Archive | April 2013

C4H Blog Announcement!

Hello dear readers!

This blog was originally created for a graduate course in Advocacy and Communication for Health taught by Dr. Kitty Corbett in the Faculty of Health Sciences at Simon Fraser University.

As of 5pm today, all the grades have been submitted and a collective sigh of relief has gone up from those of us finishing the term. Many are graduating, others are spending the next few months working on practicums, and a few are taking courses during the summer term. As a class, we contributed 108 blog posts from Jan. 17th to April 23rd 2013.

And it turns out – we’re pretty popular!

In just a few months, we’ve had almost 4000 views from 64 different countries around the world!

Screen Shot 2013-04-28 at 2.43.27 PM

Together we have built up a useful resource that many have taken the time to send their thanks for – here are just a few of the reader comments that have been left on our blog:

I love your website! Thank you so much for sharing and imparting.” -Anonymous From India

Thanks for posting this! – Philadelphia Theatre for the Oppressed

Great article. Never consider marketing ethics being played out in religious groups! Thanks for posting the bullet points for ethical behaviour, very useful!” –

I wholeheartedly believe that when you are creating any type of health communication materials, it is absolutely critical to have members of the priority community participate on the development team because they do, in fact, have a rich lived experience that simply cannot be overlooked or minimalized. Thanks for sharing!” – Ohio Government member

I’d like to thank all of my colleagues for their amazing contributions and insights. This blog is an excellent example of the great synergy that comes from collective work in our Master of Public Health program at Simon Fraser University.

Since this is such a great resource, and it seems to be helping people around the world who are interested in public health, I volunteered to continue contributing to and moderating the blog, and a few of my fellow graduate students have also chosen to come forward as continuing authors. We look forward to continuing to build on these ideas and share them with you!

If you have a specific interest that you would like us to write about, or if there is a resource you would like us to review, please leave a comment below or if you prefer, send me an email:

Sarah Topps 2013 [Communication4Health moderator]


A note to my colleagues: please send me an email by May 31st if you are interested in continuing to contribute (as little as twice every 6 months) and I will make up an author profile for you on the about page. After May 31st, I will be changing the status of anyone who has not emailed me so that they cannot modify the blog entries.


The Importance of Improving Health Literacy

What is health literacy?

Health literacy is the ability of someone to attain, comprehend and process information about health and services that then allows this person to make proper decisions related to their health. The National Assessment of Adult Literacy has found that over a third of adult Americans have a difficult time comprehending the most basic medical information. If people are unable to understand this information, then it makes it extremely difficult for them to make good health decisions and it can also lead to errors in medication use, people misunderstanding their treatment regimen or diagnosis, and poor health altogether.

Health literacy in older adults

One population that is at higher risks of poor health outcomes due to low health literacy levels are older adults. They require trustworthy health information in order to avoid and cope with disease, as well as to maintain their health status. Due to the natural aging process, many older adults lack sufficient health literacy levels, which can decrease their ability to apply health information and understand health messages.

The National Assessment of Adult Literacy explains the following about the health literacy skills of older adults:

  • 71% of adults over the age of 60 had trouble using print materials
  • 80% had trouble using health documents, which included charts and forms
  • 68% had trouble interpreting numbers

Older adults use more medical services and get more chronic diseases than any other population segments. Because of this, something needs to be done to improve their health literacy levels.

What can be done?

To improve the health literacy levels of older adults, several strategies can be employed, including:

  • Use plain language
  • Communicate procedures and advice that must be followed
  • Repeat important information
  • Decrease the amount of text provided in health messages
  • Use reminders to help with memory
  • Make information empowering and from a trusted source


Centers for Disease Control and Prevention. (2011, August 22). Older adults: Why is health literacy important? Retrieved from

Koay, K., Schofield, P., & Jefford, M. (2012). Importance of health literacy in oncology. Asia Pacific Journal of Clinical Oncology, 8(1), 14-23.

Understanding health literacy: Why it is so important and what librarians can do to help. Retrieved from

-Brendan v

Entertainment Education & The Power of a Story

Entertainment education is used all over the world to implement and design messages in the media that are used for the purpose of entertaining and educating. Some of the main reasons why entertainment education is used are to increase audience awareness of health issues, influence behaviour, and inform people of the risks that certain lifestyle choices can bring.

Stories have been utilized from the very beginning of human existence and they allow us to understand and view the world, as well as allowing us to share our personal experiences with people. Entertainment education in the media employs stories to get messages out.

There are many benefits to using entertainment education to get health messages out and these include:

  • Some audiences are difficult to reach and entertainment education is able to reach them through mediums such as television and movies. For example, teenagers are more likely to pay attention to information that is included in an episode of a show that they enjoy, compared to pamphlets about the same issue.
  • It is beneficial to both entertainment professionals as well as public health professionals to use entertainment education because entertainment professionals are able to include fascinating plots to their story lines and public health professionals are able to get their message out in the public.
  • It can be difficult to get an audience interested in a health topic, notify them on health issues, or even change their attitudes, but entertainment education is able to achieve this. In order to get correct messages out in the media, health organizations, like the CDC, give accurate health information to the entertainment professionals so that they can then use this information in their story lines.

An example of entertainment education in the media is a recent episode of Glee that looks at high school students having sex, abstinence, teenage pregnancy, as well as sexually transmitted infections. This episode emphasizes the importance of parents talking to their children about sex and how information is a very strong tool. The episode states that abstinence is not a realistic goal for students and that information is far more powerful. Thus, entertainment education is an important tool that is utilized often in media programs to get messages out to hard to reach audiences.


Entertainment Education. Retrieved from

Surround Health. (2012, December 14). Let’s talk about sex – Entertainment education and teen sex. Retrieved from’s-Talk-About-Sex-–-Entertainment-Education-and.aspx

-Brendan v

Mexico City Metro

Over reading week in early February I was luck enough to spend ten days in Mexico.  I first flew into Mexico City and then traveled on to spend the rest of my time in Oaxaca.  I met my mother in Mexico City (or as it’s often referred to the DF) and we spent a long weekend packing in as many sites and museums as we could possibly fit.   We have both spent a lot of time in Mexico and speak Spanish fluently so we felt quite comfortable taking public transit whenever possible.  While on the Metro I couldn’t help but notice the signage for the different stops.  Not only were the names of the stations indicated but they were accompanied by an image as well.  If I had not been currently taking I may have just thought, that’s a great idea and continued about my travels.  But now, months later, it still pops into my head and so I decided to do a little research on the history of the Mexico City Metro and the way that they have signed their system.


Obviously the first step to any serious research project involves entering your search into Google and then reading the entry in Wikipedia.  I was genuinely surprised that when I searched quite specifically “Mexico City Metro Low Literacy” to still be directed to Wikipedia.  Under the heading of Lines and Stations I learned that each line provides one service and is a color that is used on all logos, maps, and signs.  Beyond the color, each stations is also designated a symbol that is derived from the actual name of the station or the area surrounding it.  This was intentionally done because at the time the Metro was constructed, the literacy rate was extremely low in 1967.  This method was also used in Monterrey, Guadalajara and more recently for the bus system in Mexico City.  The entry in Wikipedia ends by stating that, “Although logos are no longer necessary due to literacy being now widespread, their usage remained.”  I would have to disagree with this last point.  While literacy rates may have improved greatly, there are still people who stand to benefit from this system.  In the time I was on the train, I witnessed many non-Spanish speakers relying heavily on the graphics to figure out where they were going.  I think that every person is low literacy in some contexts.  (All of this information from Wikipedia aligns with what is posted in Spanish on the official Mexico City Metro website.  I will provide links for both at the bottom of the entry.)



Lance Wyman is the man responsible for the designs used in the Metro along with Arturo Quiñónez y Francisco Gallardo.  Wyman had actually designed the symbol used for the Olympics held in Mexico in 1968 and because of this success he was again tapped to design the graphics for the Metro, which opened in 1969.  As mentioned above, the direction he was given was to design a graphic that had to do with the name of the station or the surrounding area.  Additionally, the name of the station had to be just one word and also had to relate to the area it was located in some way.  Being involved in both of these projects was actually towards the beginning of his career and he went on to design the graphics for the Washingon DC Metro and the Rockefeller Family Fund among many, many others.

Wyman’s website is incredible!  I highly recommend spending some time checking out all of the work that he has done.  I’m also including a link to a case study on Wyman done by Web Esteem magazine.  In this he talks about wayfinding systems, the value of symbols and how to avoid typical problems with them, navigating different languages and a short biography.



Advocacy through Arts

Health advocacy encompasses direct service to the individual or family as well as activities that promote health and access to health care in communities and the larger public. Today we don’t have to be lobbyist to be advocate for change.  More and more people are using unconventional means such as plays, photography, movies and TV shows to advocate for change.

Here are a few of such methods.

Anita Woodley an African American woman who does health advocacy through plays.   Woody is the only cast for a one man show called Mama Jugs. She uses her play to shed light on issues pertaining to breast health and body image among women particularly African American women. Whenever Woodley is on stage she channels her great grandmother Suga Babe, the 100-year-old matriarch who, through made-up songs, responded to social and economic adversity and expressed her opinions about her granddaughter. Using the words she heard as a child to make comedy, Anita not only entertains women but also raises awareness about a very important health issue. Anita lost her mother to breast cancer at the age of 47. Her mother didn’t know how to  recognise symptoms of breast cancer was diagnosed when the disease had become fatal hence had no choice of survival  hence Anita`s resolution to spread the word out there. Has her effort pay out?

Yes. Anita was approached by a not for profit clinic to partner with them. This clinic which offers free mammogram to under privileged women also helps provide medical care for the uninsured through partnership with very influential agencies to help pay their bills. Ironically the clinic had been looking for ways to bring light to the subject and Woodley’s unique way of doing so caught their attention. Today more women are being sensitized, screened and treated for breast cancer in North Carolina where Anita hails from.



Another area where advocacy through arts has made a difference is Trivoli Gardens an area west of Kingston Jamaica .Because of problems with persistent poverty and the development of wide scale, international drug trafficking, particularly between Jamaica and the United States, Tivoli Gardens at the turn of the twenty-first century became the scene of repeated confrontations between gunmen and security forces. In 2010 an armed conflict erupted between Jamaica’s military pole forces and members of the drug cartels. This lead to the death of 73 civilians and wounded at least 35 others.  People most affected here where teenage boys, some of whom were budding drug cartel workers and lost people close to them. A foundation in Jamaica decided to start a photo project give some of these boys a camera to capture their feelings and an exhibition of their photos was made available to the entire Jamaican public as a form of advocacy for intervention.

Did it make a difference? Yes it did. The cameras help these boys tell their story, their daily encounters, problems and trials and help heal their trauma. The exhibition made people who had considered a Tivoli garden as a no good area full of criminals to see a different side of it. Donations were made towards creating activities and building centers to help prevent teenage boys from joining gangs and as you can see from the video it is working.

What this tells us is that sometimes we have to go out of the box   and be creative if we want to make a difference.

So bring out the creatives in you  and go out and conquer the world!



TedxChange: Conversations about Global Health

While browsing the TED website ( for inspirational talks, I came across TEDxChange, a TEDx program organized in collaboration with the Bill & Melinda Gates Foundation to spark global conversations regarding health, development and education issues.

Each year, this event focuses on a specific theme. This year’s theme was “positive disruption” hosted by Melinda Gates on April 3, 2013. The idea is that disruption can be a catalyst for change through challenging old assumptions, igniting conversations, activating authorities and exposing new possibilities.

The TEDxChange website provides a list of the speakers at this year’s event, discussing a range of topics including how social media is changing the world and how children became the main agents of change in the slums of West Bengal. I encourage you to browse the website and listen to some of the insightful talks from this year and previous years.

A few favourites from TEDxChange:

To watch the TEDxChange event online, visit:

– Lucy G.

Dumb Ways to Die… A Smart Way to do Social Media Marketing

I first stumbled upon “Dumb ways to die” last November, when this catchy little tune from half way around the world went viral. This video is a perfect example of using effective marketing techniques to raise awareness, influence behaviour and create change. It is Australia’s most successful viral campaign, gaining over 25 million views in the first week after launch, and now has over 44 million views on Youtube. Almost half a year later, I still remember this video and the key message.

“Dumb ways to die” was a public service announcement created by Metro Trains, a public transport authority in Melbourne, Australia. The aim was to raise awareness about railway safety. This cheerful video about a morbid topic was an effective way of reaching the target audience of young people, who generally have no interest in hearing any kind of safety message.

This campaign also uses an integrated social strategy to reach its audience. The two main platforms are the YouTube channel and the website ( The website entices the audience to learn more about railway safety though the cute animations and interactive components. Beyond that, the campaign also uses various social media websites such as Twitter, Facebook, Tumblr, Instagram and Pinterest. An easy, fun and popular way to spread the message!

“This campaign is designed to draw people to the safety message, rather than frighten them away. Especially in our younger segments. We want to create a lasting understanding that you shouldn’t take risks around trains, that the prospect of death or serious injury is ever-present and that we as a community need to be aware of what constitutes both safe and dumb behaviour.” – Chloe Alsop, Marketing Manager of Metro Trains

– Lucy G.

Culture Jamming for Public Health


Culture jamming is a subversive technique used to counter mainstream advertising and consumer culture by challenging the norms it supports. Culture jamming asks people to think beyond the advertisements they are presented with by challenging the assumptions the that our society often takes for granted, like the idea that we need to shop, that we need makeup to be beautiful, or that parking spaces are just for cars. Jamming generally builds on pre-existing advertising campaigns to get an alternative message out.

Recently in Victoria, BC, a group of front-line service providers who want to challenge the city’s lack of progressive action on homelessness and harm reduction started the Radical Health Alliance (RHA), which works to question how homelessness is thought about in Victoria. Rather than an individual problem, the RHA challenges people to think about how the ways that we organize society actually create a situation in which some people are rich while others are poor, and in which those who are poor are excluded from ‘public’ spaces and cannot access necessary health care services.

Recently, the RHA launched a culture jamming campaign in response to the City of Victoria’s ‘Unacceptable’ campaign. In an attempt to highlight the idea that homelessness is unacceptable, the Victoria Coalition to End Homelessness posted images like this one:


According to the RHA, the problem with the City’s campaign is that it ignores both the corresponding levels of class privilege in Victoria, and the ways in which people in the city further marginalize homeless people.  The RHA therefore jammed the Coalition’s campaign by creating images like this one:

unacceptable-gate1Every day for 19 days the RHA highlighted specific ways that the City of Victoria works against homeless people instead of against homelessness, providing a striking image with a tagline, as well as an explanation for why they chose that image, every day of the campaign. They blogged, Tweeted and used Facebook  to get their messages out each day. In addition, the RHA created press releases to inform media of their campaign.

I love this campaign. I used to work in housing and harm reduction in Victoria and I feel like the campaign raises some great points about homelessness, lack of services, and policing, in Victoria. I also think the group has made great uses of media and images by creatively piggybacking on the campaign by the City of Victoria’s Coalition.

As a society, we often tend to look past the upstream factors that impact public health, like over-consumption, class inequity, and war. Jamming already existing campaigns that ignore root health factors can be a relatively cheap and impactful way of getting a message out.

Christie Wall

The Grasshopper And The Ant: Let’s Prepare For Winter

Do you remember the old fable entitled, ” The Grasshopper and the Ant”? It is a classic, and if you are not familiar a quick search on Google or Youtube may be worth a smile or two. To summarize, the grasshopper basks in the glory of the summer sun while the ant stores food for the winter. Once winter arrives, the grasshopper is horribly unprepared; his refusal to plan for the future catches up to him. The ant on the other hand, works hard in the summer in order to be prepared for winter. The ant invests in the long-term, while the grasshopper is far more short-sighted.

A recent report put out by the Office of the Auditor General outlined health spending in BC. The report suggests that although prevention has been a prevalent topic in previous Throne Speeches, population health and wellness accounts for less than 5% of total health care spending. This report, and the resultant response from the Health Minister, was picked up by both the CBC and the Huffington Post. As quoted in these articles, the Health Minister suggests that we need to look not only at the dollar amounts, but also on the health outcomes of British Columbians. Point taken. However, some critics, perhaps rightfully so, put an emphasis on the numbers.

If, for example, we look at the 536 million dollars that the health authorities spent on the sector of population health and wellness, and compare it to the reported 514 million dollars spent on the new roof for BC place stadium (the Globe and Mail reports that the office of the Auditor General is looking in to the cost and value of the new roof in question), some people might wonder where our priorities lie?

I think that we need to follow the ant’s lead, and prepare for winter. I think we should promote wellness, and prevent illness, wherever and whenever possible. To foster such an approach, I think we need at least three components: (1) An engaged and responsible public (2) A reduction in the fragmentation of government and (3) A commitment to evidence based prevention.

As a university student, I am often disappointed when I am presented with the voter turnout among fellow classmates. Some seem to be disillusioned and fed up with the political process, and I can understand that I suppose. However, I would encourage anyone who is feeling discouraged to avoid withdrawing themselves from the equation. Such feelings are a great time to engage one’s self, to inform one’s self, and to vote on every election day. Dissatisfied people are often looking for a change, and often have new ideas.

Speaking of new ideas, I think we are in need of one. Here’s a question, “How do we reduce the fragmentation found within governments?”. Any takers? I wish I had the answer. I think it is harder for any government to invest in prevention programs when the ‘return on the investment’ might be materialized in a sector of government that did not spend the initial dollars. I think we need to find a way to create a more collaborative governance system. I think we need an open dialogue among all parties involved.

That leaves us with the all important question of cost. Can we afford prevention? We already spend so much on healthcare, can we really afford another expense? I think we need to be very cognizant with how we spend public funds, and we need to spend responsibly. One way to help keep us honest might be to adopt and evidence based approach. Before we open the collective purse, let’s ask “How confident are we that this program will produce the desired outcomes?”. If we add some research evidence to the equation, I think we have a better chance of achieving our goals. I am not arguing that research evidence should be the only evidence required, far from it, but, I am arguing that we should certainly consider and value it.

So, as we hope for sun this upcoming summer, let’s prepare for winter…and take a lesson from the ant.


“Dear16-year old Me”

Demographic targeting, or communicating with a specific audience comprised of individuals who share common characteristics, is a strategy often used in cancer screening or prevention campaigns. With targeting, the audience is more likely to pay attention, comprehend, and discuss the information with others, which can ultimately help encourage behavior change.  A example of demographic targeting is this online campaign I came across called  “Dear 16 year-old Me.”

“Dear 16-year old Me” online campaign (see video below) was developed by the David Cornfield Melanoma Fund charity organization to promote melanoma awareness and prevention in youths.  Melanoma is a form of skin cancer, which, if not treated early, can lead to death. In Canada, it is estimated that 5,800 Canadians will be diagnosed with melanoma and 970 of them will die from the disease. Statistics for melanoma also reveal that the lifetime probability of men developing skin cancer is 1 in 67, and for women it is 1 in 85.  According to WHO, UV radiation exposure from the sun and indoor tanning equipment is a known carcinogen or cancer causing agent.  Thus, taking preventive measures such as avoiding indoor tanning equipment, and reducing and protecting oneself from sun exposure can significantly reduce the risk of melanoma. However, according to the David Cornfield Melanoma Fund organization, many people do not recognize the seriousness of skin damage caused by exposure to UV radiation, particularly during the early years. Despite increasing public awareness, skin cancer preventive behaviours are often ignored and not taken seriously until later in life by which point the adverse effect of sun exposure has already begun to accumulate.  To that end, the online campaign was created with the intent to educate and encourage self-check and preventive measures among the target audience, i.e., 16 year-old youth.


Overall, I think this is a well-produced targeted communication campaign. It grabs the audiences attention, it is personally relevant, and addresses the specific health needs important to the target population. By targeting, the campaign eliminates any exposure to unneeded information. Furthermore, by using theoretical constructs of the Precaution Adoption Process Model (a change theory), the message is more useful in eliciting behaviour change in the target audience. The Precaution Adoption Process Model specifies seven stages in the journey from lack of awareness to maintenance of behaviour, including preventive behaviour. After watching the video, it is clear that the targeted material attempts to transition the audience through the seven stages of behaviour change. Specifically, the stages the target audience must pass through before taking the risk of developing melanoma serious enough to maintain preventive behaviour include:

  • Unawareness
  • Awareness but unengaged
  • Engaged and deciding to act
  • Planning to act
  • Decided to act
  • Acting
  • Maintenance

At the maintenance stage, it is hoped that the audience is inspired to take preventive actions and make self-check as part of their regular routine. Such behaviour is crucial to early detection and positive outcomes.While this is my take of the online campaign, what did you think of it?


Canadian Cancer Society. (2012). Statistics for melanoma. Retrieved from

David Cornfield Melanoma Fund. (2003). What is melanoma. Retrieved from

Parvanta C, Nelson DE, Parvanta SA, Harner RN. Essentials of Public Health Communication. Mississauga, Ontario: Jones and Bartlett Learning, 2011. ISBN 978‐0‐7637‐7115‐7.

World Health Organization. (2013).  Health effects of UV radiation. Retrieved from


-N Sandhu