In an earlier blog (May 28, 2010), we mentioned that we were looking for new ways to talk about social determinants of health in ways that made sense to general audiences. The Robert Wood Johnson Foundation recently released a report that addresses this issue. When they tested responses to the phrase “social determinants of health” it consistently tested poorly. They were hoping to indentify a proxy phrase for “social determinants” which was not successful, but they did uncover some of the important metaphors for Republicans and Democrats and tested several scripts for effectiveness in explaining the desired concept to general audiences. The complete report including a recording and slides from a recent webinar can be accessed at http://www.rwjf.org/pr/product.jsp?id=66428. Below are some of the key highlights from the webinar and report.
Democrats tend to talk about a “system” that has broken down leading to inequities in outcomes and poverty. And because it is a system, you can’t address just one part and hope for an adequate solution. They also talk about a “right” to equality and health and feel angry when this doesn’t exist (see slides 12-18 in the PowerPoint).
Republicans talked about life as a “journey” in which “choosing” bad paths leads to unhealthy outcomes. They talk about the ability to change this situation with a lot more optimism than Democrats do. In their view, access to resources makes a successful journey more likely, but resources are finite and can’t be guaranteed for everyone. This means that the word “balance” to them means bringing some down so that others can have more. Instead, establishing a suitable minimum is more acceptable (see slides 19-25).
These are deeply held views about the world and we, as public health practitioners, have to be careful to know who our audience is and what networks (mental images, frames) we are activating when we talk.
The RWJF researchers created and tested several messages based on these frames such as:
It's time we made it possible for all Americans to afford to see a doctor, but it's also time we made it less likely that they need to. Where people live, work, learn, and play has an enormous impact whether they stay well in the first place. Health starts in strong, loving families and in neighborhoods with sidewalks safe for walking and grocery stores with fresh vegetables. Health starts in jobs we can get to without hours of commuting and in work places free of unnecessary hazards. Health starts in schools that educate our children for the jobs of the 21st century so they can compete in the world economy, that feed them healthy meals rather than junk foods, and that send them home safe at the end of the day. And health starts in having the time and financial resources to play at the end of a hard day's work, because unrelieved stress takes its toll on our hearts and immune systems. As we work on fixing health care in America, we need to start where health starts, not just where it ends.
(See more on slides 41-44 in the PowerPoint)
Some of the keys to the success of these messages were to
- Prime the audience with things they already believe
- Use colloquial, emotional language
- Use one compelling fact (not a barrage)
- Offer solutions
- Incorporate personal behavior (this is an important frame that many people hold)
- Mix traditionally conservative and traditionally progressive values (it may help to start with ideas on the political right and move to the left so that audiences we’re trying to reach don’t tune out)
- Highlight how it affects all Americans
- Lead with something inspirational, then go to something specific, then back to something inspirational
In fact, these are good lessons for pretty much any health message. And just like other messages you might be writing, think about your audience, the message that you’re trying to get across, and TEST, refine, and TEST AGAIN.
Hopefully we can begin to use this research in how we talk about where health starts, not just where it ends.
