Communication at the Core of Effective Public Health

Years from now, we may remember the fall of 2001 as the traumatic period in our country’s history when public health became visible throughout society. While the dust was still settling from the terrorist attacks and the country grappled with fears of anthrax in our mail, the American public learned what professionals have known for years: the health and security of our nation depend heavily on a robust public health system. An additional revelation from this turbulent time was the critical role of strategic, timely, and effective communication in public health. The realization that both science and communication are essential to promoting and protecting the health of the public was a major milestone in the emerging discipline of public health communication, reinforcing its vital role as a new core component of public health.

COMMUNICATION RENAISSANCE

Over the last several decades, the application and study of communication and health have rapidly developed and expanded. Originally conceived in departments and schools of communication and medicine,1 courses in health communication are now found throughout the academy, from the liberal arts to the health sciences and at many points in between. The recent proliferation of health communication is evident in the field’s significant accomplishments, including the establishment of 2 peer-reviewed health communication journals, the inclusion of a health communication chapter in Healthy People 2010,2 the funding of health communication centers of excellence by the National Cancer Institute, and the publication of 3 books from the Institute of Medicine (IOM) stressing the importance of health communication.3–5

Despite these accomplishments, the discipline of communication has until recently operated at the periphery of public health. Perceived as more skill than science, communication was equated only with dissemination of findings by many public health professionals, who assumed that public health information could “speak for itself.” Fortunately, many of today’s public health leaders realize that promoting health and protecting the public require both sound science and effective public health communication. The Centers for Disease Control and Prevention (CDC), for example, has recognized the importance of public health communication, concluding that “public health research, innovations in information technology, and advanced communications offer unprecedented opportunities for CDC to improve health in America and around the world.”6

WHAT IS PUBLIC HEALTH COMMUNICATION?

Healthy People 2010 defines health communication as “the art and technique of informing, influencing, and motivating individual, institutional, and public audiences about important health issues.”2 The IOM defined public health as “what we, as a society, do collectively to assure the conditions in which people can be healthy.”4 If we integrate these 2 perspectives, the following new definition emerges: Public health communication is the scientific development, strategic dissemination, and critical evaluation of relevant, accurate, accessible, and understandable health information communicated to and from intended audiences to advance the health of the public.

Public health communication draws from numerous disciplines, including mass and speech communication, health education, marketing, journalism, public relations, psychology, informatics, and epidemiology. Although it is transdisciplinary in nature,5 the core principles of public health communication are firmly anchored in the central tenets of public health.

Ecological Perspective

Public health recognizes that health is profoundly affected by the social, political, environmental, and behavioral factors with which people live.5,7 Public health communication embraces this ecological perspective by encouraging multilevel communication strategies and interventions, such as tailored messages at the individual level, targeted messages at the group level, social marketing at the community level, media advocacy at the policy level, and media campaigns at the population level. In addition, public health communication strategies are often combined with other intervention efforts, such as community organizing or coalition building, to produce multilevel public health interventions.

Change Orientation

Like most applied research and practice in public health,5 public health communication focuses more on improving the health of communities and populations than on deconstructing the underlying mechanisms of communication. Public health communication is inherently interventionist, seeking to promote and protect health through change at all levels of influence. When well conceived, carefully implemented, and sustained over time, public health communication programs have the capacity to elicit change among individuals and populations by raising awareness, increasing knowledge, shaping attitudes, and changing behaviors.8 Although communication initiatives often target for change those behaviors that contribute directly to morbidity and mortality, public health communication also targets social, physical, and environmental changes that can influence health outcomes.

Audience-Centered Philosophy

Health communication campaigns have sometimes been criticized as paternalistic, and concerns have been raised about the use of 1-way communication from “beneficent” experts to passive audiences.9 Public health communication recognizes that for programs to be both ethical and effective, information from and about the intended audience should inform all stages of an intervention, including development, planning, and implementation, to ensure that the program reflects the audience’s ideas, needs, and values.3,9 Areas of particular interest include the audience’s health literacy, culture, and diversity.3 Furthermore, public health communication programs rely heavily on formative research and 2-way communication between sources and receivers to ensure that messages are accessed and understood, communities are involved and invested, and programs are modified as needed.

FUTURE DIRECTIONS

The field of public health communication is poised for a period of rapid expansion, fueled in part by 2 major developments. First, the IOM report on public health professional preparation identifies communication as a critical content area for future public health education.5 Second, through its “Futures Initiative,” the CDC is creating a national center focused on public health communication and marketing. These developments, along with continued scientific and technological advances, will dramatically affect future training, research, and practice in public health communication.

The reach and impact of public health communication has never been greater, as numerous campaigns address diverse health issues and audiences throughout the United States and the world. Progress toward the Healthy People 2010 objective of increasing research and evaluation in health communication2 is evidenced by recent funding opportunities in public health communication research established by several federal agencies. However, for public health communication to reach its full potential, significantly more research will be needed, especially in the study of health disparities, communication-access disparities, and the application of electronic health interventions with underserved populations.

Greater support is also needed for research and evaluation in public health communication that is truly transdisciplinary, simultaneously addressing multiple health issues, intervention levels, and communication channels. Further, although there are many challenges for program evaluation in public health communication, conducting comprehensive evaluations and disseminating the results is critical for expanding knowledge, improving programs, and allocating limited resources.

Instructional opportunities in public health communication have been available for many years and are likely to expand in response to the IOM recommendations5 and future changes in workforce needs. Many schools and programs in public health are developing academic programs in public health communication, including certificate programs and concentrations within traditional and distance-learning MPH programs. To ensure that these programs adequately prepare students for careers in public health communication, however, it is important that disciplinary competencies be collectively developed and disseminated, ideally with support and direction from a federal agency or national organization.

Finally, public health communication professionals have a responsibility to communicate well with each other. To facilitate the exchange of information and the translation of public health communication research to practice, public health communicators need to become more visible and vocal in our professional organizations. We must also embrace innovative tools for translation and dissemination, such as the TREND Statement (http://www.trendstatement.org),10 the Health-Comm Key database (http://www.healthcommkey.org), and the Prevention Communication Research Database (http://www.health.gov/communication).

CONCLUSION

With its transdisciplinary nature, ecological perspective, change orientation, and audience-centered philosophy, public health communication has the potential to make significant contributions to the health of the public. I applaud today’s public health leaders and visionaries who have recognized this potential and the innovative work conducted by public health communication professionals. Over the coming months and years, the discipline of public health communication will continue to grow and develop, and when the dust has finally settled, public health will be changed and improved to its very core.