Championing public health amid legal and legislative threats: Framing and language recommendations

How we frame an issue matters because it shapes how our audiences will understand what the problem is, who is responsible, and what needs to be done to fix it. Frames are mental pathways that get stronger by repetition. The more we hear an idea or a concept, the quicker our brains will go to this idea the next time we hear about it. The more we repeat frames that demonstrate public health as indispensable, the easier it will be for people to see public health’s necessary role in our society.

As we elevate the importance of public health, we have to contend with well-established frames that can challenge our conception of public health — especially rugged individualism, the idea that people can solve their problems on their own if they try hard enough. Rugged individualism is reinforced in storytelling, in the media and elsewhere, by zooming in on individual actions (what we call “portrait framing”) and obscuring the systems and policies that create the conditions in which people live. (Framing that instead makes these systems and policies more visible we call “landscape framing”). The current attacks on public health leverage portrait framing, stoke a false fear of losing individual liberties, and support a larger movement to limit the role of government — the protective and coordination roles we assign to our government agencies. All of this makes it harder for people to see that public health is essential for our well-being.

To respond to the legal attacks on public health, we must reframe the conversation with a focus on the landscape — the systems and conditions that support our collective well-being. The landscape frame is supported by values and principles such as our interconnectedness and our duty to one another and the greater good. Focusing on the landscape helps us hold the government accountable for carrying out its shared responsibility for health — which includes giving public health departments the authority to respond during health emergencies. When your messages repeat values that illuminate the landscape, you reinforce the frame that public health is indispensable for a functioning society.

Putting it into practice: Firefighting metaphors can help frame public health as indispensable.

Metaphors help our brains make sense of complex issues by taking the logic we use and assumptions we make about one familiar concept and applying that to another. The way we think and talk about fire departments is rich with opportunities to draw parallels to public health to reinforce how essential these services are.

In most areas, fire departments are a manifestation of a positive role for the government: protecting the greater good by pooling our resources together. It would be hard to think of a functioning society without a fire department. No one can put out a large house fire on their own, and fires can spread easily and harm more people if not contained by our dedicated firefighters. Fire departments also help communities put in place preventive measures, such as tree trimming, ventilation standards, and fire exits. They work with our schools and children, teaching them to take care of themselves and those around them in a fire.

“You don’t cut the fire department in wildfire season — and you don’t hamstring the public health department in a pandemic.”

Public health practitioners can borrow the logic in this thinking about firefighting and fire departments’ authority to keep everyone safe and apply it to conversations about public health departments. For example, you could extend the metaphor by saying, “You don’t cut the fire department in wildfire season — and you don’t hamstring the public health department in a pandemic.” Another example comes from “The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2021,” in which the authors use a firefighting metaphor to make the case for sustained investment in our public health infrastructure: Not investing in public health infrastructure, they say, is like not “hiring firefighters and purchasing hoses and protective equipment” until you are in the middle of “a five-alarm fire.”

Metaphors that evoke the parallels between fire departments and health departments, and, by extension, firefighters and public health workers, can help audiences understand the importance of supporting public health’s everyday work of fostering safety and well-being. This communication technique also shows why public health must have robust resources at the ready for us in intense emergencies like COVID.

Order matters. Whatever the context, don’t start with the problem — start with why public health is indispensable. Illustrate its strengths and avoid emphasizing weaknesses or deficits. Showcasing what public health does well and what it can do for the greater good reminds audiences of the value of public health and why it is worthy of our public resources. You can do this by describing our collective achievements and positive impacts — e.g., “more than 210 million people have been fully vaccinated,” and “Millions of lives have been saved” — along with examples from your local context.

While it is tempting to talk about the challenged state of public health as a way to sound the alarm for support, messages about how “broken” our public health system is can suggest to a listener that public health is fundamentally flawed or has been damaged beyond repair. If this is the case, why should such a terribly broken system get more funding or be protected from political attacks? Phrases such as “[these legislative attacks are] a further erosion of the nation’s already fragile public health system” can trigger a kind of reasoning that if public health is already so weak, perhaps we should let it die.

Leading with strengths establishes the indispensability frame without concession. Then, if needed, you can address weaknesses by naming the root causes of the problem. Explain that certain actors are intentionally trying to weaken public health. For example, you could say: “Our legislators’ duty is to uphold public health’s ability to respond, protect and inform our communities. This bill introduced by [name legislator] will intensify the pressure on our public health infrastructure, which is already fighting to overcome years of funding cuts.” Actively naming those actors reminds our audiences who should be held accountable for the devastating consequences these bills pose to our communities.

Now that self-interested political actors are actively trying to undermine its role, it is crucial that people understand public health’s purview and why public health’s authority is necessary to keep whole communities safe and healthy. Public health agencies need to be recognized as deserving of the authority they have. An emergency requires quick responses that help communities feel confident in their leaders, strengthening trust in public health and government. Public health advocates and practitioners must speak decisively and establish that public health workers are moving quickly and responsively, with accuracy and competence.

Putting it into practice:
Demonstrate urgency and progress (not just “evolution”).

With a novel virus like COVID, public health’s knowledge and approaches will shift and adapt as our understanding grows. But when our communication changes and seems to be inconsistent, this can confuse the public and undermine confidence. It is important that the public understand that these shifts are the result of public health’s effectiveness and responsiveness. While our communication about COVID policy has often referred to the “evolution” of public health’s directives and recommendations, this language conveys change but not the direct improvement and urgency needed to respond to a life-threatening virus. More effective language to portray public health’s adaptations of messaging and recommendations would better demonstrate positive responsiveness — words and phrases such as “updating,” “strengthening,” “growing,” “improving.” When we talk about updating our messages, we reveal and reinforce the process behind the scenes for assessing the science and bringing public health’s experience to bear.

Discuss clarity and direction (not just “guidance”).

Similarly, the common public health term “guidance,” used widely in our official communication, does not convey to the public how critical it is that they take the steps being identified by public health experts to contain the virus. While some public health agencies cannot legally use the term “mandate” if one is not in place, they can still look for ways to include language that conveys clarity and firmness. You will determine, based on your context, what makes most sense; consider terms like “actions,” “steps,” “measures,” “professional opinion,” “directives,” or “orders.”

Use clear, active language that communicates urgency and responsiveness.

Help paint a vivid image of public health work that your audiences can picture, by using clear, concise, and active language wherever possible. Here is one example of how to add clearer and more active language to an already pretty-good message:

Before: Early in the pandemic, our public health workforce took quick, decisive action to protect our essential health care workers, who in turn protect all of us, by triaging masks to our hospitals. They also worked night and day to analyze the situation and make decisions based on new data and new supply chain developments, such as more cloth masks being available.

After: Early in the pandemic, our public health workforce jumped in right away to protect our essential health care workers — who protect all of us — by getting desperately needed medical masks to hospitals. They stayed on the trail of the virus 24/7, strengthening directives to urge mask use for everyone as soon as enhanced data on transmission and supplies were released.

Active verbs have large cognitive impacts on audiences and directly tie public health actions to public benefit. Whenever possible, describe public health people in action: “Community health workers deliver vaccines to keep people healthy…” or “We prevent the spread of diseases…”

Language that feels soft, equivocating, or vague chips away at the confidence we are trying to convey. Such language includes hedging terms such as “it seems like” or “we seek to protect.” These phrases separate public health from its active role in protecting the greater good. Stronger language includes “we know that …” or “we protect …”

Strong active verbs that practitioners generated during a live training session in May 2022 to describe what public health does included:

Show, don’t tell: A word about images

Another way to portray public health as competent, confident, and active is to show, not tell. The images you use on websites, social media, and other visual communication materials are opportunities to illustrate people engaging positively with public health. You might show community health workers going to people’s homes, doing outreach at a health fair, collaborating in a research lab, or demonstrating safer COVID practices at a public meeting or press conference. But take care to remember that certain images — such as the overused shot of a vaccine being injected into someone’s arm — can reduce public health to individuals receiving medical care rather than helping your audience see the broader landscape of public health.

In all communication materials, use plain but descriptive language that any audience can easily understand. Whenever you can, eliminate jargon, abbreviations, legalese, and academic or formal language from your message. Using simple, descriptive language is particularly important when speaking to the media or in other public forums. While decision-makers may be the primary audience, the media reach the public and our secondary audiences as well, and if they understand our words, they will have an easier time repeating the messages and pressuring decision-makers.

For example, “morbidity and mortality” can be said simply as “death and disease.” If you do have to use jargon, explain what it means. Describing jargon may add length to the message, but the tradeoff is worth it if it means more people will understand you. For example, you could describe “preemption” as “states telling local governments and officials what they can or can’t do” or “it is when the state stops local communities from deciding what’s best for them,” which makes it easier to see why preemption used to thwart public health authority is problematic.

People seeking to limit public health authority paint a negative image of well-established public health laws and science-driven approaches to keeping the public safe. They also try to portray public health officials as abusing their power. To counter this, when talking about public health “authority” or public health “powers,” don’t stop there. Include clear language that explicitly names what public health has the power and authority to do for us. For example: “We must protect our public health agencies’ authority to keep us safer and healthier: to make the decisions that ensure we have clean water to drink, safe food to eat, and fresh air to breathe.”

All of the recommendations in this guide so far are about clarifying the role and importance of public health. Depicting what public health does and why its work is indispensable puts the bills and lawsuits attacking public health in context. When advocating against a bill, you will always need to describe clearly and succinctly what public health is and why its authority to keep everyone healthy must remain intact. Without getting into the weeds about the policy, you can still trigger basic frames that help explain why the bill and the actors behind it are harmful to the healthy, safe communities we all need.

One way to do this is to repeat words and phrases like “blocks,” “doesn’t let,” “stops them from,” “takes over,” “takes away,” “limits” and “gets in the way,” which will elicit in our audiences a feeling of losing or being prevented from getting something they want — in this case, the benefits public health provides to keep communities healthy, such as safe food to eat, clean water to drink, safe and affordable medication, and more.

You can also expand from the concept of blocking to other notions of stopping public health from doing its work. For example, here is a sample response to a lawsuit against Philadelphia officials that challenged their authority to enforce mask mandates. In this sample response, we emphasize that the lawsuit blocks what people need by using the familiar phrase of tying hands:

Our duty in public health is to keep Philadelphians healthy and thriving. This means we must respond quickly to new developments, such as an increase of new cases in our city, with strategies that work, such as mask orders. We do this all the time, but especially in times of crisis. This lawsuit would tie our hands and leave us unable to respond, adapt, and inform the public on how to stay healthy in real time. That’s why we ask the judge to dismiss the case so we can focus on what matters the most, the well-being of Philadelphians.

It is both deeply problematic and ironic that the bills at issue would strip authority from public health officials but leave their duty in place. In other words, society expects the results that public health provides — and politicians demand — but these bills would make achieving those results impossible. Advocates and practitioners should point that out. Using a fire department metaphor, an advocate might say something such as, “It’s like the legislature telling fire departments they must keep putting out fires but also passing a law that takes away their authority to tap hydrants — and all in the middle of a five-alarm blaze.”

You can also elevate the value of common sense by modifying the fire department metaphor above to say:

“This bill defies common sense. It’s like the state legislature piling into a bus and parking it directly in front of the hydrant in the middle of a five-alarm fire so the fire department can’t get to the resources it needs to do its job — all while making the firefighters watch while the buildings just burn to the ground.”