"Next steps" consultation paper

CAMPAIGN DEVELOPMENT MEETING
TURKU, FINLAND
13-14  June, 2005
 

"Next steps" consultation paper

Franklin Apfel

Introduction

The HIV/AIDS Ask? And Act! It’s Your Health campaign is a globally-supported, locally-applied set of activities aimed at catalyzing a broader demand for HIV/AIDS prevention and treatment information (and supportive policies) and strengthening the capacity of health leaders and information mediators to respond effectively.  The Campaign aims to strengthen existing HIV/AIDS treatment and prevention programmes by engaging relevant stakeholders in identifying and addressing information-related obstacles to uptake of treatment, especially issues of stigma and discrimination.

Six high-risk HIV/AIDS cities affiliated with the WHO Healthy Cities Network – Izhevsk (Russian Federation), Riga/Jurmala (Latvia), Kaliningrad (Russian Federation), Kiev (Ukraine), St Petersburg (Russian Federation), and Tartu (Estonia) – have been conducting media audits in their information marketplaces as a first step to launching city-based model campaigns.  This meeting convenes all principal municipality-based organisers to share the results of their audits and explore next steps.  This consultation paper explores some campaign development ideas for cities to consider.

 
Why a Healthy Cities HIV/AIDS information campaign?

Campaign ideas

As noted above, the HIV/AIDS Ask? And Act! It’s Your Health campaign aims to increase "demand" for HIV/AIDS information and enhance the "supply" and competence of key communicators to respond.  Here are a few ideas for activities to help get discussions going. 

1.  Increasing Demand

Our challenge here is not just about "aiming messages at people - telling people what to do and what not to do.  Instead, it is much more about stimulating demand for accessible information and helping information mediators to support the public to understand, debate and come to its own conclusions ... to consider the public not as objects of change, but as agents of their own change." (Wallack et al, 1999)

1.1 Ten questions

Can you remember how "engaging" kids can be when they are in the "why?" stage of development?  "Why is this?"  "Why is that?"  This campaign concept builds on this attention-getting approach by encouraging high-risk populations and those who care for them to ask key questions of providers, systems, and policy makers.


All participants are being asked to identify 10 key questions that can form the basis of a campaign.  These questions will need to reflect the "framing" realities of each city context.

How nice it would be to have common, simple-to-understand messages with which to confront our various target audiences: messages with wake-up radio, pictures on breakfast cereal boxes, adverts in municipal public transport, public billboard space, newspaper features, pharmacy "ask about your medicine" point of sale campaigns, literature in GP surgeries, clinics and hospitals, ribbons and logos on sports teams, rock lyrics, football uniforms, schools and meeting places for young people, shopping mall displays, drug package inserts, pharmaceutical detail materials, youth web pages and games, free confidential screenings, needle exchange programmes, condom machines in bars, etc, etc, etc.

1.2 Media Advocacy Training[8]

Media audits all reveal that the voice of young people and people living with HIV/AIDS is often missing.  Media training and support to young persons, PLWHA and those working with them can help get their voices heard and change the media agenda.
 
Box 1

Checklist : Questions for Media Advocacy Development

2.  Enhancing Supply

2.1 Communication Network Building

People's and policy-makers' choices, perceptions and behaviours are shaped by the health information marketplaces within which they work, play and live.  These marketplaces are all too often dominated by economic and political forces, with public health and development concerns being marginalised.

Tackling HIV/AIDS challenges, like all other aspects of health systems strengthening, requires communication and advocacy activities to engage relevant stakeholders and to elicit and sustain high-level political commitment for the necessary structural changes.

There are many reasons why public health communication capacities are underdeveloped.  Communication tends to be seen as a support area to technical activities and not the core public health competency it truly is.  Investment in communication has been seen more as a public relations tool and as such a benefit to the sponsoring organisation rather than to end users.  Additionally, different public health communicators (eg government spokespeople, scientists, NGO advocates, industry marketers, and the media) tend to operate in isolated categorical 'silos', with more reactive critiquing of each other's work than proactive cooperation.  In short, there is poor communication between communicators.  Communicators who should be working together are suspicious of each other's motives, proprietary about their information and often lack knowledge of and sensitivity to the reality of each other’s ways of working.

This campaign approach aims to overcome these obstacles and initiate processes that will support desired HIV/AIDS prevention and treatment programmes while developing sustainable public health communication networks.

2.2 Healthy city based communication networks

Envisioned is a developmental approach which would 'reach out' to involve and support key health communicators, including media, NGO advocates, health professionals, government public information officers (PIOs), health promoters and educators, and industry marketers.  It would facilitate the engagement of these various communicators as full partners in support of HIV/AIDS programmes and initiatives.

The experience of the European Health Communication Network (EHCN) is quite relevant here (see Box 2).  It showed that strong working partnerships could be developed between WHO technical staff and the communicators involved, including journalists.  Technical staff and national counterparts become important sources for stories, and story quality and impact tend to improve.  Evidence from national health communication networks in Moldova (see Box 3) and Kyrgyzstan point to significant increases in quantity and quality of media coverage.[9]

Network activities might include communication training, development of tools, information exchange, joint project work.  See Annex 1 for some additional considerations.
 
Box 2
European Health Communication Network (EHCN)

Established in 1997 by the WHO Regional Office for Europe, EHCN linked over 2000 communicators in the 51 countries of the WHO European Region. Five groups of health communicators were targeted: government spokespeople, public health educators, advocates, advertising agencies and the media.

EHCN's goals were:


EHCN was engaged in networking, training, the Health in Europe broadcast initiative, education/travel grants, advocacy toolkits and publications, and international partnerships.

Box 3
Case Study – Republic of Moldova

In the Republic of Moldova, the WHO EHCN secretariat was asked by the Ministry of Health to help identify ways to improve communication of the country's health reform.  The Ministry indicated that the media were very negative and "only interested in scandal".  A survey indicated that the media did indeed feel negatively about the government because "they never got any useful information from them".  Ministry spokespeople, on the other hand, reported that they thought "the media were lazy" as they never did anything with the reports they gave them regarding the reform.  Additionally, it was discovered that an NGO that had done significant research on an essential drug policy (a key proposal of the health reform) had never been able to get an appointment with Ministry officials.  Clearly the problem, solution and power to make necessary changes lay with the Ministry.  The EHCN convened a network meeting at which media, NGOs and the Ministry participated.  All were presented with the results of the survey.  By bringing all the significant actors into the same room and agreeing on common interests (such as essential drug availability), the group was able to identify new administrative policies that improved their communications and effectiveness.  The Ministry established a press office and started issuing short press notes.  Over the next six months there was a significant rise in both the quality and the quantity of health reporting in the country.

Summary

The Baltic Healthy Cities are well positioned to address these HIV/AIDS communication challenges and provide the facilitative leadership that coordinating this process requires.  "Facilitative leadership" is defined here as open, participatory leadership that "catalyses, enables and supports" as opposed to "directs and commands".  Specialists dealing with the social complexities of Healthy Cities can add value to current HIV/AIDS prevention and treatment efforts and in so doing create sustainable public health infrastructures.

Annex 1


Healthy City Communication Networks (HCCNs)
Draft for discussion - drawn from previous EHCN documents
 

Privileges


Membership privileges include access to Network information products, including: embargoed press material; broadcast rights to the Health Broadcast series video materials; training; travel grants for members to participate in newsworthy events, workshops and conferences; key health and environment expert contacts; opportunities to bid on international broadcasting production contracts; and opportunities to develop Network programs and policy initiatives.

Responsibilities

Network members are health, economic, labour or education communicators.  They understand the power of communication to shape policy and people's perceptions, behaviours and choices.  Network members are committed to improving the health of their constituencies.  Network members' actions build upon a commitment to fairness, equity and social justice.  Members are committed to improving their own skills and are willing to help others.  Network members work towards realizing the EHCN ethical guidelines for health communicators[10] (see box below), and to recruit new persons into the network who could contribute to and benefit from membership.

Target audience

The HCCN targets people who can influence health policy.  Five 'actor' groups of health communicators are targeted: government spokespeople, public health educators, advocates, advertising agencies, and media.  All these groups are key contributors to and users of the network.

Management

 
Box 4
EHCN guidelines for professional health communicators[11]

Exchange between network members

The HCCN is not a public relations vehicle for any organisation.  Its strength relates to the quality and relevance of its activities in support of its members' efforts to enhance population health literacy, promote healthy choices and behaviours, influence public policy, and stand up to the hazard merchants who are the current dominant force in all health communication marketplaces.  Exchange between network members is at the core of all activities.

 

[1] GFATM round 5 includes Ukraine and Russian Federation.  Previously included Estonia.  WHO 3x5, Dfid (UK), NORAD, SIDA, DANIDA, USAID, etc are investing in HIV/AIDS prevention and treatment.  OSI has for many years invested in harm reduction programmes.

[2] Global business alliances and a wide variety of companies are investing in infrastructure and communication development projects, as potential market for HAART drugs and others is large.

[3] Several DGs investing in HIV/AIDS programmes.  Major information campaign to be launched through DG SANCO by Dec 2005; the new European Center for Disease Prevention and Control will be involved.

[4] WHO/EURO, UNAIDS and UNDP reports 2004.

[5] WHPA: World Medical Association (WMA), International Council of Nurses (ICN), International Pharmaceutical Federation (FIP).  In 1999, nurses, physicians and pharmacists joined forces, creating a unique alliance to address global health issues, striving to help to deliver cost-effective, quality health care worldwide.  The WHPA, speaking for more than 20 million health care professionals worldwide, assembles essential knowledge and experience from key health care professions in these three important sectors.  Nurses, pharmacists and physicians are key players in the health team – delivering health care to individuals, families and communities regardless of their colour, creed, gender, religion or political affiliation.  The WHPA aims to facilitate collaboration between key health professionals and major international stakeholders such as governments, policy-makers and WHO.  By working in collaboration, instead of along parallel tracks, the patient and health care system benefit.

[6] Much evidence exists regarding media communication as a determinant of health.  Maria Pallman (1997) states: "Gerbner [1985] classified mass communication as a form of 'institutionalised public acculturation', side by side with religion and public education or formal schooling.  According to Rettig [1992], the media's role in health policy deserves more analytical scrutiny because ignoring it, by definition, ignores the policy contribution of a major social institution and Nelkin [1991] argues that the most critical source of public information are the media, shaping public perceptions and how the individuals and social institutions respond to disease."

[7] In Preparing a Health Care Workforce for the 21st Century (WHO 2005), core competencies are listed as Patient-centred care; Partnering; Quality improvement; Information and communication technology; Public health perspective.  Communication and advocacy skills are implicit in these core competencies.

[8]  "Advocacy is speaking up, drawing attention to an issue, winning the support of key constituencies in order to influence policies and spending, and bring about change.  Successful advocates usually start by identifying the people they need to influence and planning the best ways to communicate with them.  They do their homework on an issue and build a persuasive case.  They organize networks and coalitions to create a groundswell of support that can influence key decision-makers. They work with the media to help communicate the message. Obviously, political protocol, media etiquette and social values vary widely from country to country: advocacy tactics that work in London might not be appropriate for Izhevsk." (WHO, 1999)

"The critical element of an effective media advocacy effort is that it is strategic. This means that you always need to assess your use of media in relation to and in support of, rather than instead of or isolated from, other approaches. Policy struggles are not easily nor quickly won, so community organizing is an important way to build support for your desired outcome and apply pressure on those whose decisions you are trying to change. You must assess various policy options and see which have the best chance of success in your political environment, and scout out potential allies and enemies in your effort." (Wallack et al, 1999)

 

[9] Reported at EHCN meeting, Bratislava 2001.

[10] These journalistic guidelines were developed by journalists for journalists, in conjunction with the PressWise Trust, the International Press Institute and the International Federation of Journalists.

[11] While such codes are often more frequently honoured in the breach than the observance, they provide a code of honour and a common commitment to responsibility: a standard that can bind communicators whether they work at village, city, country or global level; a common understanding of what is fair, what is equitable, and what is right