The Role of The Role of Media in Public Media in Public

HealthHealth

Professor SH LeeEmeritus Professor of Community

MedicineThe Chinese University of Hong Kong

What is What is Public Public

Health?Health?

Definition of Public HealthDefinition of Public Health

‘‘The science and art of promoting The science and art of promoting

health, preventing disease, and prohealth, preventing disease, and pro

longing life through the organized longing life through the organized

efforts of society.’ efforts of society.’

(Acheson Report, London, 1988(Acheson Report, London, 1988))

The New The New Public Health Public Health

MovementMovement

“Up-stream” Approach

DeterminantDeterminants of Healths of Health

Determinants of Determinants of HealthHealth

• Personal health practices and Personal health practices and coping skillscoping skills

• Biological and genetic Biological and genetic endowmentendowment

• Environmental risk factorsEnvironmental risk factors• Social and economic factorsSocial and economic factors • Health ServicesHealth Services

Personal health Personal health practices and coping practices and coping

skillsskills• Smoking• Diet• Obesity• Lack of exercise• Stress• Alcohol abuse• Drug misuse• Sexual practices

Tobacco

Source: HKCOSH

Fig. 4 Smoking Trends from Below 12 to Above 16 years of Age

0

10

20

30

40

50

60

70

12 & below 13 14 15 16 & above

Age

(%)

EverSmoking(female)

EverSmoking(male)

CurrentSmoking(female)

CurrentSmoking(male)

12526

14687

1722816017 16107

1429113547 12945

1388 1923 2328 26183388 3487 3385 3493

0

4000

8000

12000

16000

20000

1992 1993 1994 1995 1996 1997 1998 1999

Heroin Psychotropic Substance

Population

0

2

4

6

8

10

12

14

95/96 96/97 97/98 98/99School Year

% o

f O

bese

Stu

dent

s

Primary

Secondary

Biological and Biological and genetic endowmentgenetic endowment

• Gender differences

• Physiological, anatomical and mental capacities

Environmental risk Environmental risk factorsfactors

• Physical environment

• Radiation exposure

• Workplace hazards

• Infectious agents

• Home hazards

• Traffic

• Product design

Social and Economic Social and Economic factorsfactors

• Income and social status• Social support networks• Education• Employment and working

conditions• Social disintegration• Overpopulation• Geography and Transportation

Health ServicesHealth Services• Accessible preventive and primary

care services

• Healthy child development services

• Personal health services e.g.e.g.– Student healthStudent health

– Women healthWomen health

– Elderly healthElderly health

Social, Economic Cultural &

Environmental Conditions

Lifestyle

Health and Medical Services

Genetic Influences

The Health Field ConceptThe Health Field Concept

HEALTH

The Ottawa Charter The Ottawa Charter for Health Promotion for Health Promotion

and the Jakarta and the Jakarta DeclarationDeclaration

Definition of Definition of Health Health

PromotionPromotion

““A combination of health education A combination of health education and related organizational, and related organizational,

political and economic programmes political and economic programmes designed to support changes designed to support changes

in behaviour and in the environment in behaviour and in the environment that will improve health.”that will improve health.”

““The process of enabling people toThe process of enabling people toIncrease control over the Increase control over the

Determinants of health and Determinants of health and Thereby improve their health.”Thereby improve their health.”

““The process of enabling people toThe process of enabling people toincrease control over their health.increase control over their health.

‘ ‘and thereby to improve and thereby to improve their health.”their health.”

Health Promotion• Targets towards whole populationTargets towards whole population

• Basically healthyBasically healthy

• Involvement of community and Involvement of community and individual measuresindividual measures

• Promotion of healthy lifestyle Promotion of healthy lifestyle

• Goal to enhance state of well beingGoal to enhance state of well being

Disease Prevention• Activity in the medical fieldActivity in the medical field

• Dealing with a disease or Dealing with a disease or environmental threatenvironmental threat

• Protects individuals or groups of Protects individuals or groups of population at riskpopulation at risk

• Aims to conserve health Aims to conserve health

Disease PreventionDisease Prevention

Prevention of disorders before they occurPrevention of disorders before they occure.g. vaccination, healthy lifestyles

Primary Prevention

Disease PreventionDisease Prevention

Early diagnosis and treatmentEarly diagnosis and treatmente.g. screening programmes

Secondary Prevention

Disease PreventionDisease Prevention

Reducing burden of disability to Reducing burden of disability to individual and societyindividual and societye.g. treatment and rehabilitation

Tertiary PreventionTertiary Prevention

Five Priority Actions Of Ottawa Five Priority Actions Of Ottawa Charter for Health PromotionCharter for Health Promotion

• Build Healthy Public PolicyBuild Healthy Public Policy

• Create supportive environment for Create supportive environment for healthhealth

• Strengthen community actions for Strengthen community actions for healthhealth

• Develop personal skillsDevelop personal skills• Re-orient health servicesRe-orient health services

Ottawa Charter for Health PromotionOttawa Charter for Health Promotion

An International Conference on Health PromotionAn International Conference on Health PromotionThe move towards a new public healthThe move towards a new public health

November 17-21, 1986, Ottawa, Ontario, CanadaNovember 17-21, 1986, Ottawa, Ontario, Canada

The Jakarta Declaration on Leading Health The Jakarta Declaration on Leading Health Promotion into the 21Promotion into the 21stst Century (1997): Century (1997):

Five priorities for actionFive priorities for action

• Promote social responsibility for health• Increase investments for health

development• Expand partnerships for health

promotion• Increase community capacity and

empower the individual• Secure an infrastructure for health

promotion

Mass Media and Mass Media and Public HealthPublic Health

The meaning of Mass MediaThe meaning of Mass Media

Two key features:

• Mass audienceMass audience

• Message is mediatedMessage is mediated

Source: Health Promotion – effectiveness, efficiency and equity, Keith Tones and Sylvia Telford Source: Health Promotion – effectiveness, efficiency and equity, Keith Tones and Sylvia Telford

A.A.The difference between health The difference between health marketing and commercial marmarketing and commercial marketing:keting:

• Health promotion, ethical and professional goals

• Difference in size of budgets

• Health education programmes set standard often too high

• The nature of the product in offer is different

• The health education product frequently intangible and gratification seen only at distant future

• Deep seated attitudes not easy to change

B.B. Ten key marketing concepts in Ten key marketing concepts in health promotionhealth promotion

• Market philosophy Market philosophy

• The The “four Ps”“four Ps” of marketing: of marketing: product, price, place, promotionproduct, price, place, promotion

• Hierarchy of communication Hierarchy of communication effectseffects

• Audience segmentationAudience segmentation

• Understand all the relevant Understand all the relevant markets markets

• FeedbackFeedback• Interpersonal and mass Interpersonal and mass

communication interactionscommunication interactions• Commercial resourcesCommercial resources• CompetitionCompetition• ExpectationsExpectations

Mass Media and Mass Media and “Public Health “Public Health

Advocacy”Advocacy”

• Sometimes called ‘public health lobbying’

• Process of over coming major structural barriers to public health goals

• Such barriers could be political, economic or cultural

‘‘Public health advocacy’ Public health advocacy’

What are the components of an effective What are the components of an effective public health advocacy campaign?public health advocacy campaign?

• InformationInformation

• Health ProfessionalsHealth Professionals

• Skilled Professionals Skilled Professionals

• Partnerships or Coalitions Partnerships or Coalitions

• Champions or LeadersChampions or Leaders

Skills required in effective Skills required in effective public health advocacypublic health advocacy

• Competency and understanding of Competency and understanding of subjects and rolessubjects and roles

• Political science, sociology of mass Political science, sociology of mass communicationcommunication

• Structuring of mediaStructuring of media

• Health issuesHealth issues

• Networking techniques Networking techniques

• Community educators and organizersCommunity educators and organizers

• JournalistsJournalists

• Lawyers and political analysts / Lawyers and political analysts / advisersadvisers

• ResearchResearch

• Evaluation Evaluation

Skills required in effective Skills required in effective public health advocacypublic health advocacy

Does it work?Does it work?Governments (and organizations) tend to adopt policies only in activities of public headiness, using the principles that Governments (organization) should not move far from what is perceived to be public opinion

What are the conditions for success What are the conditions for success in public health advocacy?in public health advocacy?

• A recognized constituency

• Building community agreement that an issue is a priority for action and that the proposed solutions are acceptable

What are the conditions for success What are the conditions for success in public health advocacy?in public health advocacy?

• Empowered communities

• A feasible solution (a feasible solution is not necessarily based only on, for example, epidemiological evidence. Many different types of “evidence” can be used by politicians, and managers when mainly policy decisions)

The mass media, by definition, reach The mass media, by definition, reach mass audiences, including key mass audiences, including key political and bureaucratic decision political and bureaucratic decision makers. If well informed about the makers. If well informed about the process of news reporting, public process of news reporting, public health advocates may be in the health advocates may be in the position of influencing journalist to position of influencing journalist to report issues in ways more consonant report issues in ways more consonant with public health objections.with public health objections.

Case StudiesCase Studiesin Public Healthin Public Health

Advocacy in Health Advocacy in Health Education and Education and

Health PromotionHealth Promotion

Smokeless Smokeless

TobaccoTobacco

Tobacco advertising in Tobacco advertising in printed media and printed media and

outdoor advertisingoutdoor advertising

Prohibition of smoking in Prohibition of smoking in restaurants and other restaurants and other

public indoor premisespublic indoor premises

The Asia Pacific The Asia Pacific Association for the Association for the Control of TobaccoControl of Tobacco

(APACT)(APACT)

• The Asia Pacific Association for the The Asia Pacific Association for the Control of Tobacco (APACT) recognizes Control of Tobacco (APACT) recognizes that tobacco use is a major cause of death that tobacco use is a major cause of death in the Asia-Pacific region:in the Asia-Pacific region:

• The current pandemic of tobacco-related The current pandemic of tobacco-related diseases is causing tremendous harm and an diseases is causing tremendous harm and an excessive burden on the economy.excessive burden on the economy.

• Everyone, especially children, has the right to Everyone, especially children, has the right to live in a tobacco-smoke free environment.live in a tobacco-smoke free environment.

The Hong Kong Declaration The Hong Kong Declaration APACT 2001APACT 2001

• Of all the children alive today in Asia, a consOf all the children alive today in Asia, a conservative estimate is that at least 150 million wervative estimate is that at least 150 million will eventually be killed by tobacco.ill eventually be killed by tobacco.

• There is a need for an urgent effort to contain There is a need for an urgent effort to contain this pandemic of tobacco-related diseases as this pandemic of tobacco-related diseases as well as its terrible effects on the environment well as its terrible effects on the environment and the economy. If it is to effectively prevent and the economy. If it is to effectively prevent young people from smoking, it must be a comyoung people from smoking, it must be a comprehensive programme directed at the entire cprehensive programme directed at the entire community.ommunity.

The Hong Kong Declaration The Hong Kong Declaration APACT 2001APACT 2001

A comprehensive regional tobacco control policy:A comprehensive regional tobacco control policy:

1.1. An end to all tobacco advertisingAn end to all tobacco advertising

2.2. Increase in taxesIncrease in taxes

3.3. Protection of youthProtection of youth

4.4. Regulation and control of tobacco Regulation and control of tobacco productsproducts

The Hong Kong Declaration APACT

2001

A comprehensive regional tobacco control policy:A comprehensive regional tobacco control policy:

5.5. Cessation programmesCessation programmes

6.6. Strong public education programmesStrong public education programmes

7.7. Support WHO FCTCSupport WHO FCTC

8.8. Holding tobacco companies accountablHolding tobacco companies accountablee

The Hong Kong Declaration APACT

2001

In addition, the 432 participants from 34 countries to this 6th APACT Conference on Tobacco or Health give full support to Hong Kong’s current legislative proposals, particularly the recommendations for 100% smoke-free workplaces and restaurants.

The Hong Kong Declaration APACT

2001

Promotion Promotion

of Healthy Citiesof Healthy Cities

How do we get a How do we get a Healthy Healthy CityCity ? ?

1. Invite expert to introduce and explain the concept of Healthy Cities and talk about experience on implementation

2. Seek government and community support and participation

3. Establish a ‘Steering Committee’ to plan and co-ordinate Healthy City programme

4. Identify priority health issues (through community diagnosis)

5. Develop an action plan

6. Secure potential community and funding support

7. Monitor and evaluation of the project

• Eight Healthy Cities in Hong KongEight Healthy Cities in Hong Kong

– Tseung Kwan OTseung Kwan O

– Wan ChaiWan Chai

– Central & WesternCentral & Western

– Kwai TsingKwai Tsing

– Tsuen WanTsuen Wan

– Sham Shui PoSham Shui Po

– Wong Tai SinWong Tai Sin

– Tai PoTai Po

Healthy Cities

Tseung Kwan O DistrictTseung Kwan O District

Kwai Tsing DistrictKwai Tsing District

Central & WesternCentral & WesternDistrictDistrict

Health Promoting Schools Health Promoting Schools

and Healthy Schools and Healthy Schools

Award SchemeAward Scheme

• Involve Kay Personnel– School Principals

– School Teachers

– School-based Health Coordinators

– Pupils

– Parents

School-Based ApproachSchool-Based Approach

• Supportive environment and policy making

• Community Partnership

• Participation of Parents

• Networking

School-Based ApproachSchool-Based Approach

Hong Kong Healthy Schools Award Hong Kong Healthy Schools Award Scheme Opening CeremonyScheme Opening Ceremony

20 May 200120 May 2001

Hong Kong Healthy Schools Award Hong Kong Healthy Schools Award Scheme Opening CeremonyScheme Opening Ceremony

20 May 200120 May 2001

Healthy WorkplaceHealthy Workplace

Why Canada has been Why Canada has been successful in successful in

Tobacco ControlTobacco Control??

Tobacco industry’s survival Tobacco industry’s survival strategy Nine D’sstrategy Nine D’s

• DenyDeny the health consequences of the health consequences of smoking.smoking.

• DeceiveDeceive consumers about the true nature consumers about the true nature of cigarettes through marketing and PR.of cigarettes through marketing and PR.

• DamageDamage the credibility of industry the credibility of industry opponents.opponents.

• DirectDirect advertising to women and youth, advertising to women and youth, in addition to men, to maximize sales in addition to men, to maximize sales volume.volume.

TobaccoTobacco industry’s survival industry’s survival strategy Nine D’sstrategy Nine D’s

• DefeatDefeat attempts to regulate the industry or attempts to regulate the industry or control smoking. control smoking.

• DelayDelay legislation if it can’t be defeated. legislation if it can’t be defeated.• DestroyDestroy legislation once it passes, either by legislation once it passes, either by

trying to overturn the law in court, by trying to overturn the law in court, by disobeying the law, or by exploiting disobeying the law, or by exploiting loopholes.loopholes.

• DefendDefend lawsuits filed against the industry. lawsuits filed against the industry.• DevelopDevelop new markets around the world. new markets around the world.

Factors for success on Factors for success on Tobacco ControlTobacco Control

• Political will

• Bureaucratic support and experience

• Effective advocacy outside government

NO SMOKING

Political Will • To introduce, implement and enforTo introduce, implement and enfor

ce tobacco control measures ce tobacco control measures

• Political support from:Political support from: – Minister of HealthMinister of Health

– Minister of LabourMinister of Labour

– Minister of FinanceMinister of Finance

• Departments supportDepartments support

Advocacy (lobbying)

• Anti-smoking and health groups

• Tobacco-control campaign

• Collaboration between government and NG sectors

Use of effective advocacy techniques

• Factors for success: – Health Groups offer the Health Groups offer the

government solutions, not just government solutions, not just problemsproblems

– Unity is strength – advocating Unity is strength – advocating coalitionscoalitions

Use of effective advocacy techniques

• Factors for success:– Coalitions include: Coalitions include:

• Public supportPublic support• Health organizationHealth organization• Provisional councilsProvisional councils• ConsumersConsumers• Religious groupsReligious groups• Women’s organizationsWomen’s organizations• VolunteersVolunteers

Use of effective advocacy techniques

• Factors for success:– Adequate financial resources and staffAdequate financial resources and staff

– Health groups able to respond quicklyHealth groups able to respond quickly

– Use a wide array of tools Use a wide array of tools • E.g. letters, phone calls, newspaper E.g. letters, phone calls, newspaper

advertisements, meetings with government advertisements, meetings with government officialsofficials

Atypical Pneumonia Atypical Pneumonia Epidemic, Hong KongEpidemic, Hong KongImpact of Community, NGOs, Impact of Community, NGOs,

Professionals InvolvementProfessionals Involvement

給我們的醫生、護士及所有醫護人員：

面對非典型肺炎的危機，您們表現的專業精神、毅力和勇氣，我們十分敬佩。我們和全港市民一樣，衷心感謝您們﹗

在這艱難的時刻，我們要關心自己，關心身邊的人，互勵互勉。

關懷從這一分鐘開始。

ConclusionConclusion

ConclusionConclusion• Advocacy is a powerful strategy for Advocacy is a powerful strategy for

promoting healthpromoting health

• Possible to use political processes to Possible to use political processes to bring about positive changes to healthbring about positive changes to health

• Media sector has a very important role Media sector has a very important role to play in health communicationto play in health communication

ConclusionConclusion• There should be close working partnership There should be close working partnership

between health and media professionals in between health and media professionals in promoting healthpromoting health

• Joint education and training programmes fJoint education and training programmes for both the health and media sectors in heaor both the health and media sectors in health communication would greatly enhance tlth communication would greatly enhance the cooperation and communication betweehe cooperation and communication between the two sectorsn the two sectors

ConclusionConclusion• More workshops, seminars on various More workshops, seminars on various

subjects of health should be organized subjects of health should be organized and better methods of communication and better methods of communication should be developed to enable the should be developed to enable the media sector to have easy access to media sector to have easy access to health information and a good health information and a good understanding of the various issues understanding of the various issues affecting healthaffecting health

ConclusionConclusion• The World Health Organization The World Health Organization

should be requested to organize more should be requested to organize more international workshops and seminars international workshops and seminars for the media in order to acquaint for the media in order to acquaint them the major global public health them the major global public health problems which can only be dealt with problems which can only be dealt with effectively by joint forces of all effectively by joint forces of all countries on a regional and global countries on a regional and global basisbasis

THANK YOU