Media advocacy then and now: An advocate reflects on 20 years of using the media to improve public health

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When BMSG started 20 years ago, I was a grad student in public health, with big ideas and bigger hair. With a background in corporate communications and a passion for social justice, I found in media advocacy the ideal nexus of my skills and interests. I was inspired by the skilled advocates who harnessed the power of the news to shape public health policies.

I started working at BMSG in 1993 as a student research assistant, analyzing endless hours of TV news stories for studies on youth and violence on the news. When I graduated with my master's in public health, I parked on my public health professor Larry Wallack's doorstep and wouldn't budge until he created a position at BMSG for me. And I stayed for 17 exciting years, helping develop the field of media advocacy and training public health advocates nationwide on how to use the media strategically to advance policies that improve public health.

So in celebration of BMSG's 20th year, I've been pondering, how is media advocacy the same and how has it changed, 20 years later?

What's the same

The bad guys look awfully familiar. In the early days of media advocacy, advocates targeted (among others) Big Tobacco, Big Alcohol, and the NRA. Now public health targets Big Food, Big Soda, and, oh yeah, Big Tobacco, Big Alcohol, and the NRA.

Food and beverage companies even seem to be using the same old corporate strategies to buy influence in communities. Taking a page from Big Tobacco's playbook, they're disguising their marketing as philanthropy and creating sophisticated "corporate social responsibility" campaigns to improve their image and prevent government regulation. Recently in my own town, Coca-Cola donated $50,000 for school-based physical activity programs. Interestingly, this donation came after the city council had abandoned its efforts to pursue a tax on sugar-sweetened beverages.

I know a corporate "enemy" provides a clear, invigorating focal point for advocates -- and certainly, many corporations undermine health in pursuit of profits every day. These are worthy targets for public health efforts. But I also wonder whether this focus erodes our will to address complex structural issues where there's no single clear "bad guy"?

For example: One of the most powerful determinants of health in developed countries is income inequality. The wide and widening gap between rich and poor in the U.S. may be responsible for ill health as much or more than any other single factor. Who's the bad guy here? Businesses that don't pay a living wage? The erosion of education funding that makes it harder for young people to earn a college degree? Greedy big banks and the government that fails to regulate them? Monetary policies that trap lower-income Americans in cycles of debt?

The list goes on. But public health has gotten used to having a clear, often corporate, answer to "who's responsible?" I worry that when we don't know where to point the finger, we fail to tackle the biggest issues affecting health.

It's more than a message. Good media advocacy isn't PR. It's not about coming up with the best slogan or "getting the word out"; it's focused like a laser beam on strategic policy change. I love seeing advocates stay on target and create policy change -- even if I bewail the fact that sometimes they're the same exact policies we were fighting for 20 years ago. The city of Glendale, Calif., recently voted to shut down gun shows on city property -- which was one of the leading strategies to try to limit rogue gun sales back in the last century.

Problem definition is a problem. It's media advocacy 101: How you define the problem shapes the solution. That's why framing is so important; from the start, you have to shape not just your message but your entire strategy to support the structural changes you seek.

Here's one area where public health has dropped the ball in the last dozen years or so. We have allowed "obesity" to become the shorthand term for illness and early death related to diabetes, heart disease, and other ailments. This framing not only stigmatizes fat people, it sets the debate solidly in the realm of individual responsibility. From this starting point, advocates have to push the boulder uphill to get the public to consider policies to improve food environments, stem a barrage of junk food and soda marketing to kids, and provide more opportunities to be active.

We know better -- BMSG called for avoiding the "O-word" way back in 2006 -- yet the shorthand has proved irresistible, even in our own work.

Public health did it right in the '90s. After a surge of gun deaths in the '80s and early '90s, the field responded with a comprehensive cross-discipline movement focused on violence prevention. The violence prevention frame allowed a host of unlikely partners to work together on a range of interventions. Gun control efforts, such as the ban on "Saturday Night Specials" enacted in California, formed an important part of this work, but certainly not all of it. Under the umbrella of "violence prevention," we also fought against "Three Strikes" laws; worked against intimate partner violence; opposed gang injunctions that stigmatized youth of color; and supported grassroots youth development initiatives that helped young people build a stronger future.

In reproductive health, the recent 40th anniversary of Roe v Wade put the spotlight on the problem of problem definition. Despite record high rates of public support for abortion rights, states across the country are systematically eroding women's actual access to abortion services. Without ever addressing women's "right" to abortion, they are passing policies that unnecessarily regulate where and how abortion may be provided or charge exorbitant fees for licensing clinics.

The focus on "abortion rights" doesn't help in this context. I believe the issue we need to focus on isn't abortion rights nor abortion itself; it's women's autonomy. Women can't control their lives until they can control their fertility. Unplanned pregnancy and premature parenthood place disproportionate burdens on women and form a fundamental barrier to their equality and economic stability. Many of the people working in the reproductive health field share this understanding of and motivation for their work -- but it is often lost in the public discussion of abortion, obscuring what is at stake in this too technical and legalistic debate.

What's different

The medium has evolved. When we wrote News for a Change, a comprehensive guide to media advocacy in 1999, we devoted a total of nine paragraphs to using the Internet for advocacy communications. So yeah, a few things have changed since then. Social media platforms like Facebook and Twitter have transformed how the world communicates.

The possibilities for effective advocacy online are endless. Efforts can be as widespread as millions of individuals supporting marriage equality in an ocean of Facebook feeds or as narrow as one dying veteran marking the 10th anniversary of the Iraq war by writing a scathing protest letter to George W. Bush and Dick Cheney -- and letting the whole world in on the conversation.

The Internet's reach means that, today, people don't always have to go through an editor to shape media messages and win policy battles. They're able to engage their targets more directly and more publicly.

In January, for example, the Center for Science in the Public Interest used a Twitter campaign to get Taco Bell to take down a Super Bowl ad that mocked people who bring veggie trays to Super Bowl parties. In a matter of days, they succeeded, and Taco Bell pulled the ad.

On the other hand, the quick-moving nature of social media creates pressure that can distract advocates away from their broader policy goals. The need to attract and retain "eyeballs" to show that they're active and engaged online can make advocates reactive, putting quantity (of blog posts, tweets, or e-alerts) ahead of quality of those communications.

At BMSG, we've always warned advocates not to be seduced by the spotlight of media work. The relentless communication environment of the Internet makes it that much harder to stay strategic -- and know when not to communicate.

The "news hole" is bigger. Social media isn't the only huge change in communications in 20 years. The explosion of cable news channels, and the busy buzzy blogosphere, means advocates face an endlessly gaping "news hole" begging to be filled. This might mean more opportunity for advocates to get their issue covered -- but also drives them to more extremism in an effort to break through the noise.

As always in media advocacy, there are two key tasks: getting attention (setting the public agenda) and shaping the debate (framing the story to support your policy goal). These days it might be easier to make a splash but harder to sustain any attention. Sometimes it seems our whole society has attention deficit disorder -- which spells trouble in the long, arduous fight to eke out incremental policy changes.

Market forces are stronger. Back to the issue of "bad guys": The almighty dollar appears to have more sway over our society than ever. The 2010 Citizens United Supreme Court decision gave corporations more power over public policy; the Internet gives them more influence over our consumption habits. And the current climate against taxes reflects the public's increasing confidence in "market justice" and unwillingness to share the cost of investing in a healthy community.

No wonder we sometimes feel like salmon struggling our way upstream. The world affirms market justice; public health fights for social justice. And we're fighting out of our weight class. But this commitment to social justice is what got me into the field in the first place, and it's what keeps advocates going in their never-ending efforts to improve public health and create true equity. Go out there and change the world, people.

Katie Woodruff, MPH, worked at BMSG for 17 wonderful years, ultimately serving for several years as deputy director, before leaving in 2010 to focus on raising her young children. News for a Change was her first baby.

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