Health in a Time of Poverty: A Background Note

This 8-page background note was prepared in the context of the October 2006 World Congress on Communication for Development (WCCD) in Rome, Italy. Organised by the World Bank, the Food and Agriculture Organization (FAO) of the United Nations, and The Communication Initiative (The CI), this event brought together over 700 participants, many of whom were the authors of the 120 papers that were accepted as part of WCCD. (To learn more about the WCCD initiative, please see The Drum Beat #377). In this paper, Chris Morry provides an overview of the rationale informing the decision to focus on the theme of health communication at the WCCD, and identifies sub-themes on which to focus discussion during individual sessions (with an emphasis on some of the relevant communication issues and themes that cut across each sub-theme).

Having provided some context for the WCCD - a space designed for learning and advocacy around the use of communication for development - Morry proceeds to lay out the case for health communication as a core component of the gathering. Some of the questions that underlie the background analysis he provides here are: What has been working well - and what has not been working well - in terms of health communication techniques and methodologies? What are some of the innovative health communication programmes that seem to show promise in terms of having a concrete impact?

One key theme Morry stresses is that the field of health communication has evolved over its 50-year history in ways that are important to study and learn from - not only for those working on health, but in the context of other development issues as well. Specifically, practitioners in this field began by focusing on the strategy of delivering messages; their approach was informed by the observation that the economically poor face obstacles in terms of access to information, and so a focus on the channel or medium being used to transmit messages seemed logical. However, the methodology of this field has since shifted away from an emphasis on this kind of one-way, sender/recipient relationship. More recently, that is, practitioners are exploring how processes of dialogue and discussion can be drawn upon in health communication, and why attention needs to be paid to the social and political environments in which people live and earn a livelihood (and the influence those environments have on behaviour change). Thus, as one thinker that Morry quotes here explains, "The individual is no longer a target, but a critical participant in analysing and adopting those messages most suited to her or his own circumstances."

The health communication field is shaped by the understanding that "no single approach is likely to achieve the goals of any health communication project, programme or activity....Determining which will work in a given situation requires skill, patience and sufficient time to understand the economic, social and political situation and the health and communication needs of the people involved." However, as suggested above, Morry does seem to emphasise one core direction representing a consensus of sorts within the field: the shift away from an exclusive focus on individual behaviour and toward a more contextual set of approaches focusing on factors such as power relations, cultural practices and norms, policy frameworks, economic status, and gender issues.

Morry illustrates this evolution by highlighting several WCCD session health-related sub-themes, providing a bit of background for each and exploring how health communication strategies have been draw upon (and have changed, over time). For instance, he looks at:

• HIV/AIDS, Sexuality and Gender: Message and Voice - Morry provides some statistics to give context for this issue, here again stressing that, "[w]hile accurate health information will remain important in the struggle against HIV/AIDS, it is now recognised that real progress has to involve looking beyond the messages - no matter how empowering and context-sensitive they may be - to develop environments where vibrant and internally legitimate dialogue can flourish and where the needs and perspectives of the most affected can become central to the response." For example, he explains that women are particularly vulnerable, in part because of "systemic discrimination" which is "widespread"; in such a case, providing information is not enough. Rather, communication initiatives that directly engage those most involved have been, and will continue to be, "absolutely essential if we are to succeed in changing the beliefs, behaviours and long held attitudes that create such unhealthy gender roles and identities." Also looking beyond individual behaviour to integrate an appreciation for context, health communicators working to fight HIV/AIDS have explored integration of efforts at the policy level, within the media, and within civil society. Morry presents some strategies that have been emphasised recently in each of these 3 domains.
• Immunisation: Success and Stagnation - Morry provides figures illustrating the stagnation in vaccination coverage, and details some of the communication-related issues that present challenges to practitioners. Again, there has been a movement here toward attending to the broader context. For example, among the challenges Morry outlines is the active political mobilisation against immunisation programmes. This issue illustrates that the "impact of information on immunisation behaviour is mediated by socio-cultural and political influences, a situation that calls for locally appropriate communication responses."
• Maternal, Child, and Reproductive Health: Entitlement and Obligation - Increasingly, Morry explains, "public health, including reproductive health care provision, is being seen as a system - a changing dynamic of entitlement and obligations between people, communities, providers and governments. Within this lens, community participation, health promotion, social support and empowerment of individuals (especially of women) are seen as critical to achieving sustainable improvements in reproductive health care." On such a view, "[c]hanges in behaviour and changes in the environment in which individuals find themselves require communication approaches that facilitate locally determined actions towards locally appropriate changes in behaviour and the social, economic and political environments that support such change."
• Avian Influenza: Risk and Prevention - In all health emergencies, Morry stresses, it is important to have set in place well-prepared communication plans that provide reliable information, do not hide the facts, are honest about uncertainties, and offer realistic advice for dealing with the crisis at various stages. However, he indicates that "the potential risk posed by the Avian Influenza is so high and global in
  nature that it requires a coordinated global communication strategy with national and local variations appropriate to different groups..." Successfully coping with avian flu (also known as bird flu), he argues, will "require the entire communication tool box and all its approaches and methods. Information will need to be developed and disseminated at various levels and to various and different audiences. But to be successful this will require trust and acceptance - things which cannot be relied upon just because the situation is urgent. Communication approaches that build trust through local dialogue and input will be as important as the design and dissemination of accurate information."

In short, Morry endorses the WCCD's focus on health communication by indicating that "[t]he many years of health communication experience working across such complex and fundamental areas of individual and social human behaviour offer a significant pool of evidence about the centrality of communication to successful development initiatives."

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