re- spond in time to avoid the devastat- ing consequences of epidemic, or population-wide, disease. Emerging infectious diseases are diseases that hove either a ppeared in a popula tion for the firs t ti me, or hove occurred previously but are increasing in incidence or in areas where they hod not previously been reported. Changing environmental cond itions, for example , mig ht bri ng more humans into con tact w ith disease-carryi ng an ima ls o r insects, thus creat ing o n opportunity for d isease to in fect a new popu la ti on. Re-emerging infectious diseases are kn own com mun icable diseases that were once decl ining in a population but ore now increasing aga in . WHO's Division of Emerging and other Communicable Diseases Surveillance and Control (EMC) coordinates international efforts to respond to communicable diseases. We are working with many organiza- tions and countries in this effort. Global information systems are an important part of our work. Global information Relevant, accurate and timely infor- mation can avert a local or national outbreak and, at the same time, prevent an international crisis. Global information systems utilize up-to-date communications technol- ogy to make sure that information collected through global monitoring World Health • SOth Year, No. 6, November December 1997 is rapidly and widely shared. Developments in electronic communications in recent years mean that we can now use communi- cation networks to collect and analyse data rapidly in order to guide international policies, collaboration, travel and trade. We are working to ensure worldwide sharing of infor- mation - through the Weekly epi- demiological record, WHO publications, the Internet's World Wide Web, and other means. Electronic communications make that information available at any time in almost any place. Published in electronic and print formats in a bilingual English/French edition, the Weekly epidemiological record is a weekly bulletin covering diseases and health risks around the world, from major communicable and noncommunicable diseases to ill-health linked to working condi- tions, contaminated food or lifestyle. The WER is found on the World Wide Web at http://www.who.ch/ wer. Internet and the World Wide Web(WWW) We also post Disease outbreak news, a summary of disease epidemics and outbreaks reported to WHO, on the World Wide Web. Our WWW site includes fact sheets with information on diseases of public health impor- tance in the news. It is updated every time new information comes in. The simple, no-frills EMC home page is found at http://www.who.ch/ prograrnmes/emc. Disease outbreak news is available by subscription through electronic mai l. This is an automated li st enabling subscribers to receive the newsletter w eekly. To subscribe to Disease outbreak news, send an e-ma il message to: majo rdomo@who.ch. Leave the subject blank . In the body o f the message, type subscribe wer-reh as the only item in the text part of the message. Tracing disease outbreaks Rumours of disease outbreaks - whether from health workers, the media, travellers or other sources - spread quickly and can cause_ pu~lic concern or even panic, resulting m severely disrupted travel and trade. The WHO working group on surveil- lance has set up a mechanism to investigate rumours of outbreaks and to make this information available as quickly as possible on our Disease outbreak news page. Our procedure is based on sharing information through electronic communications (e-mail and the Internet) linking a network of public health profession- als within WHO headquarters, WHO's Regional Offices, country representatives and other groups involved in disease surveillance. A joint initiative of the World Bank, the United Nations Joint Programme on AIDS (UN AIDS) and EMC will enable us to connect our system of collaborating centres, laboratories and institutions electron- ically by means of local telephone services, radio-to-telephone, or radio-to-satellite. Once centres are connected, we shall establish mailing lists for priority diseases, such as yellow fever or meningitis, to share restricted information with the col- laborating centres. Improved com- munication and access to information worldwide helps us to be better prepared for disease outbreaks and better able to respond to them. WHO's influenza surveillance network Influenza viruses are the focus of the WHO influenza surveillance network which aims to detect new variants early, evaluate their potential to cause epidemics, and estimate how well existing vaccine or antibodies in the population might protect against a new variant. WHO vaccine recom- mendations are published annually and are followed by vaccine manu- facturers worldwide. 9 The WHO influenza surveillance network is a specialized network of laboratories that carry out routine disease surveillance. These laborato- ries can detect influenza viruses that could trigger a pandemic. Linking these laboratories electronically is an essential part of the preparedness plan for the next influenza pandemic. The laboratories exchange virus strains, diagnostic reagents and information to complete the under- standing of influenza during the season. Every week during the in- fluenza season, laboratories provide information which contributes to a global picture of influenz~ epi~e~- ology: geographical location, timmg and extent of activity, age groups affected and laboratory results. This information is analysed and pub- lished by WHO in the Weekly epi- demiological record, by fax service during the influenza season, and on the Internet (http://www.who.ch/ prograrnmes/emc/flu). We have developed FluNet, a prototype Internet WWW site for the electronic submission of influenza data from participating national laboratories. Submissions are possi- ble only by designated users, but the results - graphics, maps and tables of influenza activity on a global scale - are available to the general public. On submission and verification of data, the maps and summary tables are immediately updated, giving users a summary of the influenza situation. This information is accessi- ble by following links from our home page on the World Wide Web. • Dr Joan Dzenowagis is a Technical Officer working on lnformotion and Comm_unication Strategy with the Division of Emerging and other Communicable Diseases Surveillance and Control, World Health Organization, I 2 I 1 Geneva 27, Switzerland. 10 World Health • SOth Yem, No. 6, November-December 1997 A library without walls Yvonne Grandbois & Barbara Aronson The reference room of the WHO Library in Geneva. Behind this traditional image, information is being received and disseminated at the speed of light Photo WHO The popular image of a library is of hushed rooms lined floor to ceiling with books through which people leaf in search of infor- mation. But this image is out of date. Today's libraries are at the forefront of the information revolution, busily transmitting knowledge to colleagues and clients around the world using the latest technology. WHO's library is no exception. Our librarians based in Geneva and six regional offices are involved in a wealth of communi- cation activities with a wide variety of clients, from ministries of health, hospitals and international organiza- tions to individual scientists, re- searchers, students and general enquirers. Our services include sending ready-packaged mini-li- braries of vital health information to clients worldwide, running a free exchange service of books and med- ical journals for other libraries, and training librarians around the world in the latest health science library technologies. Every week we receive masses of queries and requests for information. Here is a typical selection of ques- tions and the answers we give: Our library budget is very limited, and we can't convert it to foreign hard currencies. Ho w can we sub- scribe to international journals for our researchers and purchase the latest textbooks for our medical students? You can order your books and med- ical journals through WHO Library's health literature purchasing ser- vice, and pay through WHO 's Revolving Fund with your local currency. WHO Library will ensure that you get the best value for your money. You may even be able to find some of the items you are looking for free of charge through our International Health Literature Exchange. Our documentation centre has just been connected to e-mail, and our country should have full Internet capacity by next year. What services can we already have access to, and what can we look forward to when we can enter the World Wide Web ? Through e-mail you can already use our services, including WHOLIS (for bibliographic records), WHODOC (for information about new WHO publications and docu- ments), and entire issues of our Library newsletters (for professional updates on new technologies and trends) . These same services are also available through the World Wide Web (http://www.who.ch), where they are even easier to find . Of special interest to our colleagues in Africa are AHILANET (African health sciences librarians discussion group on e-mail ), our full text WHO Library Digest for Africa, and the African Index Medicus biblio- graphic database, both on the Web and gopher. We receive WHO publications at the Ministry of Health. How can we know which one to look in to find the answer to a particular question? Consult the WHOLIS database and its WHODOC updates available on diskette, paper, or the Internet (go- pher and the Web). Write, telephone or e-mail the WHO Library closest to your country for guidance. Our health dispensary is in a rural area several days' journey from any library. How can our personnel get the information they need to provide the best possible medical services? Our Blue Trunk Libraries/ Bibliotheques bleues and WHO Documentation Modules can meet your need. They contain basic manu- als and are designed as "instant libraries", ready for use on arrival. The WHO Library can help you get started. We know that the health conditions and problems in our area are similar to those in other districts and in neighbouring countries. Is there any way we can share knowledge re- sources locally and regionally? World Health • SOth Year, No. 6, November-December 1997 How do we communicate? Besides answering queries the conventional ways - by post, telephone and fax - W HO Library commu nicates wi th clien ts: * by e-mail :library@who.ch * through its home page on the W HO Website (http://www.who.ch); * through its electronic database, WHOLIS, which enables clients to find out what WHO's view is on any heal th- related topic; * through its newsletter, Liaison, distributed to health science librarians in developing countries; * through its WHO Library Digest for Africa , transmitted by satellite to ground stations in Africa; * through the AHllANET e-mail discussion group for health science librarians in Africa WHO's Regional Office libraries organize health information and literature services programmes including training, expert counsel and advice. They also publish in- dexes - topics, authors and titles each arranged in alphabetical order- to the health and medical literature published in countries of the region. Some indexes are already on the Internet, others are on CD-ROM, or on paper. Regional libraries also run networks for sharing resources. Contact your Regional Office library to find out more about its activities. Our institute does research on public health topics. How can we know what WHO has written on these subjects? Consult WHOLIS on the Internet, CD-ROM, diskette, or paper. This international database indexes all WHO-produced knowledge and information (books, unpublished technical documents, official records , journal articles, CD-ROMs, videos, press releases) from all WHO offices and projects worldwide. • Ms Yvonne Grandbois is Chief, ond Ms Barbara Aronson is Librarian, Office of Library and Health Literature Services, World Health Organization, 12 11 Geneva 27, Switzerland. The Library of the University of Dor es So/am. Libraries in the world ore not closed in behind their wolfs: they ore links in o vast network of information, an important port of which spreads precious knowledge about health. Photo Panos Pictures/ H. Netocn y © Libraries at WHO Headquarters and Regional Offices WHO Headquarters Office of Library and Health Literature Services 20 Avenue Appia l 21 l Geneva 27, Switzerland African Region Regional Office for Africa Library P.O. Box No. 6 Brazzaville, Congo (T emriorary address): PB. BE773 Belvedere Harare, Zimbabwe Region of the Americas Regional Office for the Americas/ Pan American Sanitary Bureau Library 525 23rd Street, N.W. Washington, D.C. 20037, USA Eastern Mediterranean Region Regional Office for the Eastern Mediterraneon Library PO Box 1517 Alexandria - 2151 l , Egypt European Region Regional Office for Europe Library 8, Scherfigsvej DK-2100 Copenhagen South-East Asia Region Regional Office for South-East Asia Library World Health House lndraprastha Estate Mahatma Gandhi Road New Delhi l l 0002, India Western Pacific Region Regional Office for the Western Pacific Library PO Box 2932 l 099 Manila, Philippines Tel (41-22) 791 20 62 Fax: (41-22) 79 1 4 1 50 e-mail : library@who.ch Tel (00242) 83.90.3 l /32/33 Fax: 100242) 83.94.30 e-mail: afrobibl@htsd mail corn Tel: 100263) 4 707 493 Fax (00263) 4 705 619 Tel: (001) 202.974.3000 Fax (00 l) 202. 97 4. 3663 e-mail: library@paho.org Tel (00203) 48.202.23 Fax (00203)48 38 916 e-ma il : postmaster@who.sci.eg Tel: (0045) 39. l 7. l 7. l 7 Fax (0045) 39. 17.18 .52 e-mail: msb@who.dk Tel (0091) l l .33 l .7804 Fax (0091) l l.331.8607 e-mail: postmaster@who.ernet.in Tel (00632) 528.80.0l Fax (00632) 52 l l 036 e-mail: postmaster@who.org.ph 11 12 World Health • SOth Year, No. 6, November-December 1997 Health and the media: uneasy partners? Philippe Stroot Goodwill and mutual understanding are indispensable for a new and much-needed partnership between the health sector and the press. But if iournalists are to be effective intermediaries, they must be given the freedom to do it in their own way. Most of the information that the public receive on health problems comes through the media. This is very obvious as re- gards AIDS, Ebola fever or "mad cow" disease, and it is equally true of "diseases of civilization" linked to such unhealthy lifestyles as smok- ing, alcohol abuse or lack of physi- cal exercise. But if they serve as vehicles of information, the media also help to propagate harmful ways of life. Especially vulnerable in this respect are those people in develop- ing countries or countries in transi- tion who indiscriminately yearn to adopt "Western" lifestyles. For evidence of this we need look no further than the ubiquitous advertisements for cigarettes in eastern Europe, both in the newspa- pers and on giant hoardings. After helping to create new smokers among young people impelled by one-upmanship or unthinking admi- ration for imported novelties, the media in those countries will cer- tainly convey information about the harmful effects of smoking and Ebola crisis in Zaire. General information about health reaches the public mostly through the press. Photo Keystone/ AP /J-M. Bou ju © publicize the draconian measures taken by other countries to fight against this scourge .. . So the impact of the press, radio and television on public health is a complex affair, but its importance is steadily growing. Every opinion poll that examines what the public wants puts health high among the priorities for readers, listeners and viewers. Yet regular sections or programmes devoted to health problems are far from common in the media, though nobody could possibly imagine them failing to have a section on sport, the weather or celebrity gossip. It is something of a paradox that information about health should be considered of secondary importance by editors and programme directors when public interest is clearly so strong. One possible explanation is that "medical" news is often judged to be too "specialized" and that journalists themselves may suspect they don't have sufficient knowhow to discuss such topics without the risk of making mistakes. What cannot be denied is that many scien- tists, particularly in the health field, complain that their statements have occasionally been distorted by journalists. A shared responsibility There are wrongs committed on both sides, however; if the press some- times takes these matters too lightly, the specialists too are often ignorant of the ways in which journalists work and the constraints they face. They may refuse to make an effort to explain matters precisely to inter- viewers who, generally speaking, have rather limited ideas about the subject of the interview. The special- ists therefore have to share the responsibility and take pains to ensure that what they say is very clear. The journalists in tum should not hesitate to say so if they have not fully understood and to ask the person interviewed to explain. With a little effort on both sides, there can be much better collabora- tion between those whose precious World Health • SOth Year, No. 6, November-December 1997 findings are vitally needed by the general public (doctors, research workers, specialist groups or interna- tional bodies) and those whose task is to transmit that information. In the Swiss city of Geneva, a group called Cultural Encounters brought together experts in various fields to clarify the role of the media in the general context of "scientific and technical culture for all citizens." One of the participants, a radio journalist, commented that "if the two worlds of science and the media have long had trouble understanding each other, it 's because they really are poles apart! The one concentrates on long-term, in-depth, rigorous examination of observations or statistics, while the other necessarily works at high speed and looks for a colourful, simplified and approxi- mate story." What is true for scien- tific news in general is equally true for news about health. Another participant quoted the huge media attention given to in vitro fertilization - "test-tube babies" - and stressed that "superficial and partial knowl- edge entails the risk that the general public will see only the trivial and peripheral aspects of an ethical debate which should concern every member of society". The recent excitement about the cloned sheep called Dolly, and speculation about the implications of cloning technol- I I ogy for human beings, make these remarks particularly relevant. In practice, officials working in health and members of the press are being driven to arrive at some mu- tual understanding, the former be- cause they can only improve public health by keeping the public fully informed, and the latter because the public insists on being better in- formed about health. Ideally this information will consist of much more than the same old advice about nutrition and diet, and will be delib- erately aimed at developing funda- mental health knowledge among the general public. This would not only help people to protect their own health better and to avoid what might be harmful, but also to better appreciate the major health problems of our times and to support the efforts being undertaken to counter- act them. Priority for health Who is better placed than the press to help the public understand that the battle for health must have top priority, and that any untimely penny-pinching in this domain may put the future at risk? As witness to this risk, take the re-emergence of such diseases as diphtheria in parts of the world from which they had n-,1 ~ ~ Press Conference al the Un iversity Hospital in Zurich , Switzerland. By sharing their findings with the media, scientists can contribute lo a better understanding of fundamental health issues. Photo Keystone/ek/ Ruckstuhl © practically disappeared, simply because the health protection of the public has fallen victim to political and economic upheavals. 13 At a time when information technology is expanding at an un- precedented rate, there is no short- age of technical means to guide public opinion ; what is lacking is the willingness of decision-makers to set the right kind of priorities for the information conveyed. Press man- agers and editors have to decide whether the eradication of polio and the elimination of leprosy, children's vaccination, disease prevention and the advocacy of healthy lifestyles are minor topics compared with the mass of other news items churned out daily by newspapers, radio stations and television channels. As for those who hold key infor- mation about health matters, they ought to make a greater effort to communicate it to the press, always bearing in mind that a newspaper article is not a scientific publication and that they should not expect a journalist to write in the same way as a research worker addressing his or her peers - even if this means that the in-depth detail and strict science may not be perfectly reflected as a result. Goodwill and mutual understand- ing are indispensable in this new and much-needed partnership between the health sector and the press. If journalists are to be effective inter- mediaries , they must be given the freedom to do it in their own way; this means helping them in their task, and certainly not trying to "use" them - they have a horror of that! The activities of international or national organizations working in the field of health have everything to gain from this partnership and, at the end of the day, so too does humanity in general. • Mr Philippe Stroot is Coordinator, Media Relations, Health Communications and Public Relations Un it, World Health Organization, 1 2 1 1 Geneva 27, Switzerland. 14 World Health • SOth Year, No. 6, November-December 1997 Helping scientists to improve their communication skills Jitendra Khanna H ealth research helps to generate new knowledge to solve health problems. However, maximum benefit from research is achieved only when the new knowledge is transmitted rapidly to all who can use it. The UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) believes that a health researcher's job is not over until the research findings have been reviewed by other scientists and published, and have been transmitted in a user-friendly format to health policy-makers and the general public. Unfortunately, the advanced training that researchers undergo in their fields seldom includes writing scientific research papers or commu- nicating effectively with the general public. The latter in particular re- quires specialized training as it often involves communicating difficult scientific concepts through the mass media to lay audiences. In develop- ing countries, where literacy levels and coverage of the media are low and science journalism is not well established, communicating science poses a considerable challenge. A mock inteNiew taking place during a recent WHO communication workshop for reproductive health researchers held in New Delhi. Photo WHO/OMehta Since its establishment in 1972 HRP has been helping developing countries to strengthen their capacity to conduct research in reproductive health. Many developing countries have benefited from this support and have set up institutions that conduct valuable research of national interest. Unfortunately, a lot of the new knowledge generated by this re- search never leaves the laboratory because many scientists find it diffi- cult to write and publish papers and to communicate with the media. Most science journals around the world - even in many developing countries - are in English, and few researchers have the skills to write good papers in English . On top of that, there is stiff competition to publish papers in good science jour- nals and poorly prepared papers have little chance of being accepted even if the science is good. A small proportion of the re- search conducted in developing countries does get published. But this does not guarantee that policy- makers and the general public will hear about it. Much knowledge is doomed to remain locked up in libraries and research institutions. Many scientists do not see it as their responsibility to inform the public about their work. Moreover, lack of knowledge of the process of commu- nication hampers the efforts they may make. To help bring the research find- ings out from the dusty files and computer databases and make them available to health planners, HRP conducts workshops in scientific writing and science communication in research institutions in developing countries. So far 16 scientific paper writing and four science communica- tion workshops have been conducted in 11 countries. In 1995 a survey of the impact of the scientific paper writing workshops in Latin America showed that, after attending the workshops, researchers published more papers than before and were more confident of their ability to prepare papers for publication in learned national and international journals. In the science communication workshops the main objectives are to make researchers aware of the prin- ciples of communication and show them how to communicate effec- tively with the media. The work- shops include both researchers and journalists and seek to build trust and strengthen networking among them. This is very important as many scientists avoid contact with the press because they believe jour- nalists favour sensationalism over accuracy. On the other hand, journal- ists complain that scientists present their ideas in language that non- scientists cannot understand. HRP's experience with the sci- ence communication workshops has been very positive. Scientists taking part often express amazement that there is so much to learn about communication and that appropriate "packaging" of information can mean so much to the impact of the message. Many journalists say that after discussing science reporting with the scientists they are able to appreciate better the researchers' concerns about accuracy. Both agree that they have a vital role to play in health promotion and that they need to collaborate in this endeavour. • Mr Jitendra Khanna is Technical Officer (Com- munication and Information Dissemination), UNDP /UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, l 2 l l Geneva 27, Switzerland. World Health • SOth Year, No. 6, November-December 1997 15 Kick polio out of Africa! Poliomyelitis is the number one cause of paralysis in sub-Saharan Africa. Today, practi- cally everyone knows of someone crippled by the disease, but such cases will be increasingly rare by the end of the century if the campaign to "Kick Polio out of Africa" achieves its goal. Football is being used as the medium for the campaign's message that no one need be a victim of polio: given mass commitment to immu- nization, the disease could be eradi- cated from the African continent by the year 2000. Besides underlining the tragedy of polio through the stark contrast between the disability of victims and the super-fitness of sportsmen, "there is no better way than through football of reaching so many people at once," says John Lloyd of WHO's Expanded Programme on Immunization in Geneva. Football matches are played to packed stadiums, and live cover- age of games on television and radio regularly attracts audiences of 50 million people across Africa. The campaign, supported by Rotary International and other part- ners, was launched at the World Cup qualifying match between Nigeria and Burkina Faso in Ouagadougou on 27 April 1997. At the opening ceremony, 50 children filed on to the pitch and unfurled a huge banner bearing the campaign symbol of a sportsman kicking the virus into oblivion. A ceremonial "Kick Polio" football, first signed by President Nelson Mandela of South Africa, was signed by the President of Burkina Faso in the presence of the team captains, and journalists cover- ing the match received special polio information packs. There were an- nouncements about the eradication A moment of leisure for the veteran football reporter Apollinaire Gahungu, himself crif,pled by polio, and the Ghanaian-born footba I star Abedi Ayew Pele. Both are ambassadors for the campaign launched by WHO to "kick polio out of Africa". Photo WHO/V Abramov campaign over the public address system, and TV and radio spots broadcast regularly during the match reached homes in 31 African coun- tries. The "Kick Polio" football will be signed at every major interna- tional match this season by the presi- dent of the host country. Veteran football reporter Apollinaire Gahungu, himself crip- pled by polio, and Ghanaian-born football star Abedi Ayew Pele have been appointed ambassadors for the campaign by WHO's Regional Office for Africa. Their job is to keep polio in the public mind, and to encourage families to have their children immunized against the disease. The key to eradication is a series of national immunization days that supplement routine immunization activities and focus effort on reach- ing all children under five years of age with polio vaccine. National immunization days should be held annually and conducted in two rounds several weeks apart. Some countries have been conducting mass immunization days against polio since 1995, but the continent-wide effort to eradicate the disease began in August 1996 when WHO's Regional Director, Dr Ebrahim M. Samba, set up a Polio-Free Africa Committee chaired by President Mandela. Heads of state throughout the continent subsequently pledged support for the campaign at the 1996 Organization of African Unity con- ference. So far national immunization days have reached an estimated 73% of children under five in the 41 African countries where polio is endemic, compared with 54% of children routinely vaccinated against polio throughout the region. The goal is to vaccinate 100 million children in the endemic countries, and to declare the continent free of polio by the year 2000. However, the challenges ahead are formidable . Civil war rages in some of the worst polio-affected countries; the cold chain for delivering vaccines is weak in many places because of worn out equipment; surveillance systems for monitoring progress towards eradi- cation urgently need strengthening; and the campaign is short of money, having been pledged only about half the US$52 million budgeted for this year. Nevertheless, the continent is winning the battle against polio, and President Mandela has called for a redoubling of effort "until we can safely say we have kicked polio out of Africa for ever". • This report is adapted from an article in "Vaccine and Immunization News" (WHO, No. 4, June 1997) 16 World Health • SOth Year, No. 6, November-December 1997 Peace through health in Bosnia and Herzegovina Gregory Hess Sarajevo, early 1995. Nearing the end of the third year of war, the capital of Bosnia and Herzegovina was unrecognizable. The damage was overwhelming. Faces of apartment buildings were pocked by shelling and scarred by fire. Burnt-out frames of the trolley cars remained stuck in their tracks. Barricades of destroyed cars pro- tected women from sniper fire as they risked their lives daily to collect a few litres of water from one of only two water depots open in the city. At the western end of Sarajevo, barbed wire surrounded the airport, one of the few areas of the city under the control of the United Nations peacekeeping forces. The surround- ing area was the ground for some of the most fierce fighting in the war. Criss-crossed by front lines, the airport was a tiny quasi-safe haven for international forces. It was here that WHO initiated its first set of reconciliation activities - almost a year before the end of the war. At that time, water and sanitation infrastructures were non-functional. Huge piles of garbage had accumu- lated around the city. Rivers were polluted with rubbish and untreated sewage. Comprehensive public health programmes had ceased three years previously. In these conditions, rodent populations flourished and brought with them an increasing threat of communicable diseases, including haemorrhagic fever and tularaemia. Even during the fighting, health proved to be an issue which could be lifted above politics, hatred and war. In the airport meetings, WHO brought together health professionals from the warring parties to discuss public health measures to protect the civilian population from rodent- borne diseases. The meetings were Boys carrying a wounded person on a stretcher in a Bosnian refugee comp. Opponents in civil wars have the some health problems. Finding common solutions con be a way towards reconciliation. Photo WHO secret to protect the health workers, and minutes were not taken owing to the sensitive nature of the discus- sions. Short management action plans guided those present in their efforts to prevent increased suffering of the population. Since that time, the Dayton Peace Agreement has brought about a sustained, albeit fragile, peace. Yet restricted communication impedes efforts to strengthen this precarious peace. Restricting communication is a tool by which nationalist extrem- ists maintain and solidify their power. Moderates who seek peaceful means of conflict resolution are denied opportunities to do so. As examples, three different types of vehicle licence plates communicate political affiliations and prevent free movement around the country, international phone connections are easier than calls between the differ- ent parts of the country, and factious and monopolized media prevent information exchange and promote tensions. Some of the most positive and progressive developments to counter this communication repression have come about in the health sector. The ministers of health of the two entities meet regularly and have issued a Joint Statement to the International Community. Health policy-makers have met to discuss common issues. Supplies have been exchanged be- tween communities. And joint public health interventions are being initi- ated to protect neighbouring commu- nities from common threats. Many of these positive examples would not have occurred without the neutral umbrella and facilitation provided by WHO staff in Bosnia and Herzegovina. WHO initiatives to foster reconciliation between health professionals have evolved into a programme entitled "Peace Through Health". The fundamental objective of activities in the programme is to World Health • SOth Year, No. 6, November-December 1997 strengthen reconciliation through priority health activities. Communication, peace and health Communication, in various forms, is the most important element of WHO's Peace Through Health pro- gramme. In general, health commu- nication in this context entails sharing information and facilitating contacts. Common to any of WHO's reconciliation strategies is a focus on health issues of mutual concern. The following examples illustrate some of the communication barriers to health that WHO has tried to over- come. Health information The misuse of information and data is one of the most destabilizing factors in Bosnia and Herzegovina. Domestic media reporting often promotes ethnic nationalism and misrepresents information in order to strengthen political agendas and the divisions among people. Health data were particularly sensitive during the war, leaving a legacy of reluctance among health professionals to share data or trust data from another area. In the post-war period, WHO acts as a neutral filter for presentation of data. In a position of trust and re- spect, WHO shares information with all sides to encourage open commu- nication and to promote solutions which deal with health issues, not politics. Facilitating contacts Isolation and polarization are two of the most detrimental long-term effects of the war. As a country, Bosnia and Herzegovina has been very much isolated. Health profes- sionals, for example, have had very few external contacts over the past five years, either directly through participation in European networks or even indirectly through literature and exposure to health develop- 17 A woman returns home through the rubble of Sara;evo. Photo WHO ments. Furthermore, within the country, health professionals have been forced to choose sides and prevented from contact with their former colleagues. Developing external links is a vital WHO role. As health profes- sionals from Bosnia and Herzegovina are brought into contact with European and global counter- parts, the health sector becomes increasingly stable. On an individual level, attention is lifted from the pessimistic cycle of daily politics to a renewed hope for a peaceful and satisfying future. Internal contacts also stimulate hope and provide some much desired relief from political pressures which stifle communication. WHO-spon- sored joint activities among health professionals ensure neutral and safe environments for the re-establish- ment of communication. When brought together, former colleagues find that they have a lot in common and reunions are often emotional. A recent meeting in Republika Srpska exhibited some characteristics com- mon to many health professional reunions in Bosnia and Herzegovina. After the initial fears (for security and professional repercussions) subsided, the doctors quickly shifted into personal relations, asking each other of the whereabouts of former colleagues. The meeting ended with greetings for colleagues with whom communication had been severed and an expressed desire to renew these contacts. Protecting the health of the population is the incentive for meet- ing together. The realization that working together for health is the best- indeed the only- way forward is the incentive for future coopera- tion and collaboration. WHO is facilitating the first part of this equation by promoting opportunities for communication. If preliminary examples hold true in the long term, health professionals in Bosnia and Herzegovina will carry this momen- tum forward, creating constructive dialogue, a stable health sector, and a catalyst for other people also to choose peace and reconciliation. • Gregory Hess is Public Information Officer, World Health Organization Regional Office for Europe, Bosnia and Herzegovina Office, c/o Public Health Institute, Marsala Tito 9, 71 OOO Sara;evo, Bosnia and Herzegovina. 18 World Health • SOth Year, No. 6, November-December 1997 Breaking down the barriers to health information Neil Pakenham·Walsh & Carol Priestley The library at the University Teaching Hospital in Brazzaville. a single half-empty bookshelf of outdated material. Photo WHO/ N.Pakenham-Walsh Access to reliable health infor-mation is crucial for progress towards health for all. However, health workers in countries with few resources do not have access to the basic information they require for training and clinical decision-making. This starvation of information inevitably limits profes- sional development and the quality of health care, contributing to unnec- essary suffering and death. According to the late James Grant, former Executive Director of UNICEF, "the most urgent task before us is to get medical and health knowledge to those most in need of that knowledge. Of the approxi- mately 50 million people who were dying each year in the late 1980s, fully two-thirds could have been saved through the application of that knowledge." Lack of information is seen at all levels of health care, from village health workers to national teaching hospitals. The contrast with devel- oped countries is striking. For exam- ple, the library at St George's Hospital, London, where one of the authors (NP-W) trained, contains more than 30 OOO books and sub- scribes to 800 journals; the equiva- lent library at the University Teaching Hospital, Brazzaville, Congo, con- sists of a single half-empty bookshelf of outdated material. Why do health workers continue to lack access to reliable informa- tion? It is not because of a shortage of enthusiasm or ingenuity. An increasing number of nongovern- mental organizations, international health agencies, health librarians, publishers, multimedia producers, and information technology consul- tants , among others, are striving to improve access to health information in developing countries. Individually, these health information providers have made important contributions, but their overall impact remains fragmented. In 1994 leading figures of the health information provider commu- nity met in London to discuss ways in which health information provi- sion could be improved. This land- mark conference, 'Getting health information to developing countries ' , identified the three-part barrier that restricts their activities. First, there is a lack of coordina- tion and communication among the providers of health information themselves. Second, there is a lack of collective action to build a clear understanding of global health infor- mation needs and provision. And third, there is a lack of advocacy for political and financial commitment. These three areas were reiterated by African health librarians at the 5th congress of the Association for Health Information and Libraries in Africa (Brazzaville 1996). The challenge is to promote coordination, analysis, and advocacy so that they are no longer barriers but allies (see figure on page 19). The London conference revealed a clear need for an initiative to ease the flow of health information. This mandate was accepted by the Interna-tional Network for the Availability of Scientific Publications (INASP), which launched the IN ASP-Health pro- gramme in April 1996. Founded in 1992 by the International Council of Scientific Unions, INASP is a non- profit, nongovemmental organization that promotes the exchange of infor- mation, both printed and electronic, between and within the developed and developing world. INASP- Health is supported by the United J(jngdom's Department for International Development and the British Medical Association. In addition, DANIDA (the Danish International Development Agency) has pledged a three-year contribution for the period 1998-2000. World Health • SOth Year, No. 6, November-December 1997 Promoting coordination There is a wide scope for enhanced coordination. There is no association of health information providers, nor is there any organization dedicated to serving them. Collaboration is often limited to ad hoe partnerships, with those involved being unaware of related activities. INASP-Health's first aim is to promote collaboration and sharing of expertise and experience by building on INASP's recognized achieve- ments in cooperative networking. INASP-Health 's advisory and refer- ral network now serves more than 400 organizations and individuals, North and South, with an interest in providing health information to developing countries. The network advises on all aspects of health information provision, supported by in-house databases and the diverse expertise of network participants. A key function is to facilitate contact between health libraries in develop- ing countries and organizations that can provide assistance. Participation is free and without obligation. Promoting analysis Much remains to be learned about the varied information needs of health workers and the most cost- effective methods of meeting those HEALTH INFORMATION PROVIDERS HEALTH INFORMATION PROVIDERS The Library of St George's Hospital in London.· a collection of more than 30 OOO books and 800 journals. Photo courtesy of St George's Hospital Medical School Library needs. There is no central repository of material such as needs assess- ments , evaluations of different approaches to health information provision, and the complex links between information access, quality of health care, and morbidity and mortality. INASP-Health is therefore intro- ducing a 'needs and provision' resource, with contributions from the mainstream literature and from network participants. Promoting advocacy Health information activities are chronically underfunded. IN ASP- 19 Health will continue to lobby and work closely with others to put these needs high on the development agenda. It will also publicize spe- cific issues in response to the de- mands of its network participants. Conclusion Health information for all is essen- tial for health for all, and is poten- tially the most cost-effective approach to improve the quality of health care delivery in many of the less developed countries. International health agencies have the opportunity to play an increasingly important leadership role, not only as providers of health information, but also as coordinators and partners with other organiza- tions. A wide collaborative process is needed to define priorities and set targets. Only then can we hope to develop a coherent framework that meets the varied needs of tomor- row's health care professionals. • For further information, please contact Dr Neil Pokenhom-Wolsh, Programme Manager, INASP-Heolth, INASP, 27 Pork End Street, Oxford OX I I HU, England (e-mail: I O 137 4 . 36 I 5@compuseNe.com}. Ms Carol Priestley is Director of INASP. .,, ..... --- ........... ,; ' / ' ~, I ' - - - 1 , ,'FRAGMENTED \ ' ', : ACCESS TO \ ,)' \ HEALTH } / \ 0 0 I --- 1 / dNF RMATI N, ;,' ' I COORDINATION ANALYSIS ADVOCACY ' ,; ' ; ..... ____ __ UNIVERSAL ACCESS TO HEALTH INFORMATION Coordination, analysis and advocacy ore the facilitators towards universal access to health information. Graphics WHO/ N Pokenhom-Wolsh 20 STOP AIDS Markus Allemann Switzerland's STOP AIDS campaign calls a spade a spade. TV viewers see a man unrolling a condom on a banana and explaining, in plain language, how the condom should be used. Themes like fidelity are more difficult; for this campaign, being faithful means first and foremost being "faithful to the condom". O n the evening of 3 February 1987, the presenter of the Swiss television news, in front of the cameras, unrolled a condom, stuck it on his index finger and de- clared: "This little thing, ladies and gentlemen, can save life." The STOP AIDS campaign was born, and from then on the pink condom blossomed every day on billboards throughout Switzerland, and on every TV chan- nel a voice said in soothing tones that the condom offered the best protec- tion against AIDS. But that was some time ago. Today the campaign still favours billboards and TV spots, but the message is even more striking. The condom is an everyday item, and a pink one no longer arouses much interest. So the campaign had to become more provocative if its vital message was not going to be drowned by the routine flood of advertising for other products. World Health • SOth Year, No. 6, November-December 1997 Campagne de prevention de !'Office federal de la sante pub!ique, en cot!aboralion avec l'Alde Suisse contre le Sida, ST OP SI DA This poster produced by Switzerland's STOP AIDS campaign calls the condom a "pocket life-insurance policy". Photo Swiss Federal Office of Public Health © This change of direction was favourably received by the public, as an opinion poll showed in 1995, when 90% of the people canvassed replied that they thought it was "a good thing to keep people regularly aware of the problem by launching new STOP AIDS campaigns" . Moreover a quarter of them wanted the adverts to be even more honest, direct, bold and provocative. These results show that the principles of a campaign which has from the start been direct and frank have been publicly accepted. It has chosen the option of information and motiva- tion rather than that of fear and repression, and from the beginning it has advocated integration and soli- darity rather than discrimination. The Institute of Social and Preventive Medicine in Lausanne, which undertook an evaluation of the AIDS programme, concluded that in Switzerland "there is a strong social norm of solidarity, partly inspired by the STOP AIDS cam- paign, which causes people to react against obvious signs of exclusion". The success of this campaign is very clear. The proportion of 17-30- year-olds systematically using a condom during sexual intercourse with casual partners has risen from 8% in 1987 to 56% in 1994, and among 31-45-year-olds it has risen from 22% in 1989 to 42% in 1994. Moreover, the sales of condoms doubled shortly after the start of the campaign. The number of new HIV- positive cases fell for the first time in 1996. The keys to success On the international scene, the STOP AIDS campaign has been frequently hailed as a shining example. Here are some of the reasons for its suc- cess. • Visibility: The pink condom used as a logo for the past 10 years has kept the theme constantly in the public eye. This distinctive symbol has meant that people see the campaign as single-minded though its content is regularly renewed. Use of the billboard poster as its main medium has given it maximum exposure in public. Television spots are also often used, as they lend them- selves particularly to imbuing the subject with the necessary emo- tion and familiarity. • Consistency: For 10 years the campaign has remained consis- tent in its messages (condoms protect; single partnerships protect; mutual solidarity gives strength; not starting with drugs World Health • SOth Year, No. 6, November-December 1997 and not sharing syringes means no risk of transmission). The same goes for its principles: people can learn and can become responsible; fear inhibits action; every message should urge posi- tive action. The budget has also remained fairly constant, so the messages can be changed regu- larly. Messages have to be re- peated if they are to get through to everyone - and that doesn't mean only the 50 OOO youngsters who reach sexual maturity every year in Switzerland. Sending a message only once is useless. • Impact: The campaign has relied heavily on posters and television spots, that is to say, on the two media which various studies credit with offering the maximum visibility and being the most memorable. The effort needed to refine the messages until they can safely be circulated by these methods with a minimum of words is well justified. In fact, the STOP AIDS posters have aroused strong reactions, both negative and positive. That was the inten- tion, for a campaign that pro- vokes no reaction has no chance of stimulating public debate. • Clarity: The campaign calls a spade a spade. Television viewers see a man unrolling a condom on a banana as he explains, in plain language, just why and how the condom should be used. Fidelity is much more difficult to explain. Young people tend to be faithful anyway, but this will not neces- sarily protect them from HIV and AIDS, since a succession of faithful relationships entails a risk of transmission. For this cam- paign, therefore, being faithful means first and foremost being "faithful to the condom". • Acceptability: The campaign needs to be understood and ac- cepted by everyone. It must choose a form of communication which works in town and country, in regions and cultural settings where people speak French, German, Italian and Romansch, and in both Catholic and Protestant communities. The task 21 This young woman makes matters clear: "No condom, no sex". Photo Swiss Federal Office of Public Health © is all the more difficult because HIV I AIDS touches the taboo subject of sexuality. The determi- nation and perseverance of offi- cials at the Federal Office of Public Health have played a decisive role in the evolution of the campaign, especially in the early years. • Networking: Behind the cam- paign was and still is a creative team composed of representa- tives of the lobby group "AIDS Hilfe" (AIDS Help) and of ex- perts from various regions and institutions. This team may have made it more complicated to develop the campaign but has guaranteed its high quality. It also ensures that the campaign relates far more closely to the activities of the target audiences. Looking ahead The Federal Office of Public Health is in the process of working out with its partners an AIDS strategy for the next four years, and this will be announced during the next World Conference on AIDS to be held in Geneva in June 1998. The campaign has to contend with a tighter budget, but meanwhile messages become more complex and the public is increasingly inclined to lose interest. The media themselves are no longer as interested in the activities of the campaign as they were in the 1980s, so new approaches are needed. If the campaign wants to be noticed, it has to become even more provocative; if it wants to be accepted, it has to adopt more complex messages and start networking with its target audiences. Finally, if it wants to remain one of the leading anti-AIDS campaigns in the world, it must not turn its back on the consistency, impact, clarity, acceptability and networking which have been the hallmarks of its success in the past. • Mr Markus Allemann has since 1995 headed the Campaigns Service of Switzerland's Federal Office of Public Health in Berne, which has planned and carried out the STOP AIDS campaign in close collaboration with the "creative team " and the publicity agency Seiler. His address is. Office federal de la San te publique/Bundesamt fur Gesundheit, 3003 Berne, Switzerland. 22 World Health • SOth Year, No. 6, November-December 1997 The influence of AIDS Today radio James Deane Rural radio station in Niger. AIDS Today radio programmes: an efficient way to make people aware of the disease. Photo Still Pictures/l. Schytte © II The future impact of the AIDS epidemic will be determined not by what happens in the laboratory or in the surgery but by what happens in the bedroom." The speaker was a senior World Bank official at a recent Panos seminar. He might, with equal accuracy, have claimed that the future of AIDS will be determined not only in the bedroom but also in the boardroom - and the newsroom and the cabinet office and in all the places where decisions are taken which shape the response to HIV I AIDS in an increasingly com- plex world. The AIDS epidemic has struck at a time of rapid global political and economic change. The last 15 years have witnessed increased migration, an upsurge in global tourism and growing economic inequalities, all factors which have contributed to the rapid spread of HIV; but we have also seen lasting positive benefits, particularly in terms of increased democratization and pluralism, and a change towards more information- driven societies. People the world over are increasingly demanding to be informed, to contribute to politi- cal decision-making and to claim their rights . The policy decisions on HIV/AIDS, too, are becoming in- creasingly complex. They range, for example, from debates over the extent to which breastfeeding should be promoted among women who are HIV positive to the ethics of vac- cine-testing in developing countries, from whether sex education should be taught in schools to whether people with HIV who infect others should or should not be held crimi- nally responsible. For those of us seeking to contain HIV in developing countries, these social changes and the increasing complexity of policy responses required to tackle the epidemic present fundamental challenges. What is increasingly clear is that HIV I AIDS prevention cannot suc- ceed if it is restricted to "educating" and "persuading" people to change their sexual behaviour. People in- creasingly need to be involved in the decisions which affect their lives, as these decisions need to be their own. Responses to AIDS need to emerge not just through the top-down for- mulation of a group of agencies and government officials but principally through national debates which can draw in the views, perspectives and experiences of many components of society, particularly the most mar- ginalized. The Panos Institute produces a range of information materials for media, nongovernmental organiza- tions and policy-makers in develop- ing countries which are designed to faci litate and stimulate such debates. They include news features, media briefing documents and a regular radio programme, "AIDS Today". AIDS Today is a 15-minute programme produced on tape which is disseminated to around 80 radio stations worldwide, principally in sub-Saharan Africa, the Caribbean and the Pacific. Produced in English and funded by the European Commission, the programme is designed to fulfil four objectives: • to stimulate public debate within countries on the implications of HIV I AIDS and on the strategies being employed to combat the disease; • to provide audiences in develop- ing countries with compelling, imaginative and highly relevant analysis of HIV I AIDS issues within an international context; • to provide an international outlet for journalists in developing countries who are reporting and investigating HIV I AIDS issues in their countries; World Health • 50th Year, No. 6, November-December 1997 • to build the capacity of develop- ing country radio journalists to report on HIV I AIDS issues in their countries by carrying out a range of activities designed to improve both the substantive and the technical quality of their reporting. Programmes are accompanied by a full transcript to facilitate translation into other languages, and a number of recipients weave interviews and sound-effects of the programme into their own programming. We also produce at least one background media information sheet with the programme, providing essential facts about the issue. These can help producers to organize phone-ins or discussion programmes around issues raised in the AIDS Today programme. Information sheets are, through a separate process, trans- lated by our partners into 10 African and Asian languages and dissemi- nated to around 1500 print media worldwide. Perhaps the most important elements of the AIDS Today project are its capacity-building activities. Journalists face substantial obstacles in reporting effectively on AIDS, including poor training, few re- sources for travel even within their country, and low levels of senior editorial commitment to covering the issue. To address some of these, Panos awards fellowship grants to developing country radio journalists which enable them to take some days or weeks away from their work to research an HIV I AIDS-related issue in depth and to travel to inter- view a range of people, from experts and politicians to care workers and ordinary members of the public. We particularly stress the importance of including the views of people with HIV or AIDS. The material is com- piled by journalists into documen- taries or other programmes for their own broadcast, and we put together a condensed version of their programmes for international syndication. The project also led to two meet- ings earlier this year, one of which was for 50 radio and print journalists from 10 African countries who came together to form a new African Media Network on HIV/AIDS. The second meeting brought together radio producers and journalists from the Caribbean to form a similar network. Journalists at both meet- ings produced "codes of ethics" for journalists reporting on HIV I AIDS in their region. Building the capacity of journal- ists to produce their own radio programming on issues such as HIV I AIDS is essential. Radio is the most widely accessible medium in the world and, although AIDS Today is regularly broadcast by around 50 radio stations internationally reach- ing an audience of millions, it has limitations. The programme is pro- duced in English, thus limiting its main audience in most countries to a relatively educated middle class. Translation of the programme does take place, but on a limited scale. However, the programme can broach some sensitive issues - such as sex education - which national broadcasters otherwise would not be able to cover easily. Coming from an international source, it can help break down some taboos, as well as provide important insights into issues that otherwise would get little or no coverage. Programmes to date have focused on a range of issues, including: • the prospects for AIDS vaccines; • AIDS and young people; • vaginal virucides; • testing for HIV and the right not to know; • tuberculosis and HIV, safe blood; • Thailand's 100% condom policy; • home-based care; • combination therapies and the implications for developing countries; • traditional healers; • orphans and HIV; • employment rights of people with HIV; • sex, AIDS and children; • HIV in prison; • breastfeeding and HIV; • criminal law and HIV. Programmes are available (with scripts) from Panos priced £20.00 for each tape (two programmes per tape). They are available free of charge to radio stations in develop- ing countries. • 23 Mr James Deane is Director of Programmes of the Panos Institute in London. For further information, please contact the Panos Institute, 9 White Lion Street, London N 1 9PD, United Kingdom (tel. +44 171 278 11 11 ; fax +44 171 278 0345; e-mail: panoslondon@gn.apc.org}. Panos-London is an independent information institute which exists to stimulate debate on global development and environment issues. By providing authoritative, balanced and accessible information, Panos raises understanding of neglected or poorly understood issues . Panos- London works throug h a series of regional Centres for Publ ic and Pol icy Debate in Southern Africa, East Afr ica and the Horn and South Asia . The Institute is registered as a charity in the UK and is funded by the aid agencies of the governments of Sweden , Denmark, Norway, Germany, the Netherlands and the UK, and by the European Commission and a number of nongovernmental organizations and foundations. 24 Soul City Sue Armstrong This typical shack scene appears in one of the Soul City series. Poor communities are a privileged audience of the South African pro;ect. Photo WHO/ Soul City Pro;ect As a physician working in community clinics in South Africa, Garth Japhet was concerned by how few pregnant women made use of antenatal ser- vices, and he set out to discover why. A survey revealed that though the time and effort involved had a deter- rent effect on busy women, most were also unaware of the benefits of professional care in pregnancy. This finding, coupled with the fact that much of his time was spent dealing with emergencies that should never have happened, convinced Japhet there was a pressing need to give people the knowledge to safeguard their own health. He began writing a column on health matters for the newspapers but soon realized this was not the most effective way of reaching the people he most wanted to reach - the poorest and often least educated members of society. While watching an exuberant street carnival in Johannesburg, the idea came to him of using a combination of popular media as a vehicle for health mes- sages. Statistics show that while approximately 55% of South Africans read newspapers, 92% of them have access to radio, and 76% to television. Japhet took his thoughts to Aggrey Klaaste, editor of South Africa's widest circulating daily newspaper, The Sowetan, who was already syndicating his health column. Mr Klaaste believed a multimedia approach could be a winner, and he offered to pay the young doctor's salary for three months while he developed the idea and sought funding. "Attempts to use the mass media for health and development are not new", concedes Japhet. "But there is a difference between merely using the mass media and using them effectively." Audience ratings showed that in South Africa educa- tion programmes on television rarely reached 500 OOO viewers, whereas prime time drama regularly attracted audiences of 11 million and more. It was obvious that the most effective way to deliver health messages would be to incorporate them into a drama series. World Health • SOth Year, No. 6, November-December 1997 The electronic media are good at getting across broad messages; print media are better at providing detail. Rural people are better reached by radio, while urban people watch more television. With funding for a pilot pro- gramme from UNICEF, Japhet started work in 1994 on a soap opera for TV called Soul City. By now he had been joined by Dr Shereen Usdin, another young doctor who was attracted by these innovative ideas for health promotion. Set in a community clinic in a poor, overcrowded township with a cast of eminently recognizable characters, Soul City is the centre- piece of the multimedia programme. Its 13 weekly, half-hour episodes are supported by a series of mini-dramas broadcast on radio in nine different languages, and by booklets covering the main health topics from Soul City which are serialized in the mainstream newspapers and then distributed as booklets free with the papers and in clinics. The advantage of this approach is that the various media complement and reinforce one another, explains Japhet. The electronic media are good at getting across broad mes- sages; print media are better at providing detail. Rural people are better reached by radio, while urban people watch more television. Believing that the vehicle is as important as the messages it con- veys, Japhet and Usdin have hired some of South Africa's best creative talent to put the dramas together. World Health • SOth Year, No. 6, November-December 1997 And to ensure that the messages are right, the story-lines are based on meticulous and widely inclusive research that takes up roughly two- thirds of the production time. Having decided on the topics - mother and child health in the first series ; HIV/AIDS, TB and smoking, and living conditions in the second - the Soul City researchers start with a literature and press review. Then they approach experts in the field to brainstorm about the messages to be communicated. And they then talk to the target audience through personal interviews and focus groups to find out what impact the health issues identified have on their lives. The creative team is also involved in workshops with the different interest groups. And on their own initiative, the scriptwriters spend days visiting townships and clinics to observe what goes on before they put pen to paper. Every script is tested again on expert consultants and representa- tives of the target audience. "This process is often neglected by people working in similar fields because it takes so much effort," says Japhet. "But it's absolutely vital. Without it we wouldn't have a product. We' d maybe have a popular TV series, but we wouldn ' t achieve anything with it." Independent evaluation of the first two series showed that the pro- gramme succeeded beyond anyone's expectations. Soul City 2 was the most popular show for children under 15, and among adults it was rated the first or second most popu- lar TV programme for six of the 13 weeks on air; 78% of survey respon- dents from informal settlements had tuned in to the programme, which reached an estimated 51 % of those with no schooling. There is statistical and anecdotal evidence of increased awareness (predictably, of some issues more than others) and even of some be- haviour change. For example, before Soul City 2 began, just over 60% of the target audience surveyed knew of a sexually transmitted disease (STD) other than AIDS. After the programme, 80% of those who had watched Soul City knew of another STD, while the figure remained at just over 60% for those who had not. Moreover, people volunteered the information that they would be careful to put paraffin out of reach of children and not store it in drinks bottles, that they would be more likely to use condoms during sex, and that they would ask friends not to smoke in front of the children, having picked up these messages The Soul City team meets representatives from other African countries who ore interested in the methods and ideas of the pro;ect. Photo WHO/ Soul City Pro;ect 25 from Soul City. The programme's success has helped in attracting finance. Soul City - which today is a non-profit organization employing 12 staff - does not pay for air time or print space. Indeed, television buys the drama series from the organization. The balance of funds comes from the Government, commercial sponsors, and aid donors - of which the European Union is the biggest. Interest in Soul City has come from all over Africa, and Japhet has recently produced a training docu- ment outlining the principles and processes involved in multimedia "edutainment". At home the team has broadened its scope to create life skills materials, based on the stories from Soul City, for use in secondary schools, and similar materials for adult basic education classes. This is a vital element of the programme, says Japhet. "The evidence that popular media can raise awareness of an issue and lead to a certain amount of behaviour change is very exciting. But it 's what happens on the ground that leads to the biggest shifts in attitude. From the beginning we intended to use what became popular in the media to facilitate initiatives at the grass- roots." • Susan Armstrong is a freelance writer and broadcaster specializing in health and science. For further information Soul City con be contacted at the following address: 7 Seventh Avenue, Lower Houghton, PO Box 175, Bergvlie 2012, South Africa (tel +27 11 728 7440, fox. +27 I I 728 7442, e-mail: soulcity@oztec.co.zo). 26 World Health • SOth Year, No. 6, November-December 1997 Sport sponsorship Addy Carroll The banning of tobacco sponsor-ship in Australia brought with it the establishment of health promotion foundations in a number of Australian states. It was their task to replace tobacco sponsorship so that sports and arts organizations which had received tobacco sponsor- ship in the past would not suffer hardship. Funded through a levy on state tobacco taxes, the health promotion foundations not only replaced to- bacco sponsorship with health spon- sorship but also were able to offer sponsorship to a range of sports, arts and racing activities not previously supported by the tobacco industry. Health promotion foundations there- fore became major players in the sports sponsorship arena, promoting health messages rather than smobng. This article outlines some of the achievements of sport sponsorship initiated by Healthway, the Western Australian Health Promotion Foundation. Healthway is the major sponsor of sport in Western Australia, providing over AUS$4m per year. Sport sponsorships have been allocated to a mix of activities and events from those in the elite and promotional category to grass- roots sport development programmes. Are sports enthusiasts appropriate targets for health promotion? We often think of people who are involved in sport as healthy. However, our research shows this is not necessarily the case. Despite a lower prevalence of smobng among sports club members, spectators and club members generally have ele- vated risk factors. Behaviours such as unsafe alcohol consumption, suboptimal fruit and vegetable Youngsters ;og ot a tennis tournament, demonstrating that exercise is good for health. Their T-shirts marked "Sun Smart" advertise efforts mode to raise awareness of the dangers of excessive exposure to the sun. Photo WHO/G. Wood consumption, poor sun protection practices and suboptimal exercise are at least as high, or in some in- stances higher, than in the general population who do not claim an interest in sport. Health sponsorship of sport can therefore hit the right target group. What can be achieved from sport sponsorship? Sponsorship is used as a strategy to expand and reinforce major health promotion campaigns in Western Australia. They cover the areas of tobacco control, safe alcohol use, prevention of skin cancer, physical activity, good nutrition and safer sexual practices. In sponsoring sport we focus on three areas: • educational opportunities; • promotional opportunities; • healthy environments or healthy structural change. Educational opportunities Sport sponsorship provides an ideal opportunity for educational activities to take place. There is no doubt that a coach or high-profile player, well respected by young people, who demonstrates as well as talks about the importance of appropriate health behaviour, can have a powerful impact. As part of our sponsorship with the Australian Football League, national league players visit schools in the country and city during Quit week (an annual week-long anti- smoking campaign) to give football coaching sessions and to reinforce the very important non-smoking message. World Health • SOth Year, No. 6, November-December 1997 This and the other strategies of our football sponsorship mean that football is very clearly linked with a non-smoking lifestyle in Western Australia. Sport also acts as a vehic le for health education in other ways. Parents receive "healthy recipe" cards when they attend games or functions; officials can attend sports medicine courses to learn how to reduce sport-related injuries in their teams; steps to safe alcohol use are outlined on posters in the club bar; and coaches pass on information about sun protection at training sessions. Almost 30% of sporting organi- zations claim to provide some form of educational input as part of their sponsorship. With the average Healthway-sponsored event reach- ing more than 4000 people, there is no doubt that sports sponsorship offers excellent opportunities for education. Promotional opportunities Promotion involves those things that give profile to the health message, such as signs, advertising, posters, and even the clothing for officials and participants in events. Promotional activities raise awareness of the health message in the community. Since awareness is the first step in the process of chang- ing health-related behaviour, it is vital that a high level of awareness of the health message is achieved. Health way's sport sponsorships achieve a 68% level of awareness of the health message which shows that people who go to sporting events are open to receiving such messages and that sponsorship is an appropriate method of getting the message across. Healthy environments Healthway uses sport sponsorship to achieve healthy environments in the sporting venues of high-profile national teams as well as in commu- nity sports facilities. The safe serv- ing of alcohol, availability of healthy food and establishment of sun-safe areas and smoke-free environments can all be achieved through sponsor- ship. For example, in relation to smoke-free policies, Healthway now expects all sport organizations which receive sponsorship to keep all indoor areas under their control permanently smoke-free. Gradually we are progressing towards all outdoor seated areas at sport venues becoming smoke-free. Currently spectators watching football, cricket, hockey or baseball at the major sporting stadiums in Western Australia can sit in the outdoor grandstands in smoke-free comfort! A further example of how sport sponsorship can achieve healthier environments is in the promotion of safe drinking habits at the bars of sporting clubs. Club members and those who attend sporting events in this state have a greater tendency towards unsafe drinking than the rest of the population. "Play Hard: Drink Safe" sponsorships encourage safe alcohol consumption and responsi- ble serving practices in sporting clubs by encouraging the provision of low-alcohol and non-alcoholic drinks with water freely available; increasing the range of light and mid-strength beers; introducing a pricing policy which encourages club members to choose lower strength beer and providing appro- priate training for those who serve the drinks. 27 For some time, sport sponsorship has been attractive to tobacco, alco- hol , soft drink and other commercial interests as a means of maintaining broad awareness and image via sponsorship. More recently, health promotion professionals have adopted many of the tools of commercial marketing and are now embracing sport spon- sorship as a means of extending existing health promotion campaigns as well as reaching appropriate target audiences at specific events cost-effectively. Sport sponsorships have proved that they are able to reach those whose behaviour is often at risk and can achieve important benefits in health promotion. • Ms Addy Carroll is Director, Wes/em Australian Health Promotion Foundation (Healthway}, PO Box 1284, West Perth WA 6872, Australia. Australian football role model Craig Turley introduces iunior players to the non-smoking message: kick butt out of your life Photo WHO/ G. Wood 28 World Health • SOth Year, No. 6, November-December 1997 Media advocacy for public health Simon Chapman A lethal habit like smoking is not always acquired knowingly; ii is on addiction encouraged for commercial purposes. A supportive social climate con protect vulnerable groups against such practices. Photo Panos Piclures/ 5. Sprague © All fields of public health face barriers to progress. These barriers can range from politi- cal opposition to legislative reform, inadequate resource allocation, media indifference to a health issue, or direct opposition to progress by vested-interest industries or commu- nity groups like the tobacco industry or the anti-immunization lobby. Rendering these barriers ineffective is a task that is as real and important to public health as the traditional objectives of health promotion: changing knowledge, attitudes and personal behaviours. "Advocacy" is a word that has been used for many years in health and medicine. In its earlier manifes- tations , it usually referred to actions taken on behalf of disadvantaged consumers of health and welfare services by those acting for them. Some hospitals had patient advo- cates who were the forerunners of today's patients' rights charters and health care complaint units. Ten years ago, the term began to ease its way into the vocabulary of public health, finding favour as one of the key words of the Ottawa Charter for Health Promotion. Books have been published on the subjects giving emphasis to the importance of strate- gically using the news media in advancing public health. The Hollywood film star Mae West once said "It's better to be looked over than overlooked", and the Editor of the Journal of the American Medical Association, George Lundberg, stated "In our society public media are irreplace- able as a mechanism for moving a problem to a solution". Politics is largely about the problem of multi- ple definitions of the same events. And so it is with public health advo- cacy. There are few public health problems for which neglect or oppo- sition does not stem from the way the problem is portrayed in the mass media and in the powerful political and other decision-making circles. For example, the gun lobby seeks to define gun ownership as a means of making communities safe (via arguments about self-defence, civil defence and deterrence), controlling vermin and encouraging sporting prowess. Gun control advocates seek to define liberal gun ownership laws as leading to unacceptably high rates of suicide, homicide and accidental injury. Massacres such as those in Dunblane, Scotland, and Tasmania, Australia, can be catalysts for these two competing definitions to be contested through the mass media. In both the cases mentioned, the arguments of the gun control advo- cates prevailed and radical gun law reforms were introduced. Then take the issue of passive smoking. The tobacco industry is terrified of the march of legislation and policies which ban smoking in public places and workplaces because, simply, these policies dramatically reduce the number of cigarettes smokers can consume over a 24-hour period. The indus- try 's response has been to use three principal strategies: attacking the credibility of the scientific basis of smoke-free policies, promoting a definition of the issue as one of World Health • SOth Year, No. 6, November-December 1997 freedom versus government- sanctioned intrusion on personal liberty, and attempting to capture the middle ground by appropriating "common courtesy" as a sensible solution. Tobacco control advocates counter that smoking indoors is about the selfish and unhealthy imposition of cigarette smoke, typically from a minority, on the preferences of the majority for smoke-free air. The average time for which quoted persons speak in an Australian television news bulletin is around eight seconds. This means that complex debates often need to be distilled into succinct "sound bites" which allow audiences to grasp the core principles of the way an issue is being defined. In the debate about passive smoking and restaurants, for example, Australian advocates of tobacco control have used the analogy that "a non-smok- ing section in a restaurant is as meaningless as a non-urinating section in a swimming pool." Gun control advocates pressing for gun registration have countered the negative connotations of bureau- cratic sounding "registration" by pointing out "we register cars, boats and even dogs ... what makes guns any different?" Skills at developing apposite sound bites are vital to effective advocacy. It is essential always to remem- ber that advocacy is a strategy, not a goal in itself. The desire to see greater media coverage is a common phenomenon in public health, but much media coverage fails the test of advancing public health goals. For this reason, it is fundamental to the success of an advocacy pro- gramme that its objectives are con- sidered carefully and evaluated against their contribution to specific public health goals. All advocacy planners need continually to ask themselves three questions with regard to public health problems: Prohibited guns are collected and destroyed as part of a government scheme for avoiding massacres. Anti-violence activists in Australia say that guns should be registered like "cars, boats, and even dogs". Photo Keystone/ AP / R. Rycroft© 1. What are my policy objectives? 2. What are my media advocacy objectives? 3. How will my media advocacy objectives help achieve my policy objectives? Examples of public health policy objectives that can be pursued through advocacy include: 29 • changing political will in favour of public health; • changing the social climate to support public health; • new or improved laws and regu- lations; • implementation of existing "dormant" laws; • changing resource allocation and funding; • changing institutional practices and priorities; • increasing service provision; • accelerating product modifica- tion (e.g. requiring all cars to be fitted with front and rear seat belts). With these purposes in mind, media advocacy objectives can include: • defining health issues from a particular perspective (e.g. pro- moting the concept of cigarette smoking as an addiction, not a choice); • changing the perspective of others' definitions of health issues where these hinder progress; • introducing and emphasizing new information; • reducing media coverage of the opposition; • enhancing the credibility of pro- health advocates; • reducing the credibility of the opposition (e.g. alerting people to the commercial motives behind research sponsored by the tobacco industry). • Dr Simon Chapman is Associate Professor of Public Health at the University of Sydney, Australia. For the past six years he has taught an annual course on media advocacy to Master of Public Health students at the University of Sydney. His address is: Department of Public Health and Community Medicine, University of Sydney, Westmead Hospital, Westmead, NSW 2145, Australia. He is also Deputy Editor of the iournal Tobacco Control. 30 World Health • SOth Year, No. 6, November-December 1997 News from the Regions Reaching out by radio Only half of all children with diarrhoea in Egypt ore treated with oral rehydration salts (ORS) by the people looking after them at home. This is not because ORS ore hard to come by- the diarrhoeal diseases unit of the Ministry of Health claims it has achieved nearly l 00% coverage with the salts, and a survey found that 95% of the population knew where to get them - but because many of the people don't know why or how to use them. "Giving ORS to children with diarrhoea" was therefore chosen as the priority message for a health education campaign launched during Egypt's national diarrhoeal disease control week in April, using radio as the medium of communication. During a five-day workshop in Alexandria that brought together staff from local and regional radio stations and from the national diarrhoeal diseases programme and health education unit of the Ministry of Health, a total of 12 radio "spots" were developed in four dialects spoken in the country. The spots encouraged carers at home to give ORS as soon as a child developed diarrhoea and to accept this as sufficient treatment for the condition. (Research shows that various drugs ore often used.) Supporting messages were the importance of giving extra fluids to avoid dehydration, how to mix ORS correctly, the need to continue feeding a child suffering from diarrhoea, and when to seek medical attention for serious cases. Families are routinely given information on how to manage children's diarrhoea at home. They receive advice from health staff at clinics, from wall posters and health cards, and at special Oral Rehydration Therapy Centres which hand out packets of ORS. Radio was chosen for this campaign because it reaches huge numbers of people of all educational levels and social classes. There are 11 radio stations broadcasting in the different dialects of Arabic; virtually every household in Egypt has a radio; and almost 80% of the adult population - especially those in rural areas - ore regular listeners. Moreover, women, who usually take core of sick children, listen more to radio than do men. The workshop participants aimed for simple, clear and unthreatening messages that appealed to the emotions of mothers, grandmothers and other corers at home. Before they broadcast the spots they tried them out on a large group of women attending health centres with their babies, and made adjustments to the scripts in the light of their reactions. Using the mass media effectively for health communication depends on the commitment of all players to the idea, so the personal involvement of the director of local radio stations in the Alexandria workshop was seen as a key to the success of the campaign. Polio will soon be history in the Western Pacific Polio is well on the way to eradication in the Western Pacific Region of WHO after a concerted immunization campaign begun in 1993 that reached more than l 00 million under·five-yeor-olds in seven polio-endemic countries. The number of reported cases in the region dropped from over 6000 in 1990 to just 21 in 1996. By mid-1997 only 9 cases had been reported. But Regional Director Dr S. T. Han says there is no room for complacency. "In spite of successful national immunization days, there are still children who remain unimmunized in areas difficult to reach." To tackle this problem, countries ore using a specially intensive strategy called "high-risk response immunization" (HRRI) . Mobile teams of health staff and volunteers immunize from house to house or from boat to boat on the waterways of the region to reach previously unimmunized children. In May and June this year, over two million children were vaccinated against polio in two rounds of HRRI in Cambodia, the Lao People's Democratic Republic and Viet Nam. In June WHO's Technical Advisory Group on Polio Eradication met in Manila to set guidelines for all components of the programme. The group focused special attention on supplementary immunization activities, and on the laboratory network, since laboratory-based surveillance is essential to identify any remaining reservoirs of polioviruses. With stepped-up efforts around the region, polio should soon be past history in the Western Pacific. Do you have something to say? If you have commen ts, ideas or suggest ions on any of the topics covered in this issue, p lease wr ite to the Ed itor, World Health , Worl d Hea lth Organization , 12 1 l Geneva 27, Switze rland. Letters should be not more than 250 words in length. Letters will not necessarily be acknowledged. The Ed itor reserves the right to ed it materia l selected for publication. World Health • SOth Year, No. 6, Nove mber-December 1997 31 WHO publications Publications con be ordered from Distribution ond Soles, WHO, 121 1 Geneva 27, Switzerland. Stopping the spread al disease by vector control Vector is the word used to describe an insect or other creature that carries a disease from one person to another. Around the world, many common and dangerous diseases - such as malaria, filariasis, leishmaniasis, schistosomiasis, dengue and trypanosomiasis - are carried by vectors. Vector control aims to reduce the spread of disease by getting rid of, or avoiding, the vectors that carry it. Vector control: methods for use by individuals and communiffes is a new manual that gives practical information on how families and communities in both rural and urban areas can protect themselves from vector-borne diseases. Most of the methods are simple and cheap, do not require much training, and are safe both for the user and for the environment. The manual deals with all major disease vectors and pests - mosquitos, tsetse flies, triatomine bugs, bedbugs, fleas, lice, ticks, mites, cockroaches, houseflies, water fleas and freshwater snails. For each group of vectors there is information on biology, public health importance and control measures. Vector control : methods for use by individuals and communities {ISBN 92 4 154494 5) costs Sw.fr. 132 -/US $ I 18. 80 {Sw fr 92.40 in developing countries). Reducing health damage from • • po1son1ng Poisoning is believed to cause about half a million deaths every year. Exposure at work to agricultural and industrial chemicals, exposure to chemical contamination in the environment, and household accidents that involve common commercial and pharmaceutical products all contribute to the growing extent of poisoning worldwide. Although the size and circumstances of risk vary from country to country, massive expansion in the availability and use of chemicals in many spheres of human activity means that the risk of poisoning is hard to avoid. Many countries have set up poison control programmes and specialized centres for the diagnosis, treatment and prevention of poisoning. Others are laying the foundations for such programmes. Guidelines for poison control is a new WHO manual that aims to help ensure the best use of resources in setting up poison control or making it more effective. The manual, which draws on the experience of established poison control centres throughout the world, deals with the clinical, analytical and information services that must be provided, the prevention of poisoning, the availability of antidotes, and the crucial elements of response to major emergencies involving toxic chemicals. Guidelines for poison control {ISBN 92 4 154487 2) costs Sw.fr. 35.-/US $31.50 {Sw.fr. 24.50 in developing countries) Making sure drugs are sale and effective Global expenditure on medical drugs is enormous. In some developing countries the proportion of the health budget spent on drugs is higher than 40%. With a proliferation of drugs on the market it is essential to make sure that they are relevant to priority health needs and that they are safe, effective and of acceptable quality. WHO has long been concerned to assist governments in regulating and controlling drugs. The recent publication of Quality assurance of pharmaceuticals: a compendium of guidelines and related materials represents part of this effort. The book brings together in one volume a collection of international recommendations aimed at assuring the quality of pharmaceuticals. The sets of recommendations have been published over a number of years in separate reports. They cover assessment of drugs, registration, distribution, basic tests, laboratory services, international trade, counterfeit products and personnel training, as well as recommendations relating to The international pharmacopoeia. Quality assurance of pharmaceuticals: a compendium of guidelines and related materials, Vol. 1 {ISBN 92 4 154504 6) costs Sw.fr. 50.-/US $45.00 (Sw. Fr. 35.- in developing countries). In the next issue Did you enjoy this issue? Why not take out o subscription to World Health ond enjoy reading about the world 's major health issues six limes a year. 1998 subscription prices are listed below. World Health Day 1998 , 7 April , w ill be devoted to Sa fe M other- hood . The January-February 1998 issue of World Health will mark thi s day by describ ing the many creati ve approaches adopted in differen t countr ies to ensu re that women rece ive the professional care req ui red fo r sa fety and happiness in pregnancy, childbirth and motherhood. • W HO olso offers its popular ' Health Horizons' subscription, a combined subscription (ol a reduced role) lo World Health and the quarterly World Health Forum. Order form D World Health ( 1998 subscription) al Sw. fr . 30 - /US $25.00 D Health Horizons ( 1998 subscription) al Sw. fr. 90.- /US $72.00 D Payment enclosed D Please charge lo my credi t card D Visa D American Express D Eurocard/ M aslercard/ Access Card number _________ _ Expiry date ___ Date of order __ _ Signature __________ _ N ame _____ _____ _ Address __________ _ World Health Organization, Distribution ond Sales, 1211 Geneva 27, Switzerland. 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