The idea that stood out the most to me from this week’s readings was the Health in All Approach to policy. This wasn’t the fist time that I had come across this idea, however, in light of readings which presented theories of policy making, I found myself contemplating how likely the adoption of a HiAP approach is here in BC. This is not to say that I think that a HiAP framework would not be appropriate or beneficial, quite the contrary. Rather, I wonder what the chances are that such an approach could be adopted in BC given our current political and economic climate.
With the ten year track record of the BC liberal party proving that they are most concerned with “bottom-line-in-all-policies” I am doubtful that under the current leadership HiAP would be genuinely supported and/or adopted. As counter productive as it may seem to those of us working in or studying public health, the penny-wise-pound-foolish policies of the previous two provincial administrations doesn’t exactly jibe with the lessons presented in the publications from the 2010 Adelaide Meeting. As the Adelaide convention acknowledges HiAP is a long term forward thinking approach to public policy. Effectively implementing HiAP takes a significant amount of time and sincere dedication from various policy actors. Furthermore, realising the benefits can take years. In a political climate more concerned with immediate results and short term fiscal savings I can’t help but think HiAP uptake (from current leadership) is far from near. I am aware that a HiAP inspired initiative for improving chronic health condition in BC has been implemented (ActNow BC). However, while a complete assessment of this initiative is beyond the scope of this posting, I do question whether a one off program, targeting very narrowly defined health conditions can truly be considered HiAP? With the upcoming election polls heavily favouring Adrian Dix, will have to wait and see what tack he will take in addressing the social and health inequalities that he has campaigned on and whether a comprehensive and collaborative policy approach will factor into his solution of these issues.
Admittedly, the above discussion has been focused on political leadership which, as A Glossary of Theories for Understanding Policy Making made clear, is but one aspect of many when it comes to policymaking. I was surprised then, at the lack of discussion from this paper in regards to the role public opinion and influence has on the policy making process. Having previously studied this process I was curious to know how Canadians feel about HiAP. In November 2012 the Canadian Nursing Association published findings from a nation wide survey on its website indicating that most Canadians believe that public policy should be evaluated for the effect it will have on the health of fellow citizens. While I do find some results more striking than others, I will say that I was somewhat surprised by the extent of public support for HiAP.
I began this posting by reflecting on my reaction to this week’s readings as they apply to BCs current political landscape. While I wasn’t surprised to find HiAP research and support within the realm of public health discourse in Canada (ie CIHR, CAN) or even examples of HiAP style initiative being put into practice, I am still left wondering what it will take before the value of health is truly factored into all aspects of public policy in BC.
Here is our Oral Rehydration Therapy (ORT) slides.
Baindu and I actually re-drew some of the images in the slides to simplify them, so feel free to copy and print them off on a larger scale for your own personal use. Also, as this information/presentation is most likely to be used in the field be sure to make it culturally appropriate to whichever audience you’re working with.
Remember, ORT can be useful in many situations. Baindu and I focused on dehydration as a leading factor, but contaminated water/food sources which causes diarrhea can also require the use of ORT.
(abrubach, 2013, bkosia, 2013)
As per last week’s presentation and course reading, check out this link.
Breast cancer is one type of cancer that seems to get plenty of attention.
Along with this attention, comes education, increased awareness and usually funding. The money that accompanies all of this attention can fund any number of different things, including additional health promotion, as well as research that can help to improve treatment and care for patients who suffer from breast cancer
But why is breast cancer so visible, when there are so many other types of cancer, often more fatal types, that seem to be hidden from the public?
At look at some stats:
*Data source: Canadian Cancer Statistics 2011
If we were to prioritize awareness campaigns on the basis of mortality, clearly, lung cancer should be receiving heightened attention. Yet, breast cancer seems to saturate awareness campaigns, clearly recognized by the pink ribbon. The branding of breast cancer, has no doubt increased public awareness, which can also help to facilitate earlier detection, decreasing mortality. However, there are those who argue that the use of logos may have the opposite effect, providing only a shallow symbol that fails to recognize the gravity of the disease, nor acknowledge the struggles faced by those who have breast cancer. Erika Lade clearly articulates these issues in an article from the Huffington Post , and also brings up important concerns about corporations capitalizing on “pinkwashing” as a means to look charitable.
Also concerning is how this preference for supporting breast cancer might be affecting those who suffer from other types of cancer, who may end up feeling “slighted” that they receive little to no attention. For example, this blog post presents the views of a non-Hodgkin lymphoma survivor who reflects that during breast cancer awareness month
“Pinktober can feel awfully lonely for those of us who don’t merit the pink ribbon. And yet we’re the vast majority of people who’ve been impacted by cancer.”
In more recent years, there has been a push to raise awareness for other cancers.
Notably, the annual Movember campaign has become a highly visible strategy for promoting awareness for men’s cancers, while also raising funds. Other efforts have included marketing of products that also aim to raise awareness, such as these Christmas ornaments, that draw attention to testicular cancer, and aim to encourage men to self-check for suspicious lumps
Recognizing the discomfort that most people have in discussing colorectal cancer, recent campaigns have focused on using playful slogans, and phrases to encourage people to feel more at ease, while also raising awareness. For example, Savebutts.ca is a website hosted by the Colorectal Cancer Association of Canada used to raise funds, educate, and increase awareness about colorectal cancer, while coloncancercanada.ca displays the slogan “we’re behind your behind”. Moreover, the latest screening campaign by the Center for Disease Control has launched several public service announcements that include celebrities to help increase the visibility and familiarity of colorectal cancer.
While these efforts play an important role in raising awareness for cancer, it is vital that we also continue to provide information and education. During my time working at Princess Margaret Hospital, I remember having a conversation with a mother of a 16-year-old male patient who had been diagnosed with testicular cancer. Not only was she angry about the lack of public awareness for testicular cancer, she was disappointed that their family doctor had never discussed the importance of self-exam with her son. Instead, extreme pain had prompted her son to visit the doctor, only to find that his cancer was already in advanced stages. Inevitably, she was frustrated that her son had never been informed about testicular cancer by their family physician, nor told about the importance of regular self-checks. Clearly, there is a need to focus on combined strategies. Only once people know about the steps they can take to avoid developing cancer, and the signs and symptoms that can help lead to early detection, can we begin to maximize cancer prevention and treatment.
Apparently ‘activism’ is a ‘dirty word’ based on how people think about activists and how activists are depicted in the media (UBC, 2010; Cucow, 2011). And who knew? I certainly didn’t … and I’ve been calling myself a human rights activist for years.
To get a sense of the differences, I googled ‘activism’ and ‘advocacy’ on Google Images to see what kind of imagery is associated with each term. Below are two photos that may demonstrate the way that people may think about both change agents.
Whereas in the majority of photos, advocacy is displayed as a process of dialogue, friendly exchange or negotiation, activism is depicted as a more radical process, involving direct action such as protesting. In many images, activists are depicted as violent.
So what is the main difference and how can that difference help us understand our role as ‘change makers’ in public health?
Advocacy and activism are tools to create some sort of social and political change. Advocacy is often thought of as “an act of publicly representing an individual, organization, or idea” and used as an umbrella term for many intervention tactics such as “speaking, writing or acting in favour of a participate issue or cause, policy or group of people.” (Cucow, 2011; PHAC, 2010). This can include lobbying which the Public Health Agency of Canada prefers to distinguish from advocacy in terms of public health interventions because lobbying is conducted “by a special interest group [that] may or may not be in the public interest” (2010).
According to DoSomething.org, actress Angelina Jolie is an example of an advocate who uses her fame to advocate for refugees in her position as the United Nations Goodwill Ambassador (UNHCR) (no date).
Activism, on the other hand, often has a less favorable reputation even though by definition, it can be viewed as a form of advocacy. Activism is described as “a policy of taking direct action to achieve a political or social goal” (Zeitz, 2008). The term implies a direct action or intervention such as a protest in favour of change. According to blogger Shane Cucow, activism can be seen as part of the advocacy process or the action(s) that advocates take, such as organize a deliberate and direct protest, to increase awareness and attempt to influence the political process (2011).
According to DoSomething.org, Rosa Parks is an example of an activist. Parks was a civil rights activist in the United States that challenged racial segregation and is known for refusing to give up her seat to a white person on a public bus (no date).
Advocacy is often seen as working “within the system” whereas activism is seen as working “outside the system” to generate change (UBC, 2010). The implications of this understanding are discussed in length between two professors; Dr. R. Deibert and Dr. J. Kennelly in a panel at the University of British Columbia titled “Advocate or Activist: What is the best way to effect change?” (podcast available here). Dr. Kennelly discusses her ethnographic research with activists across Canada describing how activists “often feel left out of public discourse, and/or feel that they don’t always fit in” to the political and/or social process (UBC, 2010).
Is it possible that people that call themselves ‘activists’ have given up on working ‘within the system’ and feel like more ‘radical’ actions is necessary to bring about true and transformative change? If ‘advocating’ for a healthier society does not produce results, as public health change makers, when do we become ‘activists’ that work ‘outside the system’? What are the advantages and disadvantages of working ‘within the system’ or ‘outside the system’?
Both terms are not without a few drawbacks. Both concepts remove the importance of collective action in bringing about change. It is important to question our role as advocates if we are ‘speaking on behalf of a community, group or individual’ and how being a spokesperson affects collective action and the agency of the individuals to whom we are representing. The same applies to activism. Most importantly, both terms undermine the importance of recognizing the long and often difficult road to change that requires collective action from many individuals, communities and organizations that may work both “inside” and “outside” the system.
By: Krystyna Adams, Tara Walton, Suzanne Vander Wekken
Upon request here is our story for your reading pleasure:
- One rainy day in January in the beautiful province of BC, a head representative from Kellogg Food Manufacturing Company, Mr. Glucose, sped along the #1 Hwy in an oversized delivery truck on the way to deliver their sugary cereals to the whole region. Seeing them coming all the way from the bridge, health promotion specialists Suzanne, Krystyna and Tara waved them off to the side of the road as they approached their office at the Ministry of Health Promotion. The three began asking where exactly Mr. Glucose and his driver were going. They explained that they were off to deliver their tasty collection of sweet cereals to the major grocery chains in the lower mainland, where most of the population lives–most especially children, who gobble these products up. “But your products are so full of refined sugars…and they have nearly no protein or fibre! People who eat these products are at much higher risk of becoming overweight or obese and getting diabetes,” exclaimed Krystyna, also a pro athlete, as she read the nutritional label on the side. “We really don‘t care about producing healthy products. We just make something that tastes good,” they explained, and loaded back into their truck and with a spew of black exhaust continued on their delivery route.
- In February, the truck came roaring by again, and once again the health promotion team Tara, Krystyna and Suzanne waved them to the side of the road. Once again they asked Mr. Glucose to consider how much sugar was in the products his company produced, and consider how this was impacting the health of the population. “But these are the products we have always made. Everyone loves Fruit Loops and Captain Crunch. We never really thought of changing what we do.” So the health promotion team explained what happens when there are too many sugar-laden products on the market, and how this is a significant contributing factor to rising rates of childhood obesity.
- In March Mr. Glucose and his driver came driving in on Hwy #1 once again, forgetting that they ought to change their route if they wanted to avoid the tenacious health promotion trio–Suzanne, Tara and Krystyna. Suzanne was ready for them with new market trend research that showed that consumers are starting to recognize their need to eat healthier. “But even if people say they want to eat healthier, they won’t like our product if it has less sugar in it. We have only ever had feedback on how delicious our products are and how much children ask their parents to buy them.” So Suzanne proceeded to explain that pretty soon people will catch onto the health trend and will search for low-sugar options when they read nutritional labelling. She added “Mr. Glucose, you ought to think of reformulating your products before it is too late and your consumer market and reputation begins to erode.” Mr. Glucose took note, and agreed that he would consider it, and that he would like to meet with them the next month to talk more.
- In April, Mr. Glucose returned for the meeting as promised. “I’ve been looking at the consumer trends, and I think you ladies may be onto something with the market shifting as people wake up to diabetes, and are becoming more health conscious. However, even if I wanted to reformulate, the process is too expensive. I don’t know if we could manage the investment in new machinery, formularies and packaging.” Tara pointed out that although it was a bit of an investment, surely the company made sufficient profit and they should consider it to be a long-term investment. More importantly, it would help to show corporate responsibility in response to the public health concern of rising childhood diabetes. Mr. Glucose thought this sounded reasonable, but said he would need to go back to the drawing board and work through the financial kinks.
- In May, Mr. Glucose returned with some thoughts of new ways to reformulate the products to have lower sugar, but he was still uncertain about making the change. “We’ve contacted several of our loyal customers, and asked them about what they would think about us changing the recipes for some of our cereals. They didn’t sound interested. I don’t think it’s worth our efforts to make these changes if people won’t buy it!” Suzanne explained that most people were resistant to the idea of change at first. She suggested it might be helpful to invite some of these people in for a taste test, so that they could actually try the new and improved cereal, and see how much better it was for themselves. Mr. Glucose agreed to run some taste tests over the next month and get back to them about moving forward with the plan.
- In June, Mr. Glucose met with the girls again, this time much more confident in the new and improved healthy cereals. “The taste tests were successful, and the focus groups all agreed that the new products were just as tasty if not better than the old ones. The problem is that they don’t have the same shelf life. If the products don’t last as long there will be a lot of waste. Especially if people aren’t buying the new product right away.” Krystyna reminded him that with enough marketing and planning they could make a quick enough turn around. Especially if they used some of the positive results of the taste testing in their new advertising campaigns. Still apprehensive about investing so much money, Mr. Glucose agreed to go to his marketing team, to find out about costs and benefits.
- In July, after having met with the marketing team, Mr. Glucose brought back some new concerns to the girls. “The marketing team thinks we have some good material to promote the new cereals, but, they are worried about introducing the healthy product line when the competitors won’t change. If customers can get their sugar fix from those other cereals, they’ll just buy from our competition!” Suzanne tried to ease his anxiety by showing him recent consumer research that clearly showed an increasing rise in the desire for healthy products, and a decrease in the sale of over-processed, sugar-laden foods. Happy to see these findings, Mr. Glucose decided it was time to start thinking about production and distribution of the new products.
- One day in August, Mr. Glucose unexpectedly showed up at the ministry, looking panic-stricken. “Even though we have developed a great product, and it seems like people are interested in buying it, I went to several of the convenience stores that typically stock our cereal, and the stores won’t sell it!” Tara shared with Mr. Glucose that she wasn’t overly surprised that the convenience stores didn’t seem interested in selling the new product, since they typically stock pre-packaged foods, that are known to be less healthy. She recommended that he instead turn to some of the other grocery stores in the neighborhood that clearly had a focus on healthy foods. She gave him a list of different places to try, and Mr. Glucose set off to approach these new businesses.
- In September, when all the children were returning to school, a much happier Mr. Glucose met with the girls to share some positive news. “You were right, the stores who had health as a bottom line for their products were all thrilled to carry our new line of cereals, and now we have the competitive edge for cereals! We’ve just launched a big batch of cereals, and the shelves will be fully stocked by theend of the week!” Mr. Glucose thanked the girls and rushed off to get back to his busy factory.
- In October, Mr. Glucose sat in an office at the Ministry of Health Promotion over a cup of green tea talking with the health promotion team. “I never thought I would be convinced that we needed to change. Kelloggs Cereal have a brand new face. Our Fruit Loops actually have real dried fruit in them and our Captain Crunch Cereal has a fraction of the sugar, whole grain and more flavor from spices. We have gained a whole new market audience in addition to maintaining a good number of our old client groups. Plus the media is catching on, and our reputation is starting to be more connected with corporate responsibility and healthier products.” Tara, Suzanne and Krystyna smiled with satisfaction, and asked Mr. Glucose to sit on their Partnership board and advocate for corporate responsibility in combating childhood obesity through improved food environments.
As public health practitioners, a large proportion of our work will inevitably involve presentation of information. However, the populations that we work with, and the target audiences that we aim to reach will vary considerably. One of the biggest challenges that we will face will be adapting the information to meet a diversity of needs, including overcoming language barriers, and low literacy levels.
One way to avoid these barriers is to use images instead of words, which is where infographics come in.
What are they?
Infographics are used to present information, data, knowledge or ideas visually.
They can include lines, boxes, arrows, symbols, pictures, text, colors and labels
They have 3 basic elements:
- Visual: graphics, colors, reference icons, charts,
- Content: statistics, facts, references, time frames
- Knowledge: the underlying message of the data being presented
Why are they so useful?
Words and language are processed by the brain in a linear fashion, such that it takes time for the brain to obtain information from text. Additionally, people only tend to remember 20% of what they have read.
Images are processed by the brain simultaneously, allowing images to be processed 60,000x faster than text. Not surprisingly, infographics can be used to present complex information quickly and easily.
To help clarify these points, check out this infographic, which presents this information visually:
How do you make an infographic?
Tools to generate an infographic:
- using paper, pencils, markers, and rules to draw the images
- Various online tools and websites (Infogr.am, Piktochart and Easel.ly)
- General illustration software (Adobe illustrator, Inkscape)
- Alignment: all items should have a visual connection with something else on the page
- Proximity: position related items together
- Helps to depict relationship
- Can make it easier to understand items and their connections
- Shape: can give meaning (i.e., boxes can be more form, icons can represent brands)
- Balance: symmetry and centering important for directing gaze/focus
Tips for designing a great infographic:
- Highlight the information that is most important
- Keep it simple
- Show comparisons, contrasts and differences
- Use clear and simple language
- Use clear, legible font
How can it be useful for public health?
Health information and statistics can be bland and boring, or hard to understand by the general public. Infographics can be used to make this information simpler to understand, more appealing, and engaging. Importantly, the visual expression of ideas and messages can attract more attention, and make them more impactful, which is particularly useful for social marketing.
They can be used to provide health education in a fun and exciting way, making the information more memorable, which can help to encourage people to follow through on making important health behavior changes
Graphics and images can have cross-cultural application, allowing the message to be shared and understood by a much broader audience
Online infographics can be easily shared, which can help your message to spread more easily, allowing for a much wider reach.
Check out this link for some examples of health related infographics
While doing research for my “truth” presentation, I came across material that spoke to the power of the perceived social norm in influencing people’s behaviour. I began to look more into it and found some interesting material on the potential consequences of plusralistic ignorance and how this can be incorporated into behaviour change strategies through the medium of social marketing.
Social norms are common subjects of research studies and the research has clearly established that social norms guide action in direct and meaningful ways. During the past decade there have been numerous programs that have delivered normative information as a primary tool for changing socially significant behaviors, such as alcohol consumption, drug use, disordered eating, gambling, littering, and recycling.
Social norms are complex and studies suggest that there are two general properties people use when perceiving and communicating social norms:
1. Social norms are defined by people’s public behaviour.
2. Norms are imbued with an impression of universality: people assume that all members of a group endorse that group’s social norms.
Pluralistic ignorance is “a psychological state characterized by the belief that one’s private attitudes and judgments are different from those of others, even though one’s public behaviour is identical (Miller & McFarland, 1991). It develops most frequently under circumstances when there is a widespread misrepresentation of private views. In these cases, people tend to rely on the public behaviour of others to identify social norms. This leads them astray, as it is a misrepresentation of private views. People in these circumstances have three choices: to move their attitudes closer to the (perceived) social norm, to bring the norm closer to their attitudes, or to reject the norm altogether. The easiest thing for an individual to do in most cases is to change their private attitudes.
The rational for social norm marketing to combat binge drinking in universities is based on the idea that:a) the majority of individuals overestimate the prevalence of alcohol drinking among peers, b) people use their perceptions of social norms as a standard to which to compare their own behaviour. Thus, the idea is that negative health behaviours, such as binge drinking, could be reduced in prevalence through correcting the target audience’s misperceptions surrounding this behaviour.
In the 1990’s there was great hope that understanding this phenomenon and that educating students about the drinking attitudes, perceptions, and behaviours of peers could reduce binge drinking. However, although the majority of college students do overestimate the prevalence of alcohol consumption on campus (see Berkowitz, 2004, for a review), a significant proportion of them—approximately 1/5 to ½ actually overestimate peer drinking. This might cause an undesirable “boomerang” effect and cause those who were drinking less than average to begin drinking more. Similar results have been found with a study examining social norms surrounding energy consumption and those who found they were under average energy consumption began consuming more (Schultz et al., 2007). However, combining an injunctive message of approval was able to ameliorate this boomerang effect. Although there not yet consensus on the effect of social norm marketing to reduce binge drinking among youth, studies have found positive results and it is worth further exploration.
The truth campaign has me thinking a lot about the power of social media and social norms to address health problems. I wonder if this could be incorporated into a new binge drinking reduction marketing. Kitty discussed in class how shame and disgust-based alcohol awareness ads were effective in reducing teen drinking. I wonder if there could be a campaign could be effective that gives details about the actual prevalence of binge drinking among students, the negative health consequences, and has a message of approval for those who are drinking less than this (such as “keep it classy”).
References: Prentice, D., & Miller, D. (1993). Pluralistic ignorance and alcohol use on campus: some consequences of misperceiving the social norm. Journal of Personality and Social Psychology, 64(2), 243-256.
Schulz et al. (2007): http://www.carlsonschool.umn.edu/assets/118375.pdf
Here is another interesting post on the issue: http://www.drinkingdiaries.com/2010/03/07/do-anti-drinking-ads-backfire/