Fluent Essays

Discussion Week 2: Forming and Building Coalitions   Public Health Advocacy: Forming and Building Coalitions PLEASE READ DISCUSSION RUBRIC BEFOREYOU BEGIN WRITING. To score well on this DB, review the ASSIGNMENT DESCRIPTION & RUBRIC because it is more specific. Although individuals and organizations can advocate on their own, coalitions are particularly effective for public health advocacy. A coalition can include healthcare organizations, public and private sector agencies, for-profit companies, non-profit organizations, grassroots groups, academics, researchers, faith-based organizations, health departments, and health and social justice organizations.  A coalition may have several different types of goals/missions, but overall, each aims to come together to agree on a solution to a specific problem that affects their constituents or members and overall improve aspects that affect health outcomes.   For instance, the San Diego Tobacco Control Coalition mission is to improve and protect the health of San Diegans by promoting smoke/tobacco-free lifestyles and environments. This coalition will pursue support of policies that align with improving tobacco-free lifestyles, environments and lastly those that make the default choice the healthier choice.   This discussion activity will focus on coalitions. Students will be asked to read and identify aspects of the advocacy process that coalitions participate in. Next, students will select a coalition from a prescribed list to research, identify, and describe in order to better understand function and structure.   Step 1: Review Chapter 17 of your textbook: “Advocacy”, pps. 335-346 and the corresponding chapter PowerPoint (SEE ATTACHMENTS). The following sections will clarify key components of what coalitions are and how they address advocacy issues: a. Who Can Advocate? b. Form a Coalition and Table 17.2 c. Begin “Ground Softening” d. Determine Who Has the Power to Make the Change Sought e. Understand the Opposition and box 17.3 f. Outline a Set of Possible Solutions   Step 2: write 1-2 paragraphs describing coalitions in general: 1. What is a coalition and what members can it include/be made up of? 2. Why is including a variety of members in a coalition important? 3. What is ground-softening and why is it needed?   Step 3: Research the coalitions identified in the links below: Big Cities Health Coalition : https://www.bigcitieshealth.org/about-us-big-cities-health-coalition-bchc   Step 4: Looking at the coalition you selected from the link above summarize key aspects of the coalition you selected (2-3 paragraphs): 1. What is the mission of the coalition? 2. What are the goals of the coalition? 3. List 4-5 members of the coalition 4. Brief description (1-2 sentences) of the public health problem the coalition is focusing on 5. Review the coalition web page and tell your colleagues about what entities (organizations, policymakers, government, industry, individuals) could be considered “the opposition”? This may/may not be apparent on the web page, if not, be creative an think about what is feasible. 6. Identify what could be a potential policy solution to the public health problem the coalition identifies and why (1-2 sentences). 7. Include a screen shot of the coalition web page and a web link PU35CH17-Dorfman ARI 22 February 2014 19:4 Public Health and Media Advocacy Lori Dorfman1,2 and Ingrid Daffner Krasnow1,2 1 Berkeley Media Studies Group, Berkeley, California 94704; email: [email protected], [email protected] 2 Public Health Institute, Oakland, California 94607 Annu. Rev. Public Health 2014. 35:293–306 First published online as a Review in Advance on December 11, 2013 The Annual Review of Public Health is online at publhealth.annualreviews.org This article’s doi: 10.1146/annurev-publhealth-032013-182503 Copyright c© 2014 by Annual Reviews. All rights reserved Keywords social justice, upstream, framing, agenda setting, news Abstract Media advocacy blends communications, science, politics, and advocacy to advance public health goals. In this article, we explain how media advocacy supports the social justice grounding of public health while addressing public health’s “wicked problems” in the context of American politics. We outline media advocacy’s theoretical foundations in agenda setting and framing and describe its practical application, from the layers of strategy to storytelling, which can illuminate public health solutions for journalists, policy makers, and the general public. Finally, we describe the challenges in evaluating media advocacy campaigns. 293 A nn u. R ev . P ub li c H ea lt h 20 14 .3 5: 29 3- 30 6. D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y N at io na l U ni ve rs it y, S an D ie go o n 01 /0 2/ 17 . F or p er so na l us e on ly . PU35CH17-Dorfman ARI 22 February 2014 19:4 INTRODUCTION Media advocacy, the strategic use of mass media to support community organizing and advance healthy public policy (39), evolved in the late 1980s as tobacco and alcohol control advocates observed the policy success of public interest and consumer groups working on similar issues (38). Public interest advocates employed an array of strategies and tactics that were more common in political campaigns than in public health efforts (12). Public health efforts, however, had a strong basis in epidemiology. This article describes the result of that evolution: an approach that blends science, politics, and advocacy to advance public health goals. We begin by explaining how media advocacy can bolster public health practitioners’ efforts to advance social justice and work to solve some of our country’s most complex social and political issues. We discuss the foundations of media advocacy, how the theory translates to practical application, and the challenges of evaluating media advocacy campaigns. Public Health as Social Justice For more than a generation, public health practitioners have been guided by the work of Daniel Beauchamp, who argues that the ethic of public health is social justice, “a way of asserting the value and priority of all human life” (3, p. 8). Beauchamp called for newly constructed collective definitions of public health problems that clearly communicate “that the origins of [death and disability] lie beyond merely individual factors,” which have since been described as the socio- ecological model (3, p. 9). A formidable barrier to achieving social justice is the competing ethic of market justice. Beauchamp explains that market justice is rooted in the basic notion that the unfettered marketplace is the best way to serve people’s desires. Market justice ideals have long dominated political and cultural life in the United States. Much of the debate on public health policy issues concerns whether or how to restrain the marketplace with regulation, which, accord- ing to market justice ideals, should be tolerated only in limited circumstances. Tensions between social justice and market justice values are at the heart of nearly every major public health policy debate. Public Health Moves Wicked Problems Upstream According to the Institute of Medicine, the basic mission of public health is to ensure the conditions in which people can be healthy (8). When public health practitioners acknowledge that personal behavior is only part of what determines health status, they must contend with the physical, social, and political environments surrounding individuals. Public health’s defining metaphor— the upstream/downstream story—illustrates this perspective: If health workers are so busy rescuing drowning people downstream (i.e., people who are already sick or dying), then they do not have time to go upstream to see what is causing so many people to fall into the river (i.e., get sick) in the first place. Although medical treatment is essential—and often in short supply—the mission of public health in particular is to go upstream and identify the determinants of health status for populations, to intervene, and to develop policies that will foster conditions that stop the problems before they start. Upstream approaches recognize that social, political, and economic factors require basic social change to alter the conditions under which people easily fall into the river. Upstream problems are complex, “wicked problems” with layers of cause and effect that are difficult to disentangle from society’s other social problems, such as poverty, unemployment, 294 Dorfman · Krasnow A nn u. R ev . P ub li c H ea lt h 20 14 .3 5: 29 3- 30 6. D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y N at io na l U ni ve rs it y, S an D ie go o n 01 /0 2/ 17 . F or p er so na l us e on ly . PU35CH17-Dorfman ARI 22 February 2014 19:4 education, or housing (34). In their seminal paper, Rittel & Webber (34) argue that social scientists searching for rational answers to society’s ills must wrestle with how political interests influence the definition of the problem itself: “[T]he formulation of a wicked problem is the problem!” (p. 161, emphasis in original). Wicked problems are not amenable to technical fixes; they require political solutions that very often involve government. However, trust in government has declined precipitously (30) in the United States in the early twenty-first century as politics have become more polarized and the role of government—and so the role of public health—has been challenged. It is in this political context that public health advocates used media advocacy to make the case for the policy solutions they seek. Public Health Focuses on Policy Policy is an important tool for reaching public health’s ambitious goal and improving the social determinants of health. Policies define the structures and set the rules by which we live. If public health practitioners and community organizers are going to improve social conditions and physical environments in lasting and meaningful ways, they must be involved in policy development and policy advocacy. Media advocacy is a tool for those working upstream on primary prevention policy that trans- forms environments. Changing the terms of debate so that upstream policy approaches are con- sidered fairly means public health advocates must be able to explain that other forces, in addition to genetics and personal choice, affect health (11). Media advocacy applies social justice values to the practice of addressing the social determinants of health. MEDIA ADVOCACY: A TOOL FOR IMPROVING ENVIRONMENTS AND PROTECTING POPULATIONS As a tool for advancing and supporting community organizing and policy advocacy, media advocacy draws on theories from political science, cognitive linguistics, sociology, and other fields concerned with how public opinion is formed and political behavior is influenced. In particular, agenda-setting and media-framing theories underlie and inform media advocacy practice. Media Advocacy Differs from Other Health Communications Most health communications treat audiences as consumers, targeting them with information so they can reduce their risk for illness or injury. Other communication strategies operate from exchange theories that assume the health problem derives from a lack of information (12). In these approaches, the people with the problem are the audience for top-down messages exhorting healthier behavior. Media advocacy is less about delivering a message and more about raising voices in a democratic process using policy to change systems and conditions. Rather than targeting the people with the health problem, media advocates target policy makers and those who can be mobilized to influence them (40), harnessing the power of the media to apply pressure on decision makers for policy change. Media advocacy’s narrow audience is the policy decision maker—sometimes a single person or a few committee members. The policy action will ultimately affect whole populations, but the target for the actual policy change is narrow. Media advocacy helps people understand the importance and reach of news coverage, the need to participate actively in shaping such coverage, and the methods for doing so effectively. www.annualreviews.org • Public Health and Media Advocacy 295 A nn u. R ev . P ub li c H ea lt h 20 14 .3 5: 29 3- 30 6. D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y N at io na l U ni ve rs it y, S an D ie go o n 01 /0 2/ 17 . F or p er so na l us e on ly . PU35CH17-Dorfman ARI 22 February 2014 19:4 Theoretical Underpinnings of Media Advocacy Media advocacy’s blend of science, politics, and advocacy means that it draws on several the- oretical foundations and disciplines, including political science, communications, and cognitive linguistics. Agenda setting and framing have been the core concepts informing media advocacy strategy. Agenda setting. Successful policy advocates pay attention to the news because the news me- dia largely determine what issues we collectively think about, how we think about them, and what kinds of alternatives are considered viable; the news media set the agenda and terms of debate for policy makers and the public (9, 16, 25, 26). The public and policy makers do not consider issues seriously unless they are visible, and they are not visible unless the media have brought them to light. Public health advocates cannot afford to have their issues go unnoticed or to be caught unprepared when the events of the day catapult their issues into public discus- sion. Media advocacy helps advocates be prepared to create news and react to news on their issues. Framing. Framing, a key component of media advocacy, is the process by which people extract meaning from content of all kinds, including words, pictures, or interactions. Cognitive linguists have described how all audiences come to new information they see or hear with preformed ideas about the way the world works, why problems occur, and who is responsible for solving those problems (21). This process of reconciling new information with one’s existing understanding is called framing. In an unconscious and automatic process, people weigh new information against well-formed ideas that have been reinforced in their thinking over time. We call these established ways of thinking the default frame. Default frames. Understanding the default frame is a fundamental precursor to developing a media advocacy strategy. In the United States, the default frame is typically one of rugged indi- vidualism that emphasizes personal responsibility for solving problems. In the case of housing, for example, a default frame would suggest that families are responsible for working hard enough to afford a home and for keeping their own homes safe and healthy. But this frame is an incomplete understanding of housing because it leaves out other actors, including the role of government in providing mortgage benefits or city services such as water and garbage collection, among others, to protect residents and create environments that are healthy for all to enjoy. Public health advocates often have to reframe issues from an individual to an environmental perspective, showing that where people live, work, and play directly affects health. Although people can hold multiple, even contradictory, frames in their heads concurrently, the ones that get triggered and repeated more often have a better chance of influencing people’s interpretations. Although people may inherently understand that it is not tenants’ fault if they live in houses with lead paint, for example, the default frame will lead many people to blame tenants, asking questions such as, “Why don’t they do a better job keeping the house clean?” (a question that misunderstands the nature of residential lead poisoning) or “Why don’t they just move?” (a question that assumes resources and mobility that are not available to some families). In this case, housing advocates would need to understand and explain the complex issues behind substandard housing to reframe the issue to one of shared responsibility that can reinforce and support policy change for reducing health impacts from lead paint exposure. Because of the power of default frames, it is not always obvious that the solution will likely involve a role for government in addition to appropriate personal responsibility. 296 Dorfman · Krasnow A nn u. R ev . P ub li c H ea lt h 20 14 .3 5: 29 3- 30 6. D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y N at io na l U ni ve rs it y, S an D ie go o n 01 /0 2/ 17 . F or p er so na l us e on ly . PU35CH17-Dorfman ARI 22 February 2014 19:4 Framing for content, framing for access. Media advocacy focuses on media framing, defined by Entman (15) as selecting and making salient certain aspects of perceived reality “in such a way as to promote a particular problem definition, causal interpretation, moral evaluation, and/or treatment recommendation for the item described” (p. 52). Media advocates refine the concept as framing for access, the objective of which is to capture journalists’ attention by focusing on what is considered newsworthy, and framing for content, the objective of which is to reframe a public health issue to highlight environmental factors, core values, and the desired policy solution. This typically means that media advocates must emphasize shared individual and societal responsibility for solving problems. This frame tends to be deemphasized in news coverage, which often high- lights individuals and events. Iyengar (18) has found that such episodic news results in audience interpretations that tend to blame the victim, whereas more thematic news helps audiences un- derstand the impact of environments on personal outcomes. In media advocacy, the goal is often to reframe from episodic to thematic frames, which we liken to the difference between stories framed as portraits focused narrowly on individuals or events and those framed as landscapes that can reveal the context surrounding individuals and events (13). Applying Media Advocacy Media advocacy may be confused with other health communication strategies such as social mar- keting or public information campaigns because, at the tactical level, they all strive to garner attention—attention from the public, from policy makers, and from the news. Media advocates may use mass communication to reach a narrow audience of one or two people—members of a legislative committee or a school board, for example—who have the power to make the policy decision that shapes conditions in a given environment. Media advocacy’s strategies and tactics keep a sharp focus on supporting community organizing and policy advocacy. Layers of strategy. To leverage this democratic process, advocates must be strategic. The layers of strategy framework helps advocates (a) define the problem, the solution, and the party who has the power to make the changes in systems or structures that will improve health outcomes; (b) identify how to reach them with media; (c) determine what to say to them; and (d ) ascertain how to attract journalists’ attention (4). Overall strategy. The overall strategy articulates the need for change at a structural level in light of the limitations of personal behavior change. The focus on structural change is rooted in the basic public health principle that creating change at the population level will have a greater impact than promoting change one person at a time. In developing an overall strategy, advocates must define the problem they seek to solve, name a specific solution they believe will help address the problem, and identify which individual or body has the power to create the change they seek. Only once advocates have thought through their overall strategy can they begin to consider the media, message, and access strategies that will help them achieve their goal. Media strategy. The media strategy defines how—or whether—mass media, social media, or personal communication or some combination is best to further the overall strategy. Because in media advocacy the media (in all its modern shapes and sizes) is merely a tool for bringing attention to the need for policy change, and not an end unto itself, advocates must determine if and how the media will advance their policy change goals. Thus if advocates can influence the target in other ways, such as through in-person meetings or direct pressure from constituents, there may not be a need to engage the news media. And, if the media can be an effective vehicle for putting the issue www.annualreviews.org • Public Health and Media Advocacy 297 A nn u. R ev . P ub li c H ea lt h 20 14 .3 5: 29 3- 30 6. D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y N at io na l U ni ve rs it y, S an D ie go o n 01 /0 2/ 17 . F or p er so na l us e on ly . PU35CH17-Dorfman ARI 22 February 2014 19:4 on decision makers’ agendas, developing a solid media strategy means thinking through which modes of communication and which news outlets will be most effective. Do the targets get their information from the local newspaper? Do they pay attention to online and social media sources? Do they listen to the radio? In today’s information environment, it is likely a combination of all of these. For example, if advocates can negotiate with city government to remove lead contamination from its low-income housing stock, there may be no need for media advocacy. But if the city balks, then news coverage highlighting the health harms and policy solution could spur otherwise reluctant decision makers to act. Message strategy. The message strategy includes the message, the messenger, and the audience: what will be said, who will say it, and to whom (as identified in the overall strategy). Messages generally answer three questions: What is the problem? What is the solution? And why does it matter? How the message is framed, including expressing shared values and moving from portraits to landscapes, can influence how the targets understand the problem and whether they recognize the solution as legitimate. The message will help advocates determine which details reporters will need when telling stories from a public health perspective. For example, a story about a child with lead poisoning may be dramatic and compelling but will do little to inspire action or systems change if there is no specific solution or policy goal illuminated in the story. In fact, the story may do more harm than good if it reinforces the idea that parents can solve this issue on their own. Access strategy. The access strategy is about gaining access to journalists, bloggers, and others who have access to the desired audience (i.e., people in positions of power to create change). This strategy includes determining when and how to seek media attention and prepare spokespersons to deliver the message. An effective access strategy takes into consideration when media attention can have an impact on the policy process, perhaps leading up to a vote or budget deliberation, for example, and on what about the issue is newsworthy. Ultimately policy change takes time; inevitably, advocates will need to revise and redirect even the most thorough media advocacy plan. The most historic and far-reaching public health interventions—such as ensuring clean indoor air and clean water sources—have been and remain long-term policy battles. By working through the layers of strategy, and revisiting their goals and objectives, media advocates can track their progress and reroute themselves when needed. Story elements: framing for content and framing for access applied. Story elements are the pieces that reporters put together to tell a story—a picture, an interesting fact, a compelling statement from a source. Advocates cannot control how the reporter frames the issue, but they can control whom they put forward to make the case, what those spokespeople say, and how they illustrate the problem and solution. For example, a story about a family struggling to treat their child’s asthma condition might be a vehicle for discussing the importance of access to asthma medication. But framing research shows that a story that focuses too narrowly on individuals will not help audiences understand the environmental factors at work (18). Media advocates think about what they can provide to reporters to help them tell an interesting story that supports the overall policy goal using various story elements: authentic voices, media bites, social math, and visuals. Authentic voices. Authentic voices are spokespeople who can provide a unique perspective on the problem and the need for a solution based on their personal or professional life experience. They might have suffered from the problem directly (typically referred to as victims or real people 298 Dorfman · Krasnow A nn u. R ev . P ub li c H ea lt h 20 14 .3 5: 29 3- 30 6. D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y N at io na l U ni ve rs it y, S an D ie go o n 01 /0 2/ 17 . F or p er so na l us e on ly . PU35CH17-Dorfman ARI 22 February 2014 19:4 by reporters), such as those exposed to secondhand smoke living in multiunit housing or work- ing in a restaurant where smoking is allowed. Or they might have other direct experience with the issue, e.g., as tobacco researchers, corner store merchants, health care providers, or com- munity members. Media advocates think carefully about the range of authentic voices they can prepare to make their case because, as the saying goes, “the messenger is the message.” News professionals and the targeted decision makers will respond to who is speaking, not just to what they say. For example, researchers presenting information on the effect of tobacco marketing on children’s health may be received differently than would young people who have quit smoking who make the same argument. Once advocates have cultivated and trained the right spokes- people, they can make their case in a variety of settings from community meetings and policy hearings to press events. People directly affected by the problem can become effective spokespeo- ple by linking their experience to the need for a population-wide policy solution. For example, Newtown, Connecticut, emergency room physician Dr. William Begg told a Senate panel on gun violence, “People say that the overall number of assault weapon deaths is small. Please don’t tell that to the people of Tucson or Aurora or Columbine or Virginia Tech, and don’t tell that to the people in Newtown. This is a tipping point, and this is a public health issue” (41). Not every spokesperson has to say exactly the same thing, but they have to mean the same thing. Campaigns will rely on different authentic voices depending on the setting, audience, or immediate goal. Media bites. Reporters face serious time and space constraints in their stories, and social media has condensed text even further, sometimes down to 140 characters. No matter how complicated the issue, only a few sentences from the most compelling spokespeople are likely to appear in any given news story. The challenge is for advocates to create concise statements—media bites—to increase the chance that their most important points are repeated. EXAMPLES OF MEDIA BITES Media advocates will not always speak in media bites when they talk with reporters. Depending on where they are in developing their story, they may provide background information or longer explanations. But it is always useful to have a media bite summarizing the key position—to use on camera or even in larger discussions where a concise statement can punctuate the story. Following are characteristics that make media bites effective and a few examples of each. � Succinct, straightforward statement about the problem: “We cannot say we have made true progress in the field of medicine until we fix the appalling inequities of America’s healthcare system” [Ellen Wu, California Pan-Ethnic Health Network, speaking out for universal health care (42)]. � An analogy that brings a picture to mind: “[Food] marketing is just washing over this country like a tidal wave, and we’re trying to give people swimming lessons” [Kelly Brownell, Rudd Center on Food Policy and Obesity, Yale University (22)]. � Something that evokes strong, shared values, such as “can-do spirit”: “It took vision to save Yosemite, dig the Panama Canal, build the Golden Gate Bridge, or go to the moon, but we did it. Some believe universal preschool is the next big idea. Count me in as one of those who believes” [Former California Superintendent of Education Delaine Eastin (35)]. � A statement that makes the magnitude of a problem more visible: “It’s like two jumbo airliners crashing every day with no survivors” [a quote from tobacco advocates illustrating the number of deaths from cigarettes every day (1)]. www.annualreviews.org • Public Health and Media Advocacy 299 A nn u. R ev . P ub li c H ea lt h 20 14 .3 5: 29 3- 30 6. D ow nl oa de d fr om w w w .a nn ua lr ev ie w s. or g A cc es s pr ov id ed b y N at io na l U ni ve rs it y, S an D ie go o n 01 /0 2/ 17 . F or p er so na l us e on ly . PU35CH17-Dorfman ARI 22 February 2014 19:4 Media bites communicate the core message but may be tailored to respond to a specific hard question or be shortened to emphasize one key point. Avoiding elephant triggers. When developing strong messages, advocates must also avoid state- ments that could undermine their overall strategy. Taking a cue from cognitive linguist George Lakoff, who argues that saying “Don’t think of an elephant!” (21) practically guarantees listeners will think of an elephant, media advocate Liana Winett warns that when advocates find themselves using “not,” “despite,” or similar terms in their media bites, they are probably invoking the oppo- sition’s argument, what she calls “elephant triggers” (L. Winett, personal communication). For example, advocates for restrictions on sugary beverages reinforce their opposition’s frame when they defend their policy choice with statements such as, “We’re not trying to be the pop police or anything . . .” (36). The advocates’ intentions in these examples are to bolster support for their goal by addressing concerns about government overreach. But they put their goal in terms of their opponents’ frame instead of establishing their own frame about health. The practice of answer- ing the opposition’s claims is appropriate in some contexts, but with media advocacy, especially in a media bite that is likely to be repeated without much background, advocates should avoid repeating the opposition’s frame. Social math. Every day we are bombarded with news stories involving very large numbers. Media advocates use “social math” to translate statistics and other data so they become interesting to the journalist, meaningful to the audience, and helpful in advancing public policy (39). Social math uses comparisons to other issues, populations, geographic areas, changes over time, or policy solutions. It can be created by restating large numbers in terms of time or place, personalizing or localizing numbers, or making comparisons that help bring a picture to mind. The best social math surprises people and provokes an emotional response. Social math examples can be a powerful tool because striking comparisons stay with people and can become part of the policy debate. Compelling visuals. Whether they are broadcast, print, or web-based, media stories rely on images in our increasingly visual culture. When advocates pitch an event or story, reporters will often ask, “What will I see when I get there?” What they are really asking is, “What will I show my viewers or readers if I do this story?” If the policy goal is to reduce the pollution that causes high rates of asthma, advocates could hold a press conference outside so that reporters can … Advocacy Recap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 https://youtu.be/aTbtKRdYbYo Advocacy Recap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 https://youtu.be/bFlyt8uKy8k Advocacy Recap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 https://youtu.be/Ccr8WLFNkjw Advocacy & Media Eyler, Chriqui, Moreland-Russell & Brownson, 2016 https://youtu.be/VgqoHxZYY84 Advocacy Policy Eyler, Chriqui, Moreland-Russell & Brownson, 2016 https://youtu.be/atbZYs215Uw Chapter 6 Public Policy and Tobacco Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Identifying the Problem: Tobacco Use and Consequences Cigarette 1900s E-cigarette Now Utilized production, advertising, design, and social behavior to influence social norms and create a culture around tobacco use Death and disease patterns have emerged as a result of the cultural influence – Deeply engrained, but this is slowly changing Public health prevention strategies used by tobacco control advocates have been integral to the changing social norms spurring the decline of tobacco use Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Figure 1.1 Adult per capita cigarette consumption and major historical and policy events Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Identifying the Problem: Tobacco Use and Consequences Epidemiology Tobacco use has long been a leading cause of morbidity and mortality worldwide Currently accounts for an estimated 9\% of deaths across the globe United States, smoking is the leading preventable cause of premature death and disease. Linked with several types of cancer, coronary heart disease, chronic obstructive pulmonary disease, diabetes, asthma, and stroke Nonsmokers who are exposed to secondhand smoke suffer from tobacco-related illnesses as well Since the United States Surgeon General began reporting on smoking more than 50 years ago, almost 2.5 million nonsmokers have died from smoking- related diseases Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Identifying the Problem: Tobacco Use and Consequences Epidemiology 1965, 42\% of Americans smoked cigarettes Tobacco prevention and cessation efforts established and various policies implemented and the population better understands risks 2013 smoking prevalence rates: 18\% of adults <13\% of youth Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Identifying the Problem: Tobacco Use and Consequences Epidemiology Rate of decline recently slowed recently: above Healthy People 2020 goals Emerging growth of non-cigarette tobacco product use introduces health risks More than one in five adults and high school students report using tobacco (non-cigarette tobacco products either alone or in addition to cigarettes) The most commonly used non-cigarette tobacco products are smokeless products (e.g., snuff), little or regular cigars, pipes, hookah (water pipes), and electronic cigarettes Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Identifying the Problem: Tobacco Use and Consequences Disparities Differences in tobacco use across: Gender Race and ethnicity Educational status Poverty status Sexual orientation Groups that use tobacco at disproportionately high rates, less likely to quit successfully & experience poorer health outcomes Military workers (e.g., active service members and civilian employ- ees) Construction workers Individuals with a history of mental health problems Homeless Incarcerated individuals Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Identifying the Problem: Tobacco Use and Consequences Disparities Differences across geographic location United States smoking rates were lower than those in many countries like Norway, Egypt, China, and Chile Higher rates than Mexico, Australia, Kenya, and India Within the United States Fewer than one in ten Utah residents smoke More than one in four people in Kentucky, Arkansas, and West Virginia smoke What else do you think contributes to health-related tobacco disparities? Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Why continued disparities? Excessive exposure to tobacco product promotion Tobacco industry targeting Lack of comprehensive policies Public Policy Strategies in Tobacco Control Creating Smoke-Free Environments Smoke-free laws protect employees and the public developing chronic disease due to secondhand smoke (cancer, heart disease, and respiratory diseases) Encourage people to quit Prevent smoking initiation Change social norms around tobacco use and exposure Smoke-free policies can be designed to impact public areas, private areas, or both. Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Public Policy Strategies in Tobacco Control Creating Smoke-Free Environments Policy has expanded to include: Public access: Restaurant patios, parks, playgrounds, and beaches Private settings such as multiunit housing and cars Smoke-free laws can be adopted voluntarily or via policy Policy preferred because it mandates rules and closes the gaps in secondhand smoke protection Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Public Policy Strategies in Tobacco Control Raising the Price of Tobacco Products through Tax Increases Increasing price = less affordable = reducing use = Change social norms Prevent youth initiation Decrease tobacco-related healthcare costs Reduce tobacco related health disparities Additional benefit = make revenue for governments Children’s Health Insurance Program in 2009 Largest increase in federal taxes Resulted in federal tax of $1.01 per cigarette pack In 2014, the total per pack tax ranged from $4.35 in New York to only $0.17 in Missouri Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Public Policy Strategies in Tobacco Control Restrictions on Marketing, Packaging, and Youth Access Tobacco Control Act gave legal authority to states & communities to pursue intervention at the retail level Read p.o.s. strategies p. 124 # 1-4 New York City, New York, Providence, Rhode Island, and Santa Clara County, California ban on sales of cigars, hookah, cigarillos, pipe and chewing tobacco, and e-cigarettes flavored with tastes that might appeal to youth (e.g., apple, grape, or mint) in establishments where youth could be present Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Public Policy Strategies in Tobacco Control Tobacco control policies can be implemented at the international, federal, state, and local levels Restrictions on Marketing, Packaging, and Youth Access Tobacco advertising has been banned on television, radio, billboards, and public transportation Industry focuses on point-of-sale Exposure at this level = higher odds of initiation and regular daily smoking among youth, unplanned & relapse Eyler, Chriqui, Moreland-Russell & Brownson, 2016 http://countertobacco.org Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Tobacco Control Support & Opposition Policy Rationale Financial burden on government and public Protection of high-risk populations Ensure clear and accurate information regarding tobacco products Consequences of secondhand smoke and other chemicals for nonusers Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Testimonies used in new e-cigarette regulations Tobacco Control Support & Opposition Political Support Local and state tobacco control programs do not have the flexibility or authority to influence tobacco control policies Coalitions are most important for comprehensive tobacco control policy Due to success in organizing and encouraging policy action through legislation and voter initiatives Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Tobacco Control Support & Opposition Political Support National-level voluntary organizations are also integral to advancement of policy American Heart Association American Cancer Society American Lung Association Advocacy organizations Americans for Nonsmokers’ Rights Campaign for Tobacco Free Kids Counter Tobacco) Legal partners Tobacco Control Legal Consortium Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Tobacco Control Support & Opposition Political Opposition Tobacco industry Utilizes financial resources Lobbyists Recruits policymakers via campaign funding in exchange for votes against TCC policies At the local level Recruit third parties or front groups Convenience store associations hospitality industry groups groups that oppose government regulation “astroturf ” groups—grassroots organizations that are funded, organized, and sometimes run by the tobacco industry Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Tobacco Control Support & Opposition Watch this YouTube video of an ad that ran during the Tobacco tax campaign, intended to highlight the misleading claims made by the tobacco industry and poke fun at them encouraging people to follow the money. https://www.youtube.com/watch?v=SSHnb-9y3V8 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 CASE STUDY Pp 131 in your text First U.S. tobacco-free pharmacy policy Reduces tobacco-related disparities at the local level Sets the stage for state and national tobacco-free pharmacy efforts Break into groups of 5 Review the case study Summarize your section on the flip chart (3-4 important take homes) Come back together as a class to share and discuss Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Tobacco-Free Pharmacies Eyler, Chriqui, Moreland-Russell & Brownson, 2016 https://youtu.be/R8-Fso5gieo Health Communications & Tobacco CDC Smoking and Tobacco Use Video Methods to Spread Awareness Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Reference Eyler, A.A., Chriqui, J.F., Moreland-Russell, S.M., & Brownson, R.C. (Eds.). (2016) Prevention, policy, and public health (1st ed.) New York, NY: Oxford University Press. Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Chapter 7 Food, Nutrition & Obesity Policy Eyler, Chriqui, Moreland-Russell & Brownson, 2016 1 Identifying the Problem: Obesity & Its Consequences Obesity = excessive body fat/bodyweight BMI—a ratio of weight to height, calculated as kilograms divided by meters squared Categorize an individual as obese = BMI ≥30 In children, obesity refers to a BMI greater than, or equal to, the 95th percentile Obesity is a major risk factor for: Type 2 diabetes, cardiovascular disease, and hypertension Greater risk for additional comorbid health conditions, including stroke, arthritis, nonalcoholic fatty liver disease, kidney disease, and mental health problems related to social stigma Eyler, Chriqui, Moreland-Russell & Brownson, 2016 2 Identifying the Problem: Obesity & Its Consequences Disparities Eyler, Chriqui, Moreland-Russell & Brownson, 2016 3 Identifying the Problem: Obesity & Its Consequences Disparities: Children Between 1980 and 2004, obesity prevalence tripled among children aged 2 to 19 years increasing from 6\% to 19\% Overall prevalence has remained fairly stable since 2004 2011–2012 = 17\% of children obese Hispanic children have the highest obesity prevalence, followed by: non-Hispanic Black and non-Hispanic White children Black children are more likely to be severely obese than are White children Trends indicate the most pronounced increase of severe obesity in White female and Black male children Eyler, Chriqui, Moreland-Russell & Brownson, 2016 4 Identifying the Problem: Obesity & Its Consequences Disparities: Adults More prevalent in non-Hispanic Blacks and Hispanics Exists at the highest rate among all adults aged 40 to 59 years Gender- and income-based obesity-related disparities exist among all racial and ethnic groups Most pronounced among non-Hispanic Black women across all age categories Higher income non- Hispanic Black and Mexican American men have slightly higher obesity prevalence rates than those with lower incomes Adults in rural areas are significantly more likely to be obese than those in urban areas WHY? Eyler, Chriqui, Moreland-Russell & Brownson, 2016 5 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 6 Identifying the Problem: Obesity & Its Consequences The Costs of Obesity $315.8 billion was spent on adult obesity-related direct healthcare costs in 2010 Majority of expenses resulting from the treatment of comorbid health conditions, particularly type 2 diabetes Medicare and Medicaid spending would see decreases of 8.5\% and 11.8\% if obesity-related costs were removed from the analysis Obesity-related absenteeism translates to an estimated cost of $8.65 billion per year in lost productivity Eyler, Chriqui, Moreland-Russell & Brownson, 2016 7 Identifying the Problem: Obesity & Its Consequences Obesogenic Environment Eyler, Chriqui, Moreland-Russell & Brownson, 2016 8 https://youtu.be/5Rm7E2e1Su8 Identifying the Problem: Obesity & Its Consequences Obesogenic Environment “Obesogenic environment” Unhealthy options are frequently more accessible and affordable than healthy options Physical activity opportunities are limited Marketing of unhealthy options outweighs marketing of healthier options Eyler, Chriqui, Moreland-Russell & Brownson, 2016 9 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 10 Identifying the Problem: Obesity & Its Consequences The U.S. Food System Over the past 60 years, the American food system has transitioned from one of home- cooked meals to one of prepackaged, processed, convenience foods, and food eaten away from home (FAFH) Food technology advanced (e.g., home refrigeration systems, mechanized industrial processes, microwave technology) food became more processed, faster to prepare, and cheaper while reducing the reliance on scratch-cooked meals Eyler, Chriqui, Moreland-Russell & Brownson, 2016 11 Identifying the Problem: Obesity & Its Consequences The U.S. Food System Americans now consume more convenience foods (packaged) at home The amount of household food expenditures on FAFH increased from 25.9\% in 1970 to 43.1\% in 2012 FAFH is generally of lower nutritional quality than foods consumed at home Eyler, Chriqui, Moreland-Russell & Brownson, 2016 12 Identifying the Problem: Obesity & Its Consequences The U.S. Food System Packaged food industry further propagates obesity and health disparities by selling convenience foods and beverages higher in sugar, salt, and/or fat than unprocessed foods Required to extend the shelf life of the products It has been found that processed foods with increased shelf life lends to their ready availability in low food-access areas Resulting in increasing obesity prevalence in: Low-income Black and Hispanic urban neighborhoods Low-income, predominately White rural areas Eyler, Chriqui, Moreland-Russell & Brownson, 2016 13 Identifying the Problem: Obesity & Its Consequences The U.S. Food System Eyler, Chriqui, Moreland-Russell & Brownson, 2016 14 Identifying the Problem: Obesity & Its Consequences The U.S. Food System The Child Nutrition and Women, Infants, and Children Reauthorization Act of 2004 USDA authority to update the National School Lunch Program (NSLP) and School Breakfast Program (SBP) nutrition standards to align them with the most current Dietary Guidelines for Americans Healthy, Hunger-Free Kids Act of 2010 Sale of foods and beverages in schools (besides the NSLP and SBP) were not regulated at the federal level until the passage of the act Gave USDA the authority to impose nutrition standards for all foods and beverages sold outside of meal programs Commonly referred to as “competitive foods and beverages” because their sale competes with meal programs Eyler, Chriqui, Moreland-Russell & Brownson, 2016 15 Identifying the Problem: Obesity & Its Consequences The U.S. Food System 2013: USDA issued the Smart Snacks in School Provides science-based nutrition standards for all foods sold on school campuses during the school day Implementation started at the beginning of the 2014–2015 school year Eyler, Chriqui, Moreland-Russell & Brownson, 2016 16 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 17 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 18 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 19 Public Policy Strategies Related to Obesity Politics of Obesity Liberal policymakers frame their approach as an issue of social responsibility the need to regulate the food industry Conservatives and libertarians emphasize personal responsibility, favor fewer regulations, and resent what they perceive as government interference with the market Advocacy groups and professional organizations are also influential actors bring expertise, consumer outreach, and grassroots influence to the political landscape they do not leverage direct financial influence Eyler, Chriqui, Moreland-Russell & Brownson, 2016 20 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 21 Center for Science in the Public Interest: One of the most prominent science-based food/nutrition advocacy groups The most influential player in the food/nutrition industry political landscape is the food and beverage industry  28M to federal, state, and local candidates in 2014 More than ½ contributions went to Republican party 80\% greater to Republican: 9.1M than Democratic: 5M 75-90\% of the public agree obesity is a major health concern Little public consensus about who bears responsibility for addressing and solving the obesity crisis: individuals, governments, communities, or a combination of entities Public Policy Strategies Related to Obesity Politics of Obesity Eyler, Chriqui, Moreland-Russell & Brownson, 2016 22 Public Policy Strategies Related to Obesity – Debate Activity Sugar-Sweetened Beverage Taxation (pp153-157) Break into 2 types of groups: Support OR Opposition Topic: Case of Sugar-Sweetened Beverage Taxation Group 1: Industry Opposition to Sugar-Sweetened Beverage Taxes Group 2: Public Support for Sugar-Sweetened Beverage Taxes Eyler, Chriqui, Moreland-Russell & Brownson, 2016 23 Public Policy Strategies Related to Obesity – Debate Activity Sugar-Sweetened Beverage Taxation (pp153-157) Break into 2 types of groups: Support OR Opposition Get into pairs. Then, review the summary of SSBs p.153 Then, select your position (p.155 or 156) FOR or AGAINST Then, using your pc or phone to research your position Then, select one point to argue regarding the SSB policy that is being debated. Your point has to align with your position. Use one fact in your argument. Each student has one minute to argue their position. Let’s debate! Eyler, Chriqui, Moreland-Russell & Brownson, 2016 24 Example Policy SSB Sugar-Sweetened Beverage Taxation City:Berkeley Ordinance # 7,388 Link to ordinance text: https://www.cityofberkeley.info/ uploadedFiles / Health_Human_Services /Level_3_-_Public_Health/SSB\%20Tax\%20Ordinance\%207,388-N.S..pdf Eyler, Chriqui, Moreland-Russell & Brownson, 2016 25 Soda Tax Eyler, Chriqui, Moreland-Russell & Brownson, 2016 26 https://youtu.be/8xF3XmuBu-M Advocacy Pro SSB Tax- Berkeley Eyler, Chriqui, Moreland-Russell & Brownson, 2016 27 https://youtu.be/UwZV9Gq_0Gs Industry Opposition Eyler, Chriqui, Moreland-Russell & Brownson, 2016 28 https://youtu.be/VBK4qACB7Uw Berkeley Soda Tax: One Year Result Eyler, Chriqui, Moreland-Russell & Brownson, 2016 29 https://youtu.be/1mhszXEZEJI Reference Eyler, A.A., Chriqui, J.F., Moreland-Russell, S.M., & Brownson, R.C. (Eds.). (2016) Prevention, policy, and public health (1st ed.) New York, NY: Oxford University Press. Eyler, Chriqui, Moreland-Russell & Brownson, 2016 30 Health Communication ReCap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 1 Health Communication Models Health Communication ReCap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 2 Health Communication ReCap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 3 Social Marketing Marketing mix Four P’s Product Behavior trying to change Breastfeeding Price How much will it take to get a person to stop or adopt a behavior Place Does consumer have access to the product Is it available? Distribution system? Promotion Communication about the product, price & place TV, internet, radio, social media, newspapers, pamphlets, direct mail Health Communication ReCap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 4 Tobacco ReCap What were the 3 key legislations we covered? Smoke-free environments Smoke-free laws protect employees and the public developing chronic disease due to secondhand smoke Encourage people to quit Prevent smoking initiation Change social norms around tobacco use and exposure Raising the price of tobacco via tax Increasing price = less affordable = reducing use = change social norms Prevent youth initiation Decrease healthcare costs Reduce tobacco related health disparities Revenue for governments Eyler, Chriqui, Moreland-Russell & Brownson, 2016 5 Tobacco ReCap Marketing, packaging and youth access Tobacco advertising has been banned on television, radio, billboards, and public transportation Industry focuses on point-of-sale reduced exposure at this level = lower odds of initiation and regular daily smoking among youth, unplanned & relapse Eyler, Chriqui, Moreland-Russell & Brownson, 2016 6 Tobacco ReCap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 7 https://youtu.be/5Wlob8oCuQ8 Tobacco ReCap Eyler, Chriqui, Moreland-Russell & Brownson, 2016 8 https://youtu.be/jnGES82RL94 Chapter 16 Communicating Research to Help Influence Policy and Practice Eyler, Chriqui, Moreland-Russell & Brownson, 2016 9 Why is Communication Important? Public policies (laws or regulations) have a major role, in improving population health across a wide range of issues and topics But for evidence-based scientific information to have an impact on policy decisions, it must be communicated effectively Eyler, Chriqui, Moreland-Russell & Brownson, 2016 10 Communicating with Policymakers It is difficult to communicate science to policymakers in order to persuade them to approve and implement a public policy Few policymakers are trained in or familiar with scientific approaches Eyler, Chriqui, Moreland-Russell & Brownson, 2016 11 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 12 Communicating with Policymakers Policymaking Environment Learn about the Formal Policymaking Process in the Jurisdiction of Interest Elected policymakers operate as part of a system with formal rules for legislative or regulatory policymaking, funding decisions, and implementation Need to learn as much as possible about rules within specific jurisdictions in which you are where one is seeking adoption of a new policy A certain time period allowed and a procedure to follow e.g.: when a new bill or regulation may be introduced, or how committee hearings with witnesses are held for a specific state legislature or city council Eyler, Chriqui, Moreland-Russell & Brownson, 2016 13 Communicating with Policymakers Policymaking Environment Learn about the Formal Policymaking Process in the Jurisdiction of Interest When communicating with a policymaker in writing or in person about legislation or regulation, it is best to select an individual who resides within the policymaker’s jurisdiction A city council may be unlikely to consider, or accept, testimony at a hearing about a new ordinance from someone who does not live within the city If want to adopt a new smoking ordinance in San Francisco then… we should find constituents residing or native to that area Eyler, Chriqui, Moreland-Russell & Brownson, 2016 14 Communicating with Policymakers Policymaking Environment Understand Policymaker Characteristics Know your audience!! Understand demographic characteristics Every effort needs to be made to learn about the characteristics and preferences of a specific policymaker(s) of interest to help you encourage them to become a champion for the policy What characteristics can you think of that we may want to learn about the policymaker? Eyler, Chriqui, Moreland-Russell & Brownson, 2016 15 Communicating with Policymakers Policymaking Environment Understand Policymaker Characteristics Internet searches will likely be the best way to find detailed information about individual policymakers opinions and beliefs voting records sponsored or proposed legislative bills most national and state elected policymakers are likely to have dedicated web- sites, Facebook pages, blogs, or Twitter accounts News media stories Eyler, Chriqui, Moreland-Russell & Brownson, 2016 16 Communicating with Policymakers Policymaking Environment Understand Policymaker Characteristics Political party affiliation Assessing personal involvement, personal relevance or level of interest a policymaker has for a specific topic or issue personally affected by a disease or health issue of concern? Eyler, Chriqui, Moreland-Russell & Brownson, 2016 17 Communicating with Policymakers Policymaking Environment Understand Policymaker Characteristics San Francisco Board of Supervisors who voted on 2016 SSB tax: Scott Wiener and Eric Mar, Jane Kim, Katy Tang, Norman Yee and London Breed Scott Wiener and Eric Mar – YES effective deterrent to selling sugary drinks, could reduce consumption 30 to 40 percent children today, one-third of them will develop type 2 diabetes, and for minorities that number is even higher… Jane Kim, Katy Tang, Norman Yee and London Breed – NO objected to the measure because of the disproportionate effect the tax will have on those same communities Calling it a regressive flat tax, Kim said that it unfairly burdens low-income communities similar to other sin taxes such as high taxes on cigarettes Eyler, Chriqui, Moreland-Russell & Brownson, 2016 18 Communicating with Policymakers Policymaking Environment Build Relationships with Policymakers and Gatekeepers (Aides) Policymakers rely on gatekeepers: aides or assistants Gatekeepers have an important role in deciding who has direct access to policymakers, and the information to which they are exposed Build relationships via in-person meetings & regular communication Use the preferred communication channels Build trust: follow through on promises Eyler, Chriqui, Moreland-Russell & Brownson, 2016 19 Communicating with Policymakers Policymaking Environment Seek Media Attention Elected policymakers pay close attention to news media stories, especially those they consider relevant to their constituents Gain supportive media coverage for a policy issue is important to get the attention of policymakers National or state-based “report cards” with letter grades are used by organizations to try and raise awareness among the news media and policymakers about public health issues Eyler, Chriqui, Moreland-Russell & Brownson, 2016 20 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 21 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 22 Communicating with Policymakers Policymaking Environment Communication Planning Communication planning consists of devising the strategy, and creating messages, for policymakers Persuade policymakers to approve a new public health policy that is evidence-based and highly likely to be effective An active strategy will be used to engage policy- makers and gain their attention – do not use solely a fact sheet on a website Communication efforts with policymakers will be coordinated with supporting organizations & other allies Building partnerships and coalitions provides a united front among supporters Eyler, Chriqui, Moreland-Russell & Brownson, 2016 23 Communicating with Policymakers Policymaking Environment Develop the Storyline (Meta-message) Eyler, Chriqui, Moreland-Russell & Brownson, 2016 Creating a storyline, or meta-message is the beginning of communication planning The storyline represents the major conclusion one is trying to convey to policymakers Public health policy storylines are usually straight- forward because they are the policies themselves: 24 All children must be vaccinated against MMR before entering elementary school Manufacturers must install Safety Device B in motor vehicles beginning in Year 20XX Communicating with Policymakers Policymaking Environment Select the Messenger/Source Formal Testimony – “To Whom Will They Listen?” Should be from within the policymakers jurisdiction Credibility Fair/unbiased Provide accurate, relevant information about the issue Most effective are those with a science/health background Eyler, Chriqui, Moreland-Russell & Brownson, 2016 25 Communicating with Policymakers Policymaking Environment Develop and Deliver the Message Messages provide the rationale used to support the storyline (i.e., the public policy) Created with the goal of convincing policymakers that: there is a public health problem, and the new public health policy will solve or alleviate the problem Messages themselves consist of words, numbers, visual images, or some combination of the three, and they are presented to audiences orally, visually, or in written form Eyler, Chriqui, Moreland-Russell & Brownson, 2016 26 Communicating with Policymakers Policymaking Environment Develop and Deliver the Message To develop messages consider the questions policymakers most often want answered Is there a problem? If so, is there a solution for the problem? What do we do? How much will it cost to solve the problem? How does this help my constituents? Will this make me look good (to the media, to my constituents, and to the powerful interests that shape my region)? Eyler, Chriqui, Moreland-Russell & Brownson, 2016 27 Communicating with Policymakers Policymaking Environment Communicating Data Incorporating data into policy briefs or testimony can define a particular public health problem and demonstrate the magnitude of the problem The number of people impacted and the expected positive impact of the new policy A common and effective strategy is to use public health surveillance data (the more local the data, the better) highlight the magnitude of a specific health problem followed by findings to demonstrate the cause(s) of the problem or the projected impact of the policy (the solution) Eyler, Chriqui, Moreland-Russell & Brownson, 2016 28 Communicating with Policymakers Policymaking Environment Communicating Data- Sample Policy Brief Eyler, Chriqui, Moreland-Russell & Brownson, 2016 29 Sample policy brief: Hep C Policy Brief Communicating with Policymakers Policymaking Environment Communicating Data Eyler, Chriqui, Moreland-Russell & Brownson, 2016 30 Communicating with Policymakers Policymaking Environment Communicating Data Reducing complex data into understandable information Provide an analogy such as “X is similar to Y” Eyler, Chriqui, Moreland-Russell & Brownson, 2016 31 In Los Angeles, there are more tanning salons than schools, supermarkets, and gas stations combined Communicating with Policymakers Policymaking Environment Communicating Data Narratives like personal testimony can support research Box 16.3 p.314 Eyler, Chriqui, Moreland-Russell & Brownson, 2016 32 Communicating with Policymakers Policymaking Environment Communicating Data Eyler, Chriqui, Moreland-Russell & Brownson, 2016; CDC, 2018 33 (CDC, 2018) Communicating with Policymakers Policymaking Environment Visuals Visuals are used to present data and demonstrate magnitude, highlight changes, or make comparisons to increase understanding and interpretation by the target audience Eyler, Chriqui, Moreland-Russell & Brownson, 2016 34 Bar charts: Magnitude; patterns; relative differences Communicating with Policymakers Policymaking Environment Visuals Pie charts: Proportions; magnitude; Eyler, Chriqui, Moreland-Russell & Brownson, 2016 35 Communicating with Policymakers Policymaking Environment Visuals Eyler, Chriqui, Moreland-Russell & Brownson, 2016 36 Line graphs: Trends over time; Increases, decreases, stability Communicating with Policymakers Policymaking Environment Written Materials Eyler, Chriqui, Moreland-Russell & Brownson, 2016 37 Communicating with Policymakers Policymaking Environment In-Person Meetings Occur in: Legislative hearing: Involve one or more experts providing short testimonies to policymakers, followed by questions from legislators Testimony is short (a few minutes), and it is sometimes prepared in advance and read to committee members Data presented vis posters, PowerPoint or some other type of slide presentation software Come well-prepared to communicate key messages, and responding appropriately to questions Eyler, Chriqui, Moreland-Russell & Brownson, 2016 38 Communicating with Policymakers Policymaking Environment In-Person Meetings Occur in: Face-to-face Eyler, Chriqui, Moreland-Russell & Brownson, 2016 39 Communicating with Policymakers Policymaking Environment Anticipate Potential Opposition Arguments and Strategies Eyler, Chriqui, Moreland-Russell & Brownson, 2016 40 Communicating with Policymakers Policymaking Environment Follow-Up Send a thank you for their support regardless of the policy outcome If information is requested of you send within 24-48 hours REMEMBER: When communicating with policymakers it is important to: Have a good understanding of the policymaking environment Communication planning: creating a strategy and developing key messages Eyler, Chriqui, Moreland-Russell & Brownson, 2016 41 Communicating with Policymakers Policymaking Environment Testimony Example The Senate Judiciary Committee held a hearing on reauthorizing the Violence Against Women Act, which is set to expire in September. The committee heard from the Justice Department’s director of the Office of Violence Against Women as well as activists and a San Diego prosecutor on how the law, which was first enacted in 1994, helps survivors of domestic violence Amanda Nguyen – Violence Against Women Activist & Rise Founder https://www.c-span.org/video/?c4765914/cspan-testimony Eyler, Chriqui, Moreland-Russell & Brownson, 2016 42 Reference Eyler, Chriqui, Moreland-Russell & Brownson, 2016 43   Eyler, A.A., Chriqui, J.F., Moreland-Russell, S.M., & Brownson, R.C. (Eds.). (2016) Prevention, policy, and public health (1st ed.) New York, NY: Oxford University Press.