Misunderstood: How Public Health’s Inability To Communicate Keeps Communities Unhealthy

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Federal, state, and local public health leaders are advising, and making decisions that impact, our schools, businesses, faith communities, and nearly all aspects of our lives. The public’s willingness to accept and act on this guidance is dependent on how people perceive the credibility of public health leaders. This is absolutely critical during the COVID-19 pandemic, when efforts to update recommendations based on new information about the virus are hindered by widespread misinformation and politicization.

Research conducted by the FrameWorks Institute suggests that public health leaders lacked the relationships needed to engender familiarity and trust from leaders of key sectors—long before the beginning of the pandemic. This research, made possible with support from the de Beaumont Foundation and the Aspen Institute, found that leaders working in education, health care, housing, and business are largely unclear about what public health professionals do and about their potential to add value to work of other fields.

It’s not that people are opposed to public health or indifferent to its outcomes. Indeed, a recent poll found broad national support for public health protections such as stopping the spread of communicable diseases, protecting environmental quality, and supporting child and maternal health. 

The difficulty is that people don’t know who does this work or how they do it. Even those polled who said they support public health couldn’t identify the professionals responsible for carrying out the work. This “disconnect” limits understanding of what is required to do public health work effectively, reduces support for necessary policies, and saps motivation to partner with public health.

FrameWorks’ research finds that other sectors have a largely negative or at best a narrow perception of public health professionals. In-depth interviews revealed that leaders outside the field don’t appreciate the strategic or collaborative dimensions of public health activities. Although public health professionals have been repeatedly encouraged to think of themselves as strategists, leaders from other sectors clearly don’t see them that way. Public health agencies are assumed to be highly bureaucratic and lacking the capacity to form cross-sector collaborations. Public health professionals are widely viewed as book smart, impractical researchers, or siloed bureaucrats, unsuited to address “real-world” challenges such as affordable housing, infrastructure planning, workplace regulations (such as sick leave or maternity leave), or healthy food procurement practices.

The pandemic is showing us just how critically important these cross-sector relationships are. Times of crisis are when we need to rely on these relationships rather than try to establish them belatedly, as it’s difficult to build deep collaborations while imposing lockdowns or advising that schools should close.

By improving community health, public health supports well-being and quality of life, thriving communities, and flourishing economies—all of which are fundamental to outcomes that matter to leaders in other sectors. However, public health practitioners have not effectively communicated their contributions in advancing community-level enhancements or connected their role with the core missions of other sectors.

The FrameWorks’ research led to a set of practical recommendations for public health practitioners on how to take on this challenge. For example, when talking to business leaders, practitioners should highlight that improvements in community conditions can lead to declines in absenteeism and increases in morale among employees. When talking to school superintendents, they should underscore that better student health is linked to increases in graduation rates and improved test scores. When talking to health care executives, practitioners should emphasize that community-wide, evidence-based policies can alleviate burdens on health care providers as well as reduce health care costs.

It’s important to be able to show other sectors tangible examples of the benefits of partnering with public health. At this moment of crisis, implementing cross-sector solutions is the most effective way to prevent COVID-19 and our best and quickest way to re-start the economy and get Americans’ lives back on track. It is also necessary to address systematic inequities that the pandemic has brought to light like never before.

Communication Is A Critically Needed Skill

Poor communication is not a new or surprising problem for public health officials. In 2015 Katherine Lyon Daniel, the associate director for communication at the Centers for Disease Control and Prevention (CDC), asked whether “public health” is a “dirty word” to people not in the field. She was reflecting on a CDC Foundation study that found the term “public health” tested poorly among non-public health professionals. FrameWorks’ recent research shows that the confusion or lack of familiarity with public health persists.

Similarly, in the 2017 Public Health Workforce Interests and Needs Survey (conducted by the de Beaumont Foundation and the Association of State and Territorial Health Officials) respondents identified communication as one of the most pressing skill gaps for state and local health department employees. When asked to rank the skills most important to their daily work, communication was number one, and nearly one-fifth of respondents reported that they needed to improve their communication skills.

From CDC officials to frontline professionals in local health departments, research clearly shows that there is a longstanding barrier to communicating effectively about public health. Knocking down this barrier requires that public health practitioners first better understand how they are perceived by other sectors and then rethink how best to communicate effectively with external partners.

A Communications Guide For The Chief Health Strategist

This analysis of the problem is not new. The public health field has repeatedly identified the challenge and called for specific steps to address it. But little measurable progress has been made. The Public Health 3.0 framework encourages health departments to form vibrant, structured, cross-sector partnerships. However, most people engaged in public health—whether trained in medicine, public health, or some other discipline—have had modest formal training in communication, and most have never had to “sell” ideas to uninformed or skeptical partners.

Because of the urgent need to help public health professionals improve their communication skills and develop and strengthen partnerships with other sectors, the de Beaumont Foundation and the Aspen Institute recently launched the Public Health Reaching Across Sectors (PHRASES) website and tools. Informed by research conducted by the FrameWorks Institute and Hattaway Communications, these tools include framing and communication strategies that can help foster support, trust, and credibility and, in turn, illuminate the value of public health.

To succeed in their important work, public health professionals must learn to convey resonant, persuasive messages that communicate an understanding of community stakeholders’ needs, a vision for what healthier communities can look like, and a compelling value proposition for public health.

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