The Role of Media
in Public Health
Professor SH Lee
Emeritus Professor of Community Medicine
The Chinese University of Hong Kong
What is
Public
Health?
Definition of Public Health
‘The science and art of promoting
health, preventing disease, and
prolonging life through the
organized efforts of society.’
(Acheson Report, London, 1988)
The New
Public Health
Movement
“Up-stream”
Approach
Determinants
of Health
Determinants of Health
• Personal health practices and
coping skills
• Biological and genetic
endowment
• Environmental risk factors
• Social and economic factors
• Health Services
Personal health practices and
coping skills
•
•
•
•
•
•
•
•
Smoking
Diet
Obesity
Lack of exercise
Stress
Alcohol abuse
Drug misuse
Sexual practices
Fig. 4 Smoking Trends from Below 12 to Above 16 years of Age
Ever
Smoking
(female)
70
60
50
Ever
Smoking
(male)
(%) 40
30
Current
Smoking
(female)
20
10
0
12 & below
13
14
Age
Source: HKCOSH
15
16 & above
Current
Smoking
(male)
Population
20000
17228
16017
16107
14687
16000
14291
12526
13547
12945
12000
8000
4000
1388
1923
2328
2618
3388
3487
3385
3493
0
1992
1993
1994
Heroin
1995
1996
1997
Psychotropic Substance
1998
1999
14
% of Obese Students
12
10
Primary
8
Secondary
6
4
2
0
95/96
96/97
97/98
School Year
98/99
Biological and genetic endowment
• Gender differences
• Physiological, anatomical and
mental capacities
Environmental risk factors
•
•
•
•
•
•
•
Physical environment
Radiation exposure
Workplace hazards
Infectious agents
Home hazards
Traffic
Product design
Social and Economic factors
•
•
•
•
Income and social status
Social support networks
Education
Employment and working
conditions
• Social disintegration
• Overpopulation
• Geography and Transportation
Health Services
• Accessible preventive and primary
care services
• Healthy child development
services
• Personal health services e.g.
– Student health
– Women health
– Elderly health
Genetic Influences
Lifestyle
HEALTH
Social, Economic
Cultural &
Environmental Conditions
The Health Field Concept
Health and
Medical
Services
The Ottawa Charter
for Health Promotion
and the Jakarta
Declaration
Definition of
Health Promotion
“A combination of health education
and related organizational,
political and economic programmes
designed to support changes
in behaviour and in the environment
that will improve health.”
“The process of enabling people to
Increase control over the
Determinants of health and
Thereby improve their health.”
“The process of enabling people to
increase control over their health.
‘and thereby to improve
their health.”
Health Promotion
• Targets towards whole population
• Basically healthy
• Involvement of community and
individual measures
• Promotion of healthy lifestyle
• Goal to enhance state of well being
Disease Prevention
• Activity in the medical field
• Dealing with a disease or
environmental threat
• Protects individuals or groups of
population at risk
• Aims to conserve health
Disease Prevention
Primary Prevention
Prevention of disorders before they occur
e.g. vaccination, healthy lifestyles
Disease Prevention
Secondary Prevention
Early diagnosis and treatment
e.g. screening programmes
Disease Prevention
Tertiary Prevention
Reducing burden of disability to
individual and society
e.g. treatment and rehabilitation
Five Priority Actions Of Ottawa
Charter for Health Promotion
• Build Healthy Public Policy
• Create supportive environment for
health
• Strengthen community actions for
health
• Develop personal skills
• Re-orient health services
Ottawa Charter for Health Promotion
An International Conference on Health Promotion
The move towards a new public health
November 17-21, 1986, Ottawa, Ontario, Canada
The Jakarta Declaration on Leading Health
Promotion into the 21st Century (1997):
Five 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
Public Health
The meaning of Mass Media
Two key features:
• Mass audience
• Message is mediated
Source: Health Promotion – effectiveness, efficiency and equity, Keith Tones and Sylvia Telford
A.The difference between health
marketing and commercial
marketing:
• 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. Ten key marketing concepts in
health promotion
• Market philosophy
• The “four Ps” of marketing:
product, price, place, promotion
• Hierarchy of communication
effects
• Audience segmentation
• Understand all the relevant
markets
• Feedback
• Interpersonal and mass
communication interactions
• Commercial resources
• Competition
• Expectations
Mass Media and
“Public Health
Advocacy”
‘Public health 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
What are the components of an effective
public health advocacy campaign?
•
•
•
•
•
Information
Health Professionals
Skilled Professionals
Partnerships or Coalitions
Champions or Leaders
Skills required in effective
public health advocacy
• Competency and understanding of
subjects and roles
• Political science, sociology of mass
communication
• Structuring of media
• Health issues
• Networking techniques
Skills required in effective
public health advocacy
• Community educators and organizers
• Journalists
• Lawyers and political analysts /
advisers
• Research
• Evaluation
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
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
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
mass audiences, including key
political and bureaucratic decision
makers. If well informed about the
process of news reporting, public
health advocates may be in the
position of influencing journalist to
report issues in ways more consonant
with public health objections.
Case Studies
in Public Health
Advocacy in Health
Education and Health
Promotion
Smokeless
Tobacco
Tobacco advertising in
printed media and
outdoor advertising
Prohibition of smoking in
restaurants and other
public indoor premises
The Asia Pacific
Association for the
Control of Tobacco
(APACT)
The Hong Kong Declaration APACT 2001
• The Asia Pacific Association for the
Control of Tobacco (APACT) recognizes
that tobacco use is a major cause of death
in the Asia-Pacific region:
• The current pandemic of tobacco-related
diseases is causing tremendous harm and an
excessive burden on the economy.
• Everyone, especially children, has the right to
live in a tobacco-smoke free environment.
The Hong Kong Declaration APACT 2001
• Of all the children alive today in Asia, a
conservative estimate is that at least 150
million will eventually be killed by tobacco.
• There is a need for an urgent effort to contain
this pandemic of tobacco-related diseases as
well as its terrible effects on the environment
and the economy. If it is to effectively prevent
young people from smoking, it must be a
comprehensive programme directed at the
entire community.
The Hong Kong Declaration
APACT 2001
A comprehensive regional tobacco control policy:
1.
2.
3.
4.
An end to all tobacco advertising
Increase in taxes
Protection of youth
Regulation and control of tobacco
products
The Hong Kong Declaration
APACT 2001
A comprehensive regional tobacco control policy:
5.
6.
7.
8.
Cessation programmes
Strong public education programmes
Support WHO FCTC
Holding tobacco companies
accountable
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.
Promotion
of Healthy Cities
How do we get a Healthy City ?
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 coordinate 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
Healthy Cities
• Eight Healthy Cities in Hong Kong
– Tseung Kwan O
– Wan Chai
– Central & Western
– Kwai Tsing
– Tsuen Wan
– Sham Shui Po
– Wong Tai Sin
– Tai Po
Tseung Kwan O District
Kwai Tsing District
Central & Western
District
Health Promoting Schools
and Healthy Schools
Award Scheme
School-Based Approach
• Involve Kay Personnel
– School Principals
– School Teachers
– School-based Health Coordinators
– Pupils
– Parents
School-Based Approach
• Supportive environment and
policy making
• Community Partnership
• Participation of Parents
• Networking
Hong Kong Healthy Schools Award
Scheme Opening Ceremony
20 May 2001
Healthy Workplace
Why Canada has been
successful in
Tobacco Control?
Tobacco industry’s survival
strategy Nine D’s
• Deny the health consequences of
smoking.
• Deceive consumers about the true nature
of cigarettes through marketing and PR.
• Damage the credibility of industry
opponents.
• Direct advertising to women and youth,
in addition to men, to maximize sales
volume.
Tobacco industry’s survival
strategy Nine D’s
• Defeat attempts to regulate the industry or
control smoking.
• Delay legislation if it can’t be defeated.
• Destroy legislation once it passes, either by
trying to overturn the law in court, by
disobeying the law, or by exploiting
loopholes.
• Defend lawsuits filed against the industry.
• Develop new markets around the world.
Factors for success on
Tobacco Control
• Political will
• Bureaucratic support and experience
• Effective advocacy outside
government
NO SMOKING
Political Will
• To introduce, implement and
enforce tobacco control measures
• Political support from:
– Minister of Health
– Minister of Labour
– Minister of Finance
• Departments 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
government solutions, not just
problems
– Unity is strength – advocating
coalitions
Use of effective advocacy
techniques
• Factors for success:
– Coalitions include:
• Public support
• Health organization
• Provisional councils
• Consumers
• Religious groups
• Women’s organizations
• Volunteers
Use of effective advocacy
techniques
• Factors for success:
– Adequate financial resources and staff
– Health groups able to respond quickly
– Use a wide array of tools
• E.g. letters, phone calls, newspaper
advertisements, meetings with government
officials
Atypical Pneumonia
Epidemic, Hong Kong
Impact of Community, NGOs,
Professionals 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。
Conclusion
Conclusion
• Advocacy is a powerful strategy for
promoting health
• Possible to use political processes to
bring about positive changes to health
• Media sector has a very important role
to play in health communication
Conclusion
• There should be close working partnership
between health and media professionals in
promoting health
• Joint education and training programmes
for both the health and media sectors in
health communication would greatly
enhance the cooperation and
communication between the two sectors
Conclusion
• More workshops, seminars on various
subjects of health should be organized
and better methods of communication
should be developed to enable the
media sector to have easy access to
health information and a good
understanding of the various issues
affecting health
Conclusion
• The World Health Organization should
be requested to organize more
international workshops and seminars
for the media in order to acquaint
them the major global public health
problems which can only be dealt with
effectively by joint forces of all
countries on a regional and global
basis
THANK YOU