Presentation on theme: "Risk Communication in Health Promotion"— Presentation transcript:
1Risk Communication in Health Promotion S. ThavarajPengarah R&DMalaysian Health Promotion Board(MySihat)
2Health PromotionHealth promotion is the process of enabling people to increase control over, and to improve their health (Ottawa Charter for Health Promotion. WHO, Geneva,1986).The Ottawa Charter for Health Promotion identifies basic prerequisites for health (e.g. education, shelter, etc) and outlines priority action areas (e.g. building healthy public policy).The Ottawa Charter follows a structural approach to promoting health, driven by the core values of social justice and equity (Raphael, 2003; in Hofrichter Health and Social
3Health PromotionHealth promotion represents a comprehensive social and political processIt not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health.
4Health PromotionHealth promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health. Participation is essential to sustain health promotion action (World Health Organization Health Glossary 1988).
5Health PromotionIn 1984 the World Health Organization (WHO) Regional Office for Europe defined health promotion as "the process of enabling people to increase control over, and to improve, their health”.
6Health Promotion: WHOIn addition to methods to change lifestyles, the WHO Regional Office advocated "legislation, fiscal measures, organisational change, community development and spontaneous local activities against health hazards" as health promotion methods.
7Health Promotion and Behavior Risk Factors (relevance to Risk Communication) There is a tendency among public health officials and governments—and this is especially the case in liberal nations such as Canada and the USA—to reduce health promotion to health education and social marketing focused on changing behavioral risk factors.
8Health CommunicationHealth communication can be defined as "where health promotion and communication meet" (Hershfield & Rootman, 1996).Health communication involves the dissemination of health information through the media via the use of various communication techniques (Nutbeam, 1998).It aims to improve the health status of both individuals and populations by informing, influencing, and motivating the public about important health issues, as well as ensuring that key health concerns are on the public agenda (Nutbeam, 1998).
9Risk CommunicationRisk Communication is defined as an interactive process of exchange of information and opinion among individuals, groups and institutionsIt expresses messages about risk, concerns, opinions or reactions.Risk communication is helping people understand the nature and seriousness of a risk so that they can make an informed decision about how to deal with the risk.
10Risk CommunicationIdeally, risk communication is “an interactive process of exchange of information and opinion among individuals, groups, and institutions” .The goal of risk communication could also be defined as the need to align risk perceptions of the public with that of the risk experts and to reduce fear of risk related technology.
11Risk Communication and Health Promotion With respect to public health, risk can be separated into two main perspectives.First risk as a health danger to individuals as a result from environmental hazards (i.e. pollution, nuclear waste and toxic chemical residues). Specifically, risk is "a health threat that is regarded as a hazard which is external, over which the individual has little control“ .
12RC and HPThe second view conceptualizes risk as a consequence of "lifestyle" choices that individuals make, thus placing the emphasis upon self-control (i.e. the individuals ability to manage the self )(Lupton, 1995).
13Risk as a Consequennce of Lifestyle Choices: Behavior Risk factors The vast majority of NCD risk factors are environmental or lifestyle-related, thus NCDs are largely preventable. Greater than 30% of cancer is preventable via avoiding risk factors including: tobacco (6 million die a year), being overweight or obesity, low fruit and vegetable intake, physical inactivity, alcohol, sexually transmitted infections, and air pollution. (WHO)
14Behaviour Risk Factors A trend has emerged, particularly in the early 2000s, in which numerous studies have revealed a link between fast food and an increase in heart disease.Many major fast food chains, particularly McDonald's, have protested the methods used in these studies and have responded with “healthier menu” options.Consumers continue to patronise
15Behaviour Risk Factors Diabetes mellitus is an NCD which is largely preventable and manageable but difficult to cure.Patient education, understanding, and participation is vital since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels.Wider health problems may accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.
16Behavior Risk factorsChronic Kidney Diseases, diabetes and cardiovascular disease are closely associated conditions that often coexist; share common risk factors and treatments; and would benefit from a coordinated global approach to prevention and control.
17Others Risk FactorsThus, CKD, diabetes and cardiovascular disease are closely associated conditions that often coexist; share common risk factors and treatments; and would benefit from a coordinated global approach to prevention and control.
18Communicating the Risk to High Risk Individuals to Manage their Risk When there is risk it is important to communicate with the high risk group or vulnerable group (Haze, Melamin, Nitrofuran, Dioxin, SARS, Avian Flu, Recycled cooking oil ) as we have a Duty of Care. Communicating risk to the general public is often challenging due to a variety of issues including:increased emotion,limited access,availability of facts,clutter,distorted facts,speculation,assumptions,translating technical information into something understandable andsometimes incomplete knowledge.
19Communicating RiskThe manner in which information is communicated must be genuine and attempt to address both perceived ( may not be real) and real risk concerns
20Incorporating Risk Communication in Health Promotion Integrate with health promotion components of the existing programs of the MOHRisk Communication has already been incorporated in our existing programsIt need not stand on its ownNevertheless they are certain prerequisites
21Prerequisites: The Risk Communication Process Epidemiological assessment of RiskIdentifying the Risk GroupBehaviour risk factor surveillance along the lines of the Morbidity SurveyEducational AssessmentSetting Risk Communication ObjectivesFormulating StrategiesExecuting StrategiesDeveloping Risk Communication MessagesDisseminating the messages through the effective ChannelsImpact Evaluation
22Risk Communication Settings ClinicHospitalWorkplaceSchoolCommunity
23Strategies Planned Media Activities Electronic Print Social Face to Face
24Strategies Planned Community Intervention, NGOs. Brief Intervention; Incidental UnplannedCommunity Health Promotion CentreLobbyingEnvironmental SupportSocial Support
25Evaluation Evaluating the strategies : Formative Evaluation Evaluating the Objectives/ Goals : Impact EvaluationEvaluating Messages conveying Risk and Risk ReductionEducational Efforts as to Risk : Knowledge and Attitude on RiskBehaviour Changes as to Risk ReductionMorbidity Mortality Statistics as a result of Risk ReductionPolicy ChangesEnvironmental and Social changes
26Behaviour Change Theories: Common 1. Yale Attitude Change Approach2. Developmental Theory3. Group Dynamics Approach4. Perception Theory5. Motivation Theory6. Learning Theory7. Force Field Theory8. Group Dynamics7. Cognitive Dissonance Theory8. Attribution Theory9. Social Learning Theory10. Social Cognitive Theory11. Health Belief Model12. Theory of Reasoned Action13. Diffusion of Innovation Theory14. Precede-Proceed Model15. Kelman
27Health Belief ModelThe 7 major beliefs that influence the likelihood of taking action that is relevant to a given disease or condition arePerceived susceptibility to diseasePerceived severity of diseasePerceived threat of diseasePerceived benefits of actionPerceived barriers to actionCues to actionSelf efficacy
28RC in Malaysia Action plans eg Pandemic Flu, Emergency Response Simulation ExercisesTraining Modules and Training Key PersonnelResearch CentreResearch: FGDsASEAN and Local Strategic Plan of Action
29Example: Obesity Risk Communication : Prerequisites Epidemiology of ObesityBehaviour Factors contributing to Obesity: Walking less common nowKnowledge and Attitude towards EatingSocio Cultural factors contributing to ObesityAvailability and convenience of cheap calorie densed foodExisting Policies and Regulations
30Obesity Risk Communication: Who are the Main and Major Players? Risk Assessment (Epidemiological Assessment): NCDBehaviour Risk Factor Surveillance, and Educational Assessment: IPTKDeveloping the Strategies HECC/IPTK/NCDDeveloping Messages: HECC/ IPTKDissemination of Messages: HECC/NCD/MySihatImpact Evaluation: HECC/IPTK/MySihatPolicies/Regulations/Enforcement: Program Managers
31High Risk Group: From Epidemiological Assessment and Behaviour Risk Factor Surveillance Family history/Family LifestyleSedentarySmokers who quitPregnant mothersAge: Middle to OldMedical casesIdentify risk groups within various categories
32Risk Factors for Obesity Genetic predisposition.Inactivity.Unhealthy diet and eating habits.Family lifestyle.Quitting smoking.Pregnancy.Lack of sleep.Certain medications.Age.Social and economic issues.Medical problems.You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.
33Formulating Objectives of Risk Communication Need to knowKnowledge Gap of the RiskExisting Attitude and Perception to the RiskCurrent lifestyle
34Formulating Objectives for Risk Communication for the Obese Increase in Awareness and Knowledge of the Risk involved ie. to narrow the gapInstill changes in Perception to the RiskSusceptibilitySeverityThreatBenefitsEngineer changes in BehaviourEg. Sedentary to active lifestyle.
35Strategies for NGOs: Providing the cues to effect changes in Behaviour Community Intervention through NGOs (Profesional and non Profesional) Empowering them by doingRisk Appraisal through Screening: Opportunities for Brief InterventionNormal, Risk Group, CasesExperiential learning, personal and situationalCases will be referred and messages on complication and quality of lifeRisk Group (overweight and obese): Planned activities to reduce K gap, changes to perception and above all to reduce weightNormal weight same as above for maintenance of weight
36Strategies for NGOs: Strengthening Skills and Capabilities of the Community Providing them the technological know how through:Jointly Developing Risk Communication ModulesJointly conducting training for Community leaders and appointed TrainersConduct Training for the Members
59Strategy : Risk Communication Messages through the Media Conveying messages on Healthy Lifestyle (Normal)Conveying messages on Risk Factors and how to reduce Risk (Risk Group)Messages on complications and lifestyle changes (cases)Overcoming obstacles to Healthy LifestyleAvoiding conflicting messagesInformation Management: Who is the authority?Lobbying the risk to Policy makers to create a supporting environment
62Media Channels and Vehicles Existing Channels and NetworksPerhaps utilising the ever growing social media to a greater extentIncidental learning/Piggy ridingFace to Face intervention
63Evaluating the Risk Communication Efforts Knowledge and Perception changesBehaviour change: Life style changesReduction in weightMental Appraisal
64Overseas Examples: Environmental Support The walkability of neighbourhoods and access to recreational facilities in and around neighbourhoods may also assist in promoting healthy weights (John Spence from the U of A's Faculty of Physical Activity)(In Malaysia we are creating pathways, (KLCC-Bt Bintang Walkway, Bintang Walkway) and many others in cities and towns) but inadequate, with gaps, poorly maintained and above all often unsafe in terms manhole covers removed and cement slaps missing, reckless motorists who drive on the walkways and park their cars and snatch thieves who prowl and their likes).
65ExamplesEducation and Recreation. "Conversely, factors such as urban sprawl, lack of physical and recreational facilities favour sedentary behaviour and lower physical activity levels and promote obesity.” (University of Alberta 2008 Urban Planning a Factor in Rising Obesity Rates, in Science wise, 18th March 2008.)
66Examples: Policy to reduce Obesity In Wales Large-scale policies ranging from urban development to transport policy. For instance the Welsh Assembly Government has launched a four-year blueprint to get more people to walk and cycle as part of their daily lives. The Walking and Cycling Action Plan identifies a number of actions, including:Prioritizing walking and cycling in public transport investmentsEnsuring that local authorities provide and maintain high quality routes and facilities for cyclistsIncreasing provision of safe traffic free walking routes to schools and workplaces through continuation of the “Assembly Government’s Safe Routes in Communities Programme”
67cont: In WalesOpening an all Wales Coast Path, including provision for bikes in appropriate places, which will be completed in time for the 2012 OlympicsImplementation of Rights of Way Improvement Plans by all local authoritiesIntroduction of the Sustainable Travel Town project in Wales.In the same vein the BBC reported on radical proposals to boost children’s health by creating car-free housing developments in Wales.
68Policy on Obesity: In The UK Authority needs to be shared among many public, private and non-for-profit bodies in the UK. The Foresight report has promoted the view that obesity is a societal challenge, therefore calling for active and structural policies. As with other large-scale efforts (e.g. climate change) the UK strategy for tackling obesity entails the building of partnerships between government, science, business and civil society. This approach has underpinned the development of a UK-wide campaign, called Change4Life.
69UKThe strategy, sponsored by the Department of Health and involving the co-branding of a large array of initiatives relies on “grassroots involvement from local supporters who will encourage at-risk families in their community to trial and adopt the desired behavior The UK Change4life initiative has sought the active involvement of neutral third parties, for example:
70Change for Life Initiative UK Prominent scientistsThree NGOs who have produced a major communication campaign in support of Change4life, local voluntary and community organisations (over 20,000 of whom have signed up as Change4life partners and are using the Change4life resources)GPs and other health professionals who have endorsed and channel messages (nearly 4 million items for communication have been ordered by health care professionals)Schools, who have been active distributor of the How Are The Kids (HATKs) questionnaires. Head teachers have written to parents and planned Change4life assemblies.ur”. Change4Life focussed on prevention, and developed messages about lifestyle changes. Communication on treatment of individuals in a clinical setting (e.g. drugs and surgery) has been developed by the NHS (e.g. under NHS Choices).
71UKThis approach could help to address the challenge of a coherent and acceptable message. Opinion leaders, NGOs and independent scientists, when they are trusted sources of expertise, may contribute to build trust and change behaviour. Provided they are good communicators, they may also develop narratives that speak to people. To make an impact scientists and opinion leaders would need to spread simple messages about healthier lifestyles. Their communication may be supported by the simple framing of the Change4life key messages, “eat well”, “move more”, “live longer”. An evaluation of the impact made on the public by the messages released could help to adapt future communications. (Löfstedt, R.E Risk Management in Post-Trust Societies, Basingstoke: Palgrave.)
72UKOne major advantage of involving companies is that it avoids exposing the government to a top-down presentation of the risks of obesity. In modern “post-trust” societies, one-way communication from the Government down to the people is unlikely to deliver the desired behavioural change. For example, poor messages from government sources have contributed to amplify the MMR scare controversy. On the other hand, the format of the communication developed by commercial companies should also take account the level of trust vested in them. In this case the Department of Health assumed that they would be seen as credible sources of information:Bouder, F ‘A Contribution to Transnational risk analysis: comparativeanalysis of risk perception related to human health issues’, in Richter, I.K., Sabine Berking, S. and Müller-Schmid, R. (Eds.) Risk Society and the Culture of Precaution, Basingstoke: Palgrave Macmillan.
73Comparing Anti Smoking to Obesity “Using tobacco as a model is an interesting (and maybe not optimal) choice, since so much of the action in reducing smoking has come from making cigarettes expensive and making smoking inconvenient (e.g., through bans in different locations). Only a little traction was gained by raising awareness of the risks, and in some ways smoking behaviour is easier to understand since the goal (zero cigarettes) is clear. With eating and exercise, having a conscious goal means that people are doing some sort of calculus about how many calories they are consuming and expending every single day, an unreasonable expectation in general”.
74Smoking and ObesitySlovic has also shown that cigarette smoking is very high in perceived risk and very low in perceived benefits, which helps achieve behavioural change. It is unlikely that food intake could be treated the same way. Even restricted to the stigmatised category of “junk food” individual risk-benefit assessment is likely to be much more positive. Using tobacco as a model is a problematic choice, since so much of the action in reducing smoking has come from making cigarettes expensive and making smoking inconvenient (e.g. through bans in different locations).
75Govt. Efforts V Non. Govt.Govt. Campaigns may also backfire, especially when levels of trust for the government are declining. Critical media reporting has already suggested that health authorities’ plans for an ‘obesity tour’ may not be seen positively: The tours were aimed to “help people understand labelling in a familiar environment”. Critiques saw it as a waste of money and a prime example of the government acting as a ‘nanny state’.Martin, D. (2009), Health Chief’s ‘Obesity Tour’ of supermarkets backfires – as no one turns up to take part, The Daily Mail, 19th February
76Key Messages for Policy Makers on Risk Communication for Obesity Reflect on the risk itself, including perceptions. Define obesity risk communication on the basis of the evidence and perceptions directly related to the issue. Close parallels with other public health issues, like smoking, are likely to be misleadingContinue to ensure that, despite the complexity of the issue, evidence-based messages are presented and discussed. This implies a responsible approach to avoid spreading quack or biased theories and at the same time over simplification (e.g. ‘junk food is the cause of obesity’)
77Key Messages for Policy Makers on Risk Communication for Obesity When developing public campaigns always keep in mind that trust is a critical factor of acceptance. Make sure that regular evaluations take place looking at how well key actors are trusted, including government and private sponsors. Loud messages from distrusted actors may breed cynicism and are counter-productive.
78Key Messages to Policy Makers Ensure that the financing of government’s campaign is well understood, especially when it involves commercial sponsors.Ensure that neutral third parties (opinion leaders, scientists etc.) are invited to express their views as often as possible. Ensure that their involvement also targets those most affected and not only the general population.
79Key Messages to Policy Makers Obesity is multi-factorial and is likely to result in many policy interventions involving various parts of government. Co-ordination of the risk communication should focus on avoiding conflicting messages. A first step could be to develop a holistic evaluation of the totality of prevention and weigh control mechanisms e.g. Change4Life, Why Your Weight Matters, the NCMP letters, the NHS Choices content on weight etc.
80Operations Room: Bilik Gerakan Soft SkillsWhat should one knowWhat should one doCounter RumoursSOPHealth Education materialsCirculars and GuidelinesFrequently Asked Questions