7 things advocates should know when communicating about health equity

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Like many people in public health, I'm part of multiple social circles and sometimes find myself in situations where public health, especially health equity, isn't the typical conversation topic. Inevitably someone always asks me: So, what is it you do for work?

For many years, I struggled to answer this question. Because I wanted to convey my passion for creating the type of society that supports health for everyone, my answer would range from an angry diatribe about some policy issue to a long-winded account of every article I had ever read on the underlying social, political, and economic injustices that cause people in some communities to live shorter, sicker lives than those in other communities. Needless to say, this didn't get me too far.

Why, I wondered, was I struggling to explain the work that inspired so much passion and urgency for me? And if I couldn't explain it to someone in casual conversation, how could I possibly communicate about such a crucial public health issue in a way that resonates with people and helps build collective action toward creating healthy communities?

This struggle, I soon learned, wasn't unique to me. I see similar challenges across the field of public health: At times, our messages resonate with people and help rally them. However, as we dive into our data or policy recommendations, I see a lot of missed opportunities because our passion gets lost in the language we use. Discussions about equity and social justice that could improve our collective health get tuned out or simply misunderstood.

So how can we change this? How can we emphasize the importance of equity in the stories we tell about health? And how can we use these stories to help create communities where everyone has the opportunity to be healthy?

As I pursue my Doctor of Public Health degree at U.C. Berkeley, I am delving deeper into these questions. A great part of this process has involved connecting my research to the work of Berkeley Media Studies Group, which helps advocates use the media strategically to advance policies that improve health. While my journey is far from over, here are some of the things that I've learned:

1. We have to know what we want to change

Anyone who has worked with Berkeley Media Studies Group knows its catchphrase: You can't have a media strategy without having an overall strategy. While this applies to any type of policy work, it is great advice for health equity advocates. It's tempting to jump right into creating a message. However, BMSG reminds us that "Creating healthy environments starts with knowing what you want to change" and who has the power to change it, which influences every aspect of a communication strategy. And engaging the media may or may not be a part of that strategy.

This means that when we are talking about health equity, we should always make sure it is tied back to our goals. At times, this may be a specific policy recommendation. But even when we are asked to give general presentations on health inequities, we can ask ourselves: What do I want to achieve with this presentation? What do I want the audience to do after they walk away? How does this presentation tie into my long-term work on health equity?

2. Communication should be incorporated from the start

While we need to begin with an overall strategy, that doesn't mean putting communication on the back burner. This is easy to remember but can be hard to do for busy public health practitioners, many of whom have no choice but to be a jack-of-all-trades. Our days may include interpreting data, managing staff and major initiatives, building coalitions, developing policy, navigating complex financial systems, and doing all of this with budgets that are inadequate and frequently under attack. And while we often build data analysis or project meetings into our timelines, communication can get short shrift and become an afterthought, considered once a report has been written or a policy is about to be voted on at city council, rather than incorporated from the beginning.

By keeping communication at the forefront, we can more clearly define the problem we are trying to solve and what solutions we are really ready to stand behind, what data we should be collecting, and who our target audience is for any materials we develop. Keeping communication on the agenda helps us work on health equity because it gives more people an opportunity to shape strategy and messages and to surface and discuss differing perspectives of coalition or team members early on rather than right before speaking to decision-makers.

3. Effective communication is collaborative — and flips the script on power

Creating strategies and messages isn't a task for a communications person or team to create alone, behind closed doors. Their focus should be creating space for team and coalition members to develop strategies and messages. "Efforts to separate communications out into some separate process of persuasion disconnected from organizing strategy is just as problematic as organizing without any integrated communications strategy," writes the Praxis Project's Makani Themba. "In order to get to transformation, we need both aspects of work operating synergistically — and that's just for starters." This means weaving communication into all activities that organizations or coalitions engage in as they build a movement for social change, as well as creating opportunities for coalition or team members to engage every step of the way.

It also means making sure that those who are the most affected by health inequities lead the efforts to eliminate them. Otherwise, advocates risk reinforcing the very power relations they are working to dismantle.

This is yet another reason why planning for communication from the early stages is important. Doing so gives us the time and space needed to develop a collaborative and participatory approach — one that includes discussions about the role of power and privilege in undermining health. For example, if a coalition receives funding to conduct a Health Impact Assessment, early planning might include discussions about collecting data that illustrate the impact of structural inequities on health and using participatory research methods that allow people to share the stories behind the numbers. The discussions about power can continue into who presents the results and how they are presented, including who is portrayed as an expert.

4. Logic alone won't win the day

It can be tempting to think that by connecting the dots among social injustices, negative health outcomes, and policy solutions, our logic will be enough to persuade people to act. This is one part of our work, but if advocates don't create messages that people can connect to, our communication may alienate them and move us further away from our goals.

Using plain language is one way to take a complex topic like health equity and make it relatable. We do this best when we have community partners and residents at the forefront of communication work: They will know if messages resonate beyond a coalition and can make sure jargon doesn't sneak into the conversation.

Additionally, including shared values like dignity, interconnectedness, justice, and fairness in our communication can help engage people when the policy details are complex. Providing a vision of what our community will look like when we achieve a policy win can help make abstract policies more concrete. Hiring staff with diverse experience, such as journalism, campaign work, and organizing backgrounds, can help build a team's capacity to communicate effectively. And creating ongoing opportunities to practice and receive feedback can help people develop clear messages during crunch time.

5. We have to talk about racism and white privilege

Public health advocates face many challenges in communicating about health equity — at the center is how to talk about racism and white privilege. Although these issues are recognized as root causes of health inequities, I have found understanding, addressing, and communicating about them to be among the most difficult aspects of working to eliminate health inequities. Yet if we really want to improve health for everyone in the U.S., we have to be able to discuss these concepts and why they matter.

As professor and civil rights advocate john a. powell describes, having conversations about these issues is essential to understanding why the very systems that members of society need to be healthy — systems like health care and education — lack adequate support and funding. This wasn't always the case. Throughout our country's history, public systems and resources that were only available to whites were often accepted, even welcomed. But, as hard-won battles opened up these systems to people of color, our country began investing less in them, leading to the erosion of support for public structures and fueling health inequities.

If we want to repair and strengthen the social fabric that holds us all together and achieve health equity, we have to get more comfortable with talking about the deeply rooted collective and, at times, unconscious bias our country holds against people of color and in favor of whiteness, as well as the structures we have created that institutionalize these biases.

That's easier said than done, in part because the term "racism" itself often evokes ideas about individual acts of discrimination, yet reducing inequities requires dismantling entire systems of power and privilege — and that's where we need to focus the conversation. To do that, powell advocates guiding people's understanding of "racism" towards what he calls "structural racialization," which emphasizes a social process rather than a single person or event.

Recognizing how structural racialization is at work is a critical part of developing an overall strategy, which, in turn, influences our communication strategy and messages. Public health advocates can create a dedicated and ongoing space to talk about these issues internally with other staff or coalition members. With this space carved out, advocates can discuss what examples and plain language can be used to translate complex ideas like structural racialization to the audiences identified in their overall strategy. Taking time to have these discussions will help advocates speak to the public, policymakers, and the media. A great example is the Boston Public Health Commission's Place Matters community newsletter: They keep the focus on racial inequities in health at the forefront, and while they don't shy away from discussing the complex causes of these inequities, they use plenty of examples and clear language to make abstract concepts more concrete.

These are some of my favorite resources to help get conversations started, as well as refine those that we've already begun: You Can Get There From Here...; Talking the Walk: A Communications Guide for Racial Justice; Fair Game: A Strategy Guide for Racial Justice Communications in the Obama Era; Systems Thinking And Race: Workshop Summary; and Levels of Racism: A Theoretic Framework and a Gardener's Tale.

6. There are low-cost ways to integrate communication into our work

Investing in communication capacity for our organizations and coalitions is a critical long-term goal if we want to address the injustices that affect our communities. But that doesn't mean we have to wait for our next big grant to come in before we get started. There are ways we can prioritize effective communication about health equity by making the most of tools that already exist. We already know a lot about what we need to do — we just need to put it into practice. While many organizations, including BMSG, put out great tools, it's our job as public health practitioners to use them and practice, practice, practice.

This can be as simple as creating a monthly group meeting where people read and discuss resources, write letters to the editor, and conduct mock interviews. When organizational leadership or coalition leaders support this work, it makes it easier for people to take the time to attend. Coalitions can create a communication subgroup, or a supervisor can make space in staff meetings to discuss and practice using some of the available resources on communication.

7. We can all take steps to improve our communication every day

I still have many unanswered questions about communication and health equity, but I'm no longer afraid to talk to people outside of public health about what I do. I look forward to those questions as an opportunity to connect, to reach across divisions, and to experiment with how I talk about the issues I deeply care about. I still have some missteps, but I have also seen that people care about and will engage in discussions about healthy neighborhoods, justice, equity, and creating the places and the kind of society we all want to live in, when I apply what I have learned.

As Makani Themba has said, "We are all communicators. ... Everyone communicates and every interaction with others — be it canvassing or Facebook — is a form of communications that we must honor and take into account as we work with each other."

Whether we are at a community meeting, a city council hearing, or just talking to friends, investing in building the capacity of all public health practitioners and our partners to communicate is an important part of our collective work to achieve health equity.

Have a tip for communicating about health equity? Let us know! Send your suggestions to info@bmsg.org or connect with us on Facebook or Twitter @bmsg.

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