The Role of Media in Public Health Professor SH Lee Emeritus Professor of Community Medicine The Chinese University of Hong Kong

What is Public Health?

Definition of Public Health ‘The science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society.’ (Acheson Report, London, 1988)

Public Health Movement The New Public Health Movement

“Up-stream” Approach

Determinants of Health

Determinants of Health Personal health practices and coping skills Biological and genetic endowment Environmental risk factors Social and economic factors Health Services

Personal health practices and coping skills Smoking Diet Obesity Lack of exercise Stress Alcohol abuse Drug misuse Sexual practices

Tobacco

Smoking 1994 Source: HKCOSH

Substance Abuse 1990 - 1999

Substance Abuse 1992 - 1999 Population

Obesity Student Survey 95/96 - 98/99

Biological and genetic endowment Gender differences Physiological, anatomical and mental capacities

Environmental risk factors Physical environment Radiation exposure Workplace hazards Infectious agents Home hazards Traffic Product design

Social and Economic factors Income and social status Social support networks Education Employment and working conditions Social disintegration Overpopulation Geography and Transportation

Health Services Accessible preventive and primary care services Healthy child development services Personal health services e.g. Student health Women health Elderly health

Environmental Conditions Genetic Influences Health and Medical Services Lifestyle HEALTH Social, Economic Cultural & Environmental Conditions The Health Field Concept

The Ottawa Charter for Health Promotion and the Jakarta Declaration

Definition of Health Promotion

“A combination of health education and related organizational, U.S. Department of Health Education and Welfare (1979) “A combination of health education and related organizational, political and economic programmes designed to support changes in behaviour and in the environment that will improve health.”

“The process of enabling people to Increase control over the Nutbeam (1985) “The process of enabling people to Increase control over the Determinants of health and Thereby improve their health.”

“The process of enabling people to increase control over their health. WHO (1984) (1986') “The process of enabling people to increase control over their health. ‘and thereby to improve their health.”

Health Promotion Targets towards whole population Basically healthy Involvement of community and individual measures Promotion of healthy lifestyle Goal to enhance state of well being

Disease Prevention Activity in the medical field Dealing with a disease or environmental threat Protects individuals or groups of population at risk Aims to conserve health

Disease Prevention Primary Prevention Prevention of disorders before they occur e.g. vaccination, healthy lifestyles

Disease Prevention Early diagnosis and treatment Secondary Prevention Early diagnosis and treatment e.g. screening programmes

Disease Prevention Tertiary Prevention Reducing burden of disability to individual and society e.g. treatment and rehabilitation

Five Priority Actions Of Ottawa Charter for Health Promotion Build Healthy Public Policy Create supportive environment for health Strengthen community actions for health Develop personal skills Re-orient health services

Ottawa Charter for Health Promotion An International Conference on Health Promotion The move towards a new public health November 17-21, 1986, Ottawa, Ontario, Canada

The Jakarta Declaration on Leading Health Promotion into the 21st Century (1997): Five priorities for action Promote social responsibility for health Increase investments for health development Expand partnerships for health promotion Increase community capacity and empower the individual Secure an infrastructure for health promotion

Mass Media and Public Health

The meaning of Mass Media Two key features: Mass audience Message is mediated Source: Health Promotion – effectiveness, efficiency and equity, Keith Tones and Sylvia Telford

Mass Media in Health Promotion The difference between health marketing and commercial marketing: Health promotion, ethical and professional goals Difference in size of budgets Health education programmes set standard often too high

Mass Media in Health Promotion The nature of the product in offer is different The health education product frequently intangible and gratification seen only at distant future Deep seated attitudes not easy to change

Mass Media in Health Promotion Ten key marketing concepts in health promotion Market philosophy The “four Ps” of marketing: product, price, place, promotion Hierarchy of communication effects Audience segmentation

Mass Media in Health Promotion Understand all the relevant markets Feedback Interpersonal and mass communication interactions Commercial resources Competition Expectations

Mass Media and “Public Health Advocacy”

‘Public health advocacy’ Sometimes called ‘public health lobbying’ Process of over coming major structural barriers to public health goals Such barriers could be political, economic or cultural

Skilled Professionals Partnerships or Coalitions Champions or Leaders What are the components of an effective public health advocacy campaign? Information Health Professionals Skilled Professionals Partnerships or Coalitions Champions or Leaders

Skills required in effective public health advocacy Competency and understanding of subjects and roles Political science, sociology of mass communication Structuring of media Health issues Networking techniques

Skills required in effective public health advocacy Community educators and organizers Journalists Lawyers and political analysts / advisers Research Evaluation

Does it work? Governments (and organizations) tend to adopt policies only in activities of public headiness, using the principles that Governments (organization) should not move far from what is perceived to be public opinion

What are the conditions for success in public health advocacy? A recognized constituency Building community agreement that an issue is a priority for action and that the proposed solutions are acceptable

What are the conditions for success in public health advocacy? Empowered communities A feasible solution (a feasible solution is not necessarily based only on, for example, epidemiological evidence. Many different types of “evidence” can be used by politicians, and managers when mainly policy decisions)

Mass Media The mass media, by definition, reach mass audiences, including key political and bureaucratic decision makers. If well informed about the process of news reporting, public health advocates may be in the position of influencing journalist to report issues in ways more consonant with public health objections.

Advocacy in Health Education and Health Promotion Case Studies in Public Health Advocacy in Health Education and Health Promotion

Case Study 1 Smokeless Tobacco

Tobacco advertising in printed media and outdoor advertising Case Study 2 Tobacco advertising in printed media and outdoor advertising

Prohibition of smoking in restaurants and other public indoor premises Case Study 3 Prohibition of smoking in restaurants and other public indoor premises

The Asia Pacific Association for the Control of Tobacco (APACT)

The Hong Kong Declaration APACT 2001 The Asia Pacific Association for the Control of Tobacco (APACT) recognizes that tobacco use is a major cause of death in the Asia-Pacific region: The current pandemic of tobacco-related diseases is causing tremendous harm and an excessive burden on the economy. Everyone, especially children, has the right to live in a tobacco-smoke free environment.

The Hong Kong Declaration APACT 2001 Of all the children alive today in Asia, a conservative estimate is that at least 150 million will eventually be killed by tobacco. There is a need for an urgent effort to contain this pandemic of tobacco-related diseases as well as its terrible effects on the environment and the economy. If it is to effectively prevent young people from smoking, it must be a comprehensive programme directed at the entire community.

The Hong Kong Declaration APACT 2001 A comprehensive regional tobacco control policy: An end to all tobacco advertising Increase in taxes Protection of youth Regulation and control of tobacco products

The Hong Kong Declaration APACT 2001 A comprehensive regional tobacco control policy: Cessation programmes Strong public education programmes Support WHO FCTC Holding tobacco companies accountable

The Hong Kong Declaration APACT 2001 In addition, the 432 participants from 34 countries to this 6th APACT Conference on Tobacco or Health give full support to Hong Kong’s current legislative proposals, particularly the recommendations for 100% smoke-free workplaces and restaurants.

Promotion of Healthy Cities Case Study 4 Promotion of Healthy Cities

How do we get a Healthy City ? Invite expert to introduce and explain the concept of Healthy Cities and talk about experience on implementation Seek government and community support and participation Establish a ‘Steering Committee’ to plan and co-ordinate Healthy City programme Identify priority health issues (through community diagnosis) Develop an action plan Secure potential community and funding support Monitor and evaluation of the project

Healthy Cities Eight Healthy Cities in Hong Kong Tseung Kwan O Wan Chai Central & Western Kwai Tsing Tsuen Wan Sham Shui Po Wong Tai Sin Tai Po

Tseung Kwan O District Kwai Tsing District Central & Western District

Health Promoting Schools and Healthy Schools Award Scheme Case Study 5 Health Promoting Schools and Healthy Schools Award Scheme

School-Based Approach Involve Kay Personnel School Principals School Teachers School-based Health Coordinators Pupils Parents

School-Based Approach Supportive environment and policy making Community Partnership Participation of Parents Networking

Hong Kong Healthy Schools Award Scheme Opening Ceremony 20 May 2001

Case Study 6 Healthy Workplace

Healthy Workplace

Healthy Workplace

Why Canada has been successful in Tobacco Control? Case Study 7 Why Canada has been successful in Tobacco Control?

Tobacco industry’s survival strategy Nine D’s Deny the health consequences of smoking. Deceive consumers about the true nature of cigarettes through marketing and PR. Damage the credibility of industry opponents. Direct advertising to women and youth, in addition to men, to maximize sales volume.

Tobacco industry’s survival strategy Nine D’s Defeat attempts to regulate the industry or control smoking. Delay legislation if it can’t be defeated. Destroy legislation once it passes, either by trying to overturn the law in court, by disobeying the law, or by exploiting loopholes. Defend lawsuits filed against the industry. Develop new markets around the world.

Factors for success on Tobacco Control Political will Bureaucratic support and experience Effective advocacy outside government NO SMOKING

Political Will To introduce, implement and enforce tobacco control measures Political support from: Minister of Health Minister of Labour Minister of Finance Departments support

Advocacy (lobbying) Anti-smoking and health groups Tobacco-control campaign Collaboration between government and NG sectors

Use of effective advocacy techniques Factors for success: Health Groups offer the government solutions, not just problems Unity is strength – advocating coalitions

Use of effective advocacy techniques Factors for success: Coalitions include: Public support Health organization Provisional councils Consumers Religious groups Women’s organizations Volunteers

Use of effective advocacy techniques Factors for success: Adequate financial resources and staff Health groups able to respond quickly Use a wide array of tools E.g. letters, phone calls, newspaper advertisements, meetings with government officials

Atypical Pneumonia Epidemic, Hong Kong Case Study 8 Atypical Pneumonia Epidemic, Hong Kong Impact of Community, NGOs, Professionals Involvement

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Conclusion

Conclusion Advocacy is a powerful strategy for promoting health Possible to use political processes to bring about positive changes to health Media sector has a very important role to play in health communication

Conclusion There should be close working partnership between health and media professionals in promoting health Joint education and training programmes for both the health and media sectors in health communication would greatly enhance the cooperation and communication between the two sectors

Conclusion More workshops, seminars on various subjects of health should be organized and better methods of communication should be developed to enable the media sector to have easy access to health information and a good understanding of the various issues affecting health

Conclusion The World Health Organization should be requested to organize more international workshops and seminars for the media in order to acquaint them the major global public health problems which can only be dealt with effectively by joint forces of all countries on a regional and global basis

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