Back in the 1970s, the National Institutes of Health launched a famously successful campaign designed to reduce heart disease, the nation’s number one cause of death, by convincing the public to stop smoking and start exercising. Employing a variety of media channels through which to promote behaviors shown to support heart health, their message was simple: Heart disease is a silent killer, but with some basic lifestyle adjustments, you can significantly reduce your risk of dying from it.
In addition to traditional media outlets, the Institutes’ initiative, known as the Stanford Heart Disease Prevention Program, relied on interpersonal communication techniques used by local opinion leaders and public figures to move people from awareness to behavior change (“Do it for the loved ones in your life”). Several years later, the number of smokers and smoking-related deaths had decreased dramatically. To this day, the Stanford program remains a model of health communications.
Shortly afterward, the U.S. Agency for International Development funded an international health communication program aimed at child survival in 12 countries. Known as the HEALTHCOM Project, it used similar strategies as the Stanford Heart Disease Prevention Program — straightforward, evidence-based public messaging — to prevent child deaths from diarrheal dehydration and to promote child immunization.
In Gambia, a village-level education program reinforced by radio messages, graphic design materials, and trained village volunteers who motivated families to use a simple oral rehydration solution through interpersonal support, child survival rates quickly rose. In the Philippines, the project worked creatively with the Ministry of Health and an ad agency to develop engaging mass media messaging at both the national and local levels that promoted both oral rehydration and immunization. And in Honduras, “Dr. Salustiano” delivered radio messages to mothers about immunization and oral rehydration solution.
So, what has all this got to do with the COVID-19 pandemic?
Today, the disease may be different, but the groundwork for beating COVID-19 through behavioral change has already been laid. Health communications would go a long way toward containment, including targeted media placements tailored for local belief systems and cultural practices. But regardless of geography, just as in the ‘80s, these strategies would share elements of a finely honed, partnership-driven methodology grounded in the use of bottom-up communication that always begins with understanding what people want, what they resist, and why.
History shows us that successful mitigation of health crises is achieved by a multidisciplinary team of specialists including public health professionals, psychologists, media gatekeepers, and instructional design experts. Joining forces with health communication practitioners, together they conduct research, design focus groups, and create regionally appropriate, meaningful communications that not only address the immediate concern, but also become essential to long-term health education.
Back in the not-so-distant pre-Trump administration days, the field of health communications flourished in research settings, while agencies like the Centers for Disease Control and Prevention (CDC) had robust health communications departments that designed campaigns to raise awareness and foster behavior change around such crises as HIV/AIDS, Ebola, SARS and more.
They recognized that carefully chosen public health spokespeople were key partners. When Dr. C. Everett Koop, then-U.S. Surgeon General, served as the nation’s trusted messenger for the Stanford Heart Disease Prevention Project, he quickly became a household name and helped change social norms around smoking in dramatic ways that still prevail.
Today, when Dr. Anthony Fauci speaks, most people listen. Yet, Donald Trump chose to rid himself of an expert public health team and to de-staff the health communications arm of the CDC and other relevant agencies. In this wilderness of disinformation, Dr. Fauci alone can’t be expected to shoulder the burden of public education. And while no one would dream of having a pandemic team without epidemiologists, the Trump task force, such as it was, included no communications, social marketing, or media expertise. That is a travesty the Biden task force must remedy.
Behavior change critical to reducing the spread of COVID-19 is complex. Overcoming mask resistance — and soon, resistance to the new vaccine — is a huge challenge. But simply showing bar charts and graphs, holding talking head updates, and spewing overwhelming numbers will not affect behavior.
Creative epidemiology might: “Over 1,000 people are dying every day of COVID. That’s equivalent to three jumbo jets crashing every day.” Revealing a graphic number of jets that went down, metaphorically, every day could raise awareness about one’s responsibility during a catastrophic pandemic. Demonstrating a dialogue in which one person gets another one to accept that masks save lives could provide a learnable moment.
Meanwhile, today’s creative media environment is still waiting for us to take advantage of its offerings. T-shirts, billboards, and social media influencers spreading salient messages based on behavioral and attitudinal research empower people to change the outcome of a deadly pandemic.
It may be too late to save lives lost unnecessarily to this dangerous virus, but it’s not too late to prevent further tragedy. We must do it for the loved ones in our lives.