1. Health Communication - from individual behaviour change to civil society development and participatory governance By Thomas Tufte, Ph.D, Professor Roskilde University, Denmark ttufte@ruc.dk Presentation given at seminar in Copenhagen 4 May 2010: Communication for Social Change – lessons learnt from public health ADRA/AIDSNET/ENRECA Health/Glocal NOMAD

2. Introduction  3 key questions framing the discussion  3 hypotheses related to public health, globalisation and health and the discipline of health communication  Example: Femina HIP in Tanzania

3. Question 1  What role does communication play in the configuration of health citizenships? Three levels of analysis: The level of health policies (long trad. for broad definitions + notion of comm??) The level of health policies (long trad. for broad definitions + notion of comm??) The level of the sciences or disciplines (health + comm) The level of the sciences or disciplines (health + comm) The level of health and the health communication practice (emerging experiences..) The level of health and the health communication practice (emerging experiences..)

4. Question 2  What dimensions of globalization are influencing the politics, disciplines and practices of health communication? The relation between globalisation and modernity: Arjun Appadurai The relation between globalisation and modernity: Arjun Appadurai Mass migrationMass migration The electronic mediation of everyday lifeThe electronic mediation of everyday life The articulation of an ontological insecurityThe articulation of an ontological insecurity

5. Question 3  What are the key challenges that health communication face today – in terms of policies, theories and practices? A discipline and a practice in crisis and in profound transformation A discipline and a practice in crisis and in profound transformation There exists a strong current of rethinking the discipline and the practice There exists a strong current of rethinking the discipline and the practice

6. Hypothesis I  The centre of public health lies outside of the public health system Public health problems relate to broader questions: citizenship, empowerment, socio- economic conditions, culture, power relations and political priorities Public health problems relate to broader questions: citizenship, empowerment, socio- economic conditions, culture, power relations and political priorities

7. Hypothesis 2  The forces of globalisation are at the centre of the challenges we must understand and relate to in order to achieve the construction of a ’healthy’ society ’Glocalized’ lives that we need to reconstruct and understand better in order to respond accordingly and better ’Glocalized’ lives that we need to reconstruct and understand better in order to respond accordingly and better

8. Hypothesis 3  Health communication is a discipline in crisis and in transformation. There is a strong need for a more solid philosophical and epistemological basis which parts from a broad notion of health and which connects the health related challenges more strongly with the other key challenges within development and social change

9. Towards health citizenships  Alma Alta 1978  Ottawa Charter 1986  UNFPA Conference, Cairo 1994  Round-table on Communication for Development, Managua 2001 (and subsequent ones in Rome, Addis and Washington)

10. 7 challenges emerging from globalization  Epidemics travel (HIV, SARS, Bird Flu, etc)  Media development – expanding and diversifying symbolic worlds  Transnational agency and advocacy  New Economy – mainstreaming of principles of market liberatiion and deregulation of the media  Changing public sphere (transnational + diasporic)  Risk society  Migration, marginalisation and social exclusion

11. Challenges for health comm  Scope, size and interconnectedness of issues – national policy frameworks + glocal dimensions..  Reclaiming agency – TANs  Questioning economic and ideological logic informing management, org. Dev, policies. Are there alternatives?  Changing public sphere

12. Communication for social change  Rethinking subject, culture and social change results in CFSC…  Interaction between popular culture, communication practices and construction of meaning  Confront the structural challenges, linked to questions of inequity and social injustice

13. Introducing Femina HIP  Tanzanian NGO, 1999-  Focuses on SRHR and HIV/AIDS  Many donors on board, but is a ’homegrown’ organisation  EE through real life stories  Media outlets include: Two large magazines, tv talk show, radio drama, interactive website  Femina clubs

14. Femina HIP Objectives To build supportive environments in Tanzania where:  Young people in their communities enjoy their right to access information & services and are empowered to make positive informed choices around sexuality and lead healthy lifestyles in order to reduce the negative impact of HIV/AIDS.

15. Today: Femina HIPs 2nd Objective To build supportive environments in Tanzania where:  Communities exercise their right to express themselves, participate in public debate & engage in civil society. (Femina HIP Logical Framework, 2007)

16. FEMA  FEMA. A glossy magazine, 64 pages, 170.000 copies Published 4 x year. Targets youth aged 15-24 especially secondary school students in every region of the country

17. SiMchezo  Si Mchezo! 32 pages, 175.000 copies.  6 x year. Targets out of school youth and their communities particularly in rural areas.  Is expanding to 250.000

18. Results (1) - All secondary schools in the country have Fema magazines, read in Fema- clubs and used in class –Widespread Fema-club structure –Increased youth talk about the subjects –Changed authorities: collaboration with MOE, also on Zanzibar –Political clout

19. Tanzanian Context  Still low – but now growing- levels of participation in public life and decision- making  Changing and growing civil society  Much more diverse media infrastructure – new media emerging  Comparative advantage: Femina HIP became a visible NGO early on

20. Other Media Outlets  Pilika Pilika. A radio soap opera. Carries messages from Femina as well as two other organisations. Airs on national radio 4 times a week.  FEMA Tv Talk Show. Half ½ hour talk show. Broadcasts on national TV 4 times a week. Mobile phones are used for feedback and voting, particularly around the TV.  ChezaSalama (‘play safe’). Interactive website with a series of activities and information in English and Swahili. First of its kind in Tanzania.  Individual Publications: Range of specialist publications produced on for example HIV-testing, Treatment (500.000 copies distributed to all CTC clinics), youth empowerment (Watata Bomba, for children/youth was produced in 90.000).

21. 10 years down the line…  FEMINA HIP today: reaching 25% of the population!  Conceptual sharpening –Participatory Communication/CFSC –Exploring citizenship and governance perspectives on an HIV/AIDS communication initiative –Exploring CFSC-oriented process indicators (ownership, leadership, particpation, social norms, etc)  Improving M&E

22. Re-examining results  KAP: Increased knowledge, changing attitudes and practice  Voice: Established and growing ’discursive spaces’  Media: Strong media vehicle for any subject/developed media infrastructure  Organisation: Grown NGO with huge network of stakeholders  Embryonic civil society at community level

23. CFSC Indicators FEMINA HIP Leadership Emerging amongst youth Degree and Equity of Participation Broader participation Information Equity Voice of all groups Collective Self-Efficacy Open talk Sense of Ownership Growing engagement (letters) Social Cohesion Long term change Social Norms Democratic values..and others (gender, entrepreneurship, etc)

24. The driving forces of communication for social change  CFSC is horizontal and strengthens community bonds by amplifying the voices of the people who are poorest  people within poor communities must be the protagonists for their own change and manage their own communication tools  rather than focusing on persuasion and information dissemination, CFSCpromotes dialogue among equal voices, and debate and negotiations within communities  the results of the CFSC process go beyond individual behaviour and consider the influence of social norms, values, current policies, culture and the overall development context  CFSC strives to strengthen cultural identity, trust, commitment, voice, ownership, community engagement and empowerment  CFSC rejects the linear model of information transmission from a central sender to an individual receiver, and relies instead on a cyclical process of interactions focused on shared knowledge and collective action

25. Thanks!