WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU R~GIONAL OU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Thirty-eighth session Beijing 8-14 September 1987 Provisional agenda item 16
WPR/RC38/12 20 May 1987 ORIGINAL: ENGLISH
COMMUNICATION AND HEALTH Report by the Regional Director
During its thirty-seventh session, the Regional Committee decided to select the subject of informatics for the Technical Discussions in 1987. However, some representatives indicated that the topic Communication and health was also deserving of attention, particularly as health education in general is an important tool in the promotion of health and, furthermore, is one of the essential components of primary health care. Communication and health, as outlined to the Regional Committee at its thirty-seventh session, focuses on social marketing as an aggressive approach to stimulate the public and motivate it to modify its behaviour. It depends on the use of communication methods such as the mass media to bring about such motivation. However, there are other approaches under this item which the Committee may wish to consider.
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1.
INTRODUCTION
Communication and health is a subject which covers a very broad area and is currently undergoing considerable refinement. New approaches for influencing public behaviour are being introducedt new technologies in the mass media continue to be developedt and social research is adding to our understanding of how human societies wo·r k and how people react to attempts to influence their behaviour. Everyone will be familiar with the methods of traditional health education. Health workers teach people about health through individual counselling and group meetingst utilizing various educational media and technologies. Another common approach is the use of the school system and other institutions employing the teacher-learner relationship to encourage the adoption of healthy practices. Much still remains to be done in the way of developing school health curricula and strengthening the education system for health. Nowt howevert other concepts and approaches within the broad field of health education are coming to the fore, some of them already familiar, others in the process of becoming popularized: the advocacy approach, social marketingt use of traditional art forms and mediat the adaptation of traditional forms to modern developments in mass communication such as the radio and television, the application of other audiovisual technology, and the use of regular news and information channels to impart health information. Member States already have some insights into how radio drama or plays and discussion programmes can promote healthy behaviour; traditional drama has also adopted health themes which have become part of the popular entertainment at the village level in many countries of the Region. WHO has already collaborated with several governments in building up the skills of scriptwriters for producing radio dramas on healtht for example, in Fiji, Papua New Guinea, Solomon Islands and Vanuatu. All of the fields mentioned above are open to further development. Each method has its advantages and disadvantages, its different approaches and different target audiences, whether large or small. In further developing its health education programme, each country will have to decide which particular mix of approaches is appropriate, according to its resources and capabilities. However, this paper is particularly concerned with recent developments in communication and health, that is, the use of mass media to reach the general public.
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To begin with, it would be especially useful to examine more closely the most recent concepts which have been added to the vocabulary of health education: social marketing and advocacy. The advocacy-for-health approach is still in the process of being clarified in order to determine specific ways in which it can make an Social marketing is one impact on the health of the public. component of the advocacy approach which has received much attention and is already recognized as a useful tool.
2.
ADVOCACY FOR HEALTH
Advocacy for health implies the transfer of meaningful health messages from institutions and other sources which possess the knowledge (WHO, the health ministries, nongovernmental organizations, etc.), through intermediaries wherever possible, to each individual member of society. Advocacy for health implies a broad dialogue between individuals and communities, on the one hand, and the social sectors, including health, on the other. The goal is the promotion of the health-forall philosophy, with its assumption that individuals can accept much of the responsibility for their own health, once they understand how it is possible to do so. The issue is to promote health-for-all concepts within the limits of what a country and its people want and can afford. Health advocacy must be target-oriented and rely on clear, well-designed messages. In broad terms, the advocacy approach is targeted not so much on the existing consumers of health care as on the underserved and unmotivated members of society. Health advocacy can take many forms and operate at many levels: (1) (2) At the policy-making leadership. level, to reach the political
At the intermediate level, to furnish a pool of health advocates with the necessary materials for use in their respective spheres (e.g. religious leaders, teachers, employers, trade union leaders, agricultural extension workers, health professionals, health workers, mass media professionals, etc.). Finally, at the village level, where advocacy can take place in the context of community interactions, and where feedback must be obtained in designing health advocacy messages.
(3)
It is apparent that the media, including mass media, have a very important role to play in advocacy for health.
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3.
SOCIAL MARKETING
3.1
Social marketing as a component of advocacy component of the broader
Social marketing may be viewed as a concept of advocacy for health.
Social marketing for health aims to modify individual behaviour on a mass scale, so that people will realize what is necessary to lead a healthier life and take the necessary action themselves. Social marketing is a strategy for translating scientific findings about health and nutrition into education and action programmes, using the mass media as its major vehicle and applying the methodologies of commercial marketing. The methodologies it borrows from include market studies, target group analysis, creativity in message design, strategy and planning to make particular use of visual media impact, etc. The overmarketing of products like cigarettes, non-nutritious foods, breast-milk substitutes and unnecessary drugs is an example of this marketing process at its worst, reinforcing negative health trends. To counteract this, social marketing can establish new ways of thinking. It shapes practices, services and previously intangible ideas into "products" to be marketed. Social marketing encapsulates ideas in short messages which seize the imagination. It is a method which uses all available techniques, sometimes with a persuasive or emotive approach, appropriate to the target audience. The Alma-Ata Declaration designated "education concerning prevailing health problems and the methods of preventing and controlling them" as the first of eight essential activities in primary health care. The adoption of primary health care and the emphasis given to media by the Technical Discussions held in conjunction with the Thirty-sixth World Health Assembly, provide a strong rationale for the adoption of social marketing techniques. 3.2 Social marketing as a tool for development
In order to be successful, social marketing approaches need to start with research into the communities where they are to be used, to determine cultural norms, values and beliefs that have a bearing on the design of the message. Social marketing approaches must be tested and refined in the community itself, with the participation of its members, to ensure the receptivity of' messages and their effectiveness in modifying people's behaviour patterns. With the continuing development of mass communications in the Region, governments may wish to consider new investments in this area. The type of media to be used (whether television, radio, print media, etc.) will need to be considered. Training of suitable staff will also be necessary.
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An important feature of this training will be the development of leadership and management skills, particularly in the context of advocacy for health. For this, the cooperation of a wide crosssection of health and media personnel will be needed at all levels, so that their knowledge and skills can be channelled into advocacy via the mass media. The development of such leadership and management for advocacy is an integral part of the "Health-for-All Leadership Development Initiative" launched by the Director-General of WHO in 1985. The initiative sets out to strengthen national capabilities, particularly of those in leadership positions in health and related sectors who play a major role in meeting the challenges of health for all by the year 2000. It aims to develop leaders with a strong motivation and sense of direction, who, where necessary, can define new collective goals and create the appropriate structures to meet those goals. This leadership is considered to be necessary in every unit of the health system, including the national policy-making level, for generating commitment to the health-for-all goal. The fostering of health for all through the advocacy approach and the opportunities presented by the mass media is one such area where this leadership needs to be developed. Organizational skills and creative vision are both a part of this special kind of leadership. The impact that a social marketing approach to health education .will have on broadcasting policies will also need to be examined. For example, there is a wide spectrum of broadcasting systems in the Region (whether for television or radio), ranging from statecontrolled and state-financed broadcasting to privately owned stations financed entirely by commercial revenues. There is a middle ground which mixes commercial interest with public interest: for example, where governments stipulate that a certain amount of air time should be made available for programmes and messages promoting public interests, without any commercial fee being charged to the agency concerned. A question that arises, therefore, is, how can policies on broadcasting be modified to accommodate the valuable health messages that are to be conveyed by the social marketing approach? This agenda item is designed States the directions in which activities can proceed. in part to elicit from Member their communication-for-health
The Committee may therefore wish to discuss the activities enumerated in the following list and, if necessary, propose other initiatives, arranging them in an order of priority, so as to guide the Regional Director in his subsequent actions.
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(1) (2)
Development of capabilities for incorporating social marketing techniques into radio and television broadcasts. Development or strengthening of expertise for the production of radio dramas on health, or for other information-type programmes on health for the media. Development of other traditional media, such as puppet shows or indigenous drama. Building up of journalistic capacity for the production of news, feature articles and advocacy articles on health for the print media and radio. Strengthening of audiovisual capacities. Any other activities proposed by the Committee.
(3) (4)
(5) (6)