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Pushing the Boundaries of Health Communication: Trends and Challenges Rafael Obregon, Ph.D. School of Media Arts & Studies Communication & Development Studies Ohio University Roskilde University, Denmark May 4 th , 2010. We Have Met the Enemy and He Is PowerPoint.

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Pushing the Boundaries of Health Communication: Trends and Challenges Rafael Obregon, Ph.D. School of Media Arts & StudiesCommunication & Development StudiesOhio UniversityRoskilde University, DenmarkMay 4th, 2010

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We Have Met the Enemy and He Is PowerPoint

Pushing the Boundaries of Health Communication: Trends and Challenges Rafael Obregon School of Media Arts & StudiesCommunication & Development StudiesWe Have Met the Enemy and He Is PowerPointOhio University, USACommunication for social change: Lessons learned from public healthRoskilde University, DemarkMay 4th, 2010

“When we understand that slide, we’ll have won the war,” General McChrystal, NY Times, April 27th, 2010

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Outline of Presentation

  • A quick tour of international health communication experiences

  • Health Communication and Communication for Social Change

  • Trends and Challenges

  • Conclusions

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A quick tour of international health communication experiences

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Public Debate and Social Mobilization on HIV/AIDS and Children’s Rights in Southern Africa

  • Theory and research-driven process

  • Multimedia / multi-strategy /multi-communication channel platform - contributes to addressing health issues in southern Africa

  • Change at individual, community, social and policy levels

  • Promotion of public debate and discussion

  • Changes in social norms

  • Focus on community engagement

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Community Dialogue and Women’s Rights and Empowerment in the Amazon

Minga Peru

  • Constructivism, interculturality and dialogue to address gender-based violence and promote women’s rights

  • Radio magazine Bienvenida Salud, education, and income generation – focus on voice and social determinants; long-term approach

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Positive deviance and nutritional improvement of children in Asia and Africa

Positive deviance (PD) - approach to social and organizational change that enables communities to discover wisdom they already have, and act on it

Focus on local/within community solutions and resources

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Complexifying social mobilization in health communication: learning from polio communication

  • Activist SM - community participation and empowerment - bottom-up approach: communities express demands, define goals, make key decisions

  • Pragmatist SM - means to strengthen health services and achieve goals

  • Competing understandings of SM

  • Media as social and political

  • institution

  • Interpersonal comm as dialogue

  • and engagement

  • Gender

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ICTs and access to information in South Africa – Cell Life

  • Mass messaging for prevention;

  • Mass information for positive living;

  • Linking patients and clinics;

Peer-peer support and counselling;

Building organisational capacity of HIV-related organisations;

Monitoring and evaluation.

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News agendas and children’s rights in Brazil - ANDI

  • Media monitoring

  • Social mobilization

  • Capacity strengthening and editorial analysis

  • Accountability

  • Social control

  • Media, democracy and governance

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What key concepts emerge

from those experiences?

  • Voice

  • Public debate and dialogue

  • Participation and engagement

  • Empowerment and agency

  • Rights and citizenship

  • Social mobilization

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Health Communication

and Public Health

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care delivery system


Assuring the Conditions for Population



Public Health Infrastructure


and Business



The Public Health System

Institute of Medicine, Public Health in the 21st Century, 2003

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Health Communication

Health Communication

Health care delivery

Promotion of public health

Interpersonal Communication

Mediated Communication


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Health Promotion Principles














  • Developing personal skills

  • Building healthy public policy

  • Creating supportive environments

  • Support/promote community action

  • Re-orientation of services

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Broad social, economic, cultural, health, and environmental conditions and policies at the global, national, state, and local levels

Living and working conditions


Social, family and community networks

Individual behavior


individual traits:

age, sex, race, and




The biology of


Over the life span


Social determinants of health

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

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Health communication can…

  • Increase intended audience’s knowledge and awareness of a health issue, problem, or solution;

  • Influence perceptions, beliefs, attitudes that may change social norms; prompt action; demonstrate or illustrate healthy skills;

  • Reinforce knowledge, attitudes, or behavior;

  • Show the benefit of behavior change;

  • Advocate a position on a health issue or policy;

  • Increase demand or support for health services;

  • Refute myths and misconceptions;

  • Strengthen organizational relationships

Freimuth, 2004

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Conceptual trends in communication for social change and health communication

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C4D Continuum: Approaches/Theories/Models

(adapted from Obregon & Mosquera, 2005)







Social Marketing








For Social


Social Ecological Approach

Convergence model

No magic formula

New conceptual approaches + diversity of frameworks + diversity of strategies

+ multiplicity of interventions = (Growth of the field)

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Health Communication Continuum: Approaches/Theories/Models

(Adapted from Obregon & Mosquera, 2005)

  • While the field is largely dominated by two theoretical models, its ability to generate new conceptual approaches to development is the result of a creative convergence of diverse frameworks, strategies and interventions.





Behavior Change Communication










Social Marketing


For Social




Social Marketing

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Communication for social change and health promotion

People as objects Agents of own change

Delivering messages Supporting dialogue/debate

Individual behaviour focusSocial norms/policies/culture and supportive environments

Persuading people Negotiating the best way forward

Away from technical expertsPeople affected in central role

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Context & the UNAIDS HIV/AIDS Communication Framework

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Communication, Culture and Health

Communication campaigns with common-denominator messages relevant to most audiences

Unified campaigns with systematic variations in messages to increase relevance for different audience segments, retaining one fundamental message

Developing distinctly different messages or interventions for each audience segment

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Communication, Culture and Health

  • Culture as a central element in health communication

  • Two approaches (Dutta, 2009)

    • Cultural sensitivity

    • Culture-centered

  • Two levels (Resnicow and Braithwaite, in Freimuth 2004)

    • Surface structure

    • Deep structure

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  • Audiences and Health Communication

  • Powerful media assumptions in many health communication campaigns

  • Effects of health messages

  • Limited attention to audience reception and negotiation of meanings

  • Analysis of reception of health messages – an audience perspective

  • Media ethnography and reception studies

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Trends in health

communication practice

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Trends in HC practice

  • Evaluate communication strategies and tactics and identify under which conditions they function more effectively

    • Maximize resources/impact

  • Identify strategies for synthesis and integration of multiple data sources

    • Epi data – Polio

    • Socio-demographic data-marketing – audiences/lifestyles

    • Qualitative / ethnographic data /sense-making

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Trends in HC practice

  • Integrate communication strategies into broader public health initiatives

  • Evaluate aspects related to cost, reach, impact, etc.

    • Interdisciplinary teams

  • Create trust and credibility

    • Prepare audiences

  • Ethical Considerations

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Challenges in health

communication theory and practice

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Incorporating increasing theoretical growth and interdisciplinarity – from public health, communication, and other disciplines

Reflecting trends toward theoretical and methodological convergence– strategic and catalyzing; participatory; multimedia; change at different levels

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Addressing structural issues that determine people’s health or create vulnerability

Responding to increased (donor) pressure on demonstrating impact of interventions

Incorporating innovative evaluation methodologies - ethnographic approaches that provide deeper understanding of complexity of public health issues

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Positioning itself as a legitimate field through professional and graduate level training (i.e. MPH/SBCC program at Univ of Witwatersrand)

Emphasis on competency-based training

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Final thoughts

Growth of health communication as field – different approaches

Expansion of health communication thinking and integration into broader development and social change issues

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Social change starts with public debate

Amartya Sen

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Thank you…time for questions…

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