What has changed, and how do we proceed?
The pandemic has shone a clear light on the importance of community risk factors in shaping health outcomes. Depending on where a family lives, they may or may not have had access to testing and vaccines and proper care, schools with the ability to implement adequate safety precautions, jobs that allow for remote work, safe and uncrowded commuting or transit options, personal protective equipment, grocery delivery services, safe spaces for gathering outdoors, and more. While the impacts of these differences are generally felt over lifetimes and generations, the speed and severity of the pandemic made it easier to observe these differences in real-time.
Even still, popular understanding maintains that health is primarily a product of health care, and that remaining differences are merely a result of personal choice. The piece that is often missing from that narrative is the understanding that those choices are limited due to place-based constraints that often play out over the course of a lifetime.
While the sped-up timeline that has accompanied the COVID-19 pandemic could present unique communications opportunities, attempts to inform the public and shift opinions have gotten increasingly complicated in a highly politicized environment, full of othering, misinformation, and distrust.
To better understand public perception of these issues and possible communications opportunities to raise the profile of place-based determinants of health, the Nova Institute for Health commissioned a series of focus groups conducted by the Center on Society and Health at Virginia Commonwealth University, with recruitment support from the Millbank Memorial Fund. These groups consisted of participants with varying levels of political involvement (including active and former state legislators), differing ideologies, and widespread geographies, and helped us uncover some important takeaways as we continue to think about drawing attention to the importance of addressing certain place-based differences in a post-COVID world.
The main themes we took away from this work are as follows.
- Right now, it is too early to use COVID-19 as a “themed talking point.” The issue and the experiences are too polarized. But a time is coming when the stories and takeaways can be used as a vehicle for underscoring important themes, and it will be important to seize that opportunity when it comes. The challenge is timing, as the pandemic will lose its poignancy when the memory is no longer fresh.
- Terms like “social determinants of health” and “public health” mean different things to different people. Breaking the habit of using familiar or more academic terms can be challenging, but speaking in plain language and avoiding potentially loaded terms can help reach and persuade new audiences. We found the phrase “community health” to be more relatable and well-received than “public health” or “population health.”
- Trust will need to be rebuilt—in leaders, public health, and science itself. The pandemic showed us the hazards of inconsistent messaging, especially by leaders, and it also taught us the need to respond deftly to changing science in ways that maintain public confidence.
- Mandates can be used creatively to protect health and safety, but with caution to not trample on personal freedom. Changing the “environment” to facilitate desired behaviors is often a more effective and subtler alternative.
- Appeal to both civic responsibility and personal responsibility. While health is certainly shaped by individual choices, it is important to support our communities and ensure the choices that support health and wellbeing are truly accessible to everyone.
- Public health needs far more developed “story-campaigns,” which grab attention in evocative ways that statistics and epidemiology cannot.
- Accurate information is not enough—and is often readily available. Communicators should pay more attention to the way their audiences communicate, the channels and sources they use, and where the messages land.
- As our society has become more polarized, the tendency to use stereotypes has increased, but it is unhelpful. Audiences are not a monolith and are easily put off by messages that assume they are.
- “We” may not be the most effective messengers. We, as researchers or public health professionals, national leaders, or politicians, are less compelling than trusted leaders from within a community.
We hope these findings can offer our colleagues some support as they move on from pandemic communications and continue to advocate for changes that will better support community health and wellbeing. In the wake of the pandemic, complex and fraught controversies from abortion to gun violence and racial justice are at the center of public dialogue.
It’s safe to predict that the need for health professionals to do better in fostering healthy communication about sensitive issues will challenge us for some time. Learning new ways to frame conversations that encourage understanding, dialogue, and progress is urgent.
To learn more about this study, contact Dawn Stoltzfus.
